NOTICE OF PRIVACY PRACTICES
FOR AMIN VIP, PLLC
THIS NOTICE IS EFFECTIVE ON MAY 8, 2023.
Amin VIP, PLLC (referred to as “Amin VIP”, “we,” or “us”) is a cash-based practice that does not accept insurance or process transactions governed by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Nonetheless, Amin VIP is dedicated to maintaining the privacy of your personal information, medical information, and complying with applicable state privacy laws. This Notice describes the privacy policies of Amin VIP, and applies to the physicians, health care professionals, employees, staff and other personnel who provide services at Amin VIP. We agree to abide by the terms of this notice. We may share your information with each other for purposes of treatment, and as necessary for payment and operations activities as described below.
This notice applies to any information in our possession that would allow someone to identify you and learn something about your health. It is intended to describe the policies that protect medical information relating to your past, present and future medical conditions, health care treatment and payment for that treatment (called “health information”). It does not apply to information that has been de-identified in such a way that it could not reasonably be used to identify you.
- We will maintain the privacy of your health information.
- We will provide you with a copy of this notice.
- We will abide by the terms of this notice.
HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION.
This notice describes the categories of reasons for using or disclosing your health information. The examples given do not include all of the specific ways we may use or disclose your health information. However, any time we use or disclose your health information, it will be for one of the categories of listed below.
Treatment. We may use your health information to provide you with medical care and services. This means that our employees and staff and others who work under our direct control may read your health information to learn about your medical condition and use it to make decisions about your care. For instance, a medical assistant may read your medical chart in order to care for you properly. We may also disclose your health information to healthcare providers who need it in order to provide you with medical treatment services. For instance, we may send your doctor the results of laboratory tests or X-rays we perform.
Payment. We may use your health information, and disclose it to others, as necessary to obtain payment for the services we provide to you. For instance, an employee in our business office may use your health information to prepare a bill. We may send that bill, and any health information it contains, to a third party for payment. We will not use or disclose more information for payment purposes than is necessary.
Health Care Operations. We may use your health information for activities that are necessary to operate our health care practice as provided for by law. For example, we may disclose your health information to a company that assists us with quality assurance. We may disclose your health information as necessary to others who we contract with to provide administrative services. In these cases we will require that the party receiving access to health information agrees in writing to protect the privacy of your health information.
Family and Friends. We may disclose your health information to a member of your family or to someone else who you have chosen to involve in your medical care or payment for care, unless you object. We may also disclose health information to a personal representative who has authority to act on your behalf under applicable law (for example, to parents of minors or to someone with a power of attorney).
Public Health Oversight. Subject to applicable law, we may disclose your health information to a public health oversight agency for oversight activities. This includes uses or disclosures in civil, administrative, or criminal investigations; licensure or disciplinary actions (for example, to investigate complaints against health care providers); inspections; and other activities necessary for appropriate oversight of government programs (for example, to investigate Medicaid fraud).
To Report Abuse. In accordance with applicable law, we may disclose your health information when the information relates to a victim of abuse, neglect, or domestic violence.
Legal Requirement to Disclose Information. We may disclose your health information when we are required by law to do so. This includes reporting information to government agencies that have the legal responsibility to monitor the health care system. For instance, we may be required to disclose your health information and the information of others, if we are audited by Medicare or Medicaid.
Law Enforcement. We may disclose your health information for law enforcement purposes. This includes providing information to help locate a suspect, fugitive, material witness, or missing person, or in connection with suspected criminal activity.
For Lawsuits and Disputes. We may disclose health information in response to an order of a court or administrative agency, but only to the extent expressly authorized in the order. We may also disclose health information in response to a subpoena or other lawful process. We will comply with applicable state laws when certain information is afforded additional protections.
To Avert a Serious Threat. We may disclose your health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual. The disclosure will only be made to someone who is able to prevent or reduce the threat.
Research. We may disclose your health information in connection with medical research projects if allowed under federal and state laws and rules. We have to meet many conditions in the law before we can share your health information for research purposes, including for example, ensuring your identity is protected or obtaining prior authorization from you.
Communicating with You. We may use your health information to provide you with additional information. This may include sending you appointment reminders. This may also include giving you information about treatment options.
Emergencies: We will request that you provide our practice with emergency contact information. In an emergency, we may use or disclose your health information to notify, or assist in the notification of a family member or anyone responsible for your care, to inform them of your location, general condition, or death.
Authorization. We will ask for your written authorization if we plan to use or disclose your health information for reasons not covered in this notice or otherwise permitted or required by law. For example, uses and disclosures relating to psychotherapy notes, marketing activities, and any sale of your health information will only be made with your prior written authorization. If you authorize us to use or disclose your health information, you have the right to revoke the authorization at any time. If you want to revoke an authorization, you can do so by sending a written notice to the Privacy Official listed at the end of this notice, but you should note that any such revocation will not apply to actions already taken in reliance on the authorization.
Request Restrictions. You can ask us to restrict how we use or disclose your health information. You must make this request in writing. We will consider your request, but we may say “no” if we think it would affect your care. If we do agree, we will comply with the restriction unless the information is needed to provide you with emergency treatment. We cannot agree to restrict disclosures that are required by law.
Confidential Communication. You may request that we communicate with you about healthcare matters in a certain way or at a certain location. For example, you may ask that we contact you only at home or only by mail. If you want us to communicate with you in a special way, you will need to give us details about how to contact you, including a valid alternative address. You also will need to give us information as to how payment will be handled. We will honor reasonable requests. However, if we are unable to contact you using the requested ways or locations, we may contact you using any information we have.
Access to and Copies of Health Information. You have a right to access, inspect and receive a copy of certain health information that we have in our records. You may make this request by submitting your request in writing to the Privacy Official whose information is included at the bottom of this notice. Your request should specifically list the information you want copied. To the extent your health information is maintained electronically, you have a right to request an electronic copy of those records. We may charge a reasonable, cost-based fee for fulfilling your request to the extent allowed by applicable law.
Amend Health Information. You may request us to amend health information about you in your medical records which you believe is not correct or not complete. You must make this request in writing, and give us the reason you believe the information is not correct or complete. We may deny your request in certain situations. Please note that we cannot completely delete information contained in your record and the change requested by you will appear as an addendum to the existing record.
Accounting of Disclosures. You may request an accounting of certain disclosures of your health information to others. We will provide the first list of disclosures you request at no charge. We may charge you for any additional lists you request during the following 12 months. You must request this list in writing. Please note the accounting will not include disclosures made for treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).
Breach Notifications. In accordance with applicable law, we will notify you of a breach of your unsecured personal and/or health information.
Personal Representatives: If you have given someone the legal authority to exercise your rights and choices covered by this Privacy Notice, we will honor such requests once we verify their authority. This Privacy Notice also applies to minors, disabled adults, or others that are not able to make health care decisions for themselves or who choose to designate someone to act on their behalf. Personal Representatives (including parents and legal guardians) can exercise the rights described in this Privacy Notice. There are, however, some limited situations under state law where prior authorization of a minor patient is required before certain actions can be taken and where the minor would be treated as the individual for the purposes of this Privacy Notice. We comply with applicable state laws in this regard.
Paper Copy of this Privacy Notice. We will provide you with a paper copy of this notice. If you have received this notice electronically, you may receive a paper copy by contacting the privacy official listed at the end of this notice.
Complaints. You have a right to complain if you think your privacy has been violated. We encourage you to contact our Privacy Official using the contact information provided at the end of this notice if you have a complaint or question about how your health information is being used or disclosed. We will not retaliate against you for filing a complaint.
CHANGES TO THIS NOTICE.
We reserve the right to change our privacy practices, as described in this notice, at any time. Any changes will apply to health information which we already have, as well as to health information we receive in the future. We will post the new notice in our office and make copies available upon request. The new notice will include an effective date. A copy of the latest version of this notice will also be maintained on our website.
CONTACT THE PRIVACY OFFICER FOR MORE INFORMATION
If you have any questions regarding this Notice or if you wish to exercise any of your rights described in this Notice, you may contact the Privacy Official at:
Amin VIP, PLLC
Attn: Privacy Officer
1621 22 Avenue N
St. Petersburg, FL 33713