Privacy Policy

SARASOTA NEUROLOGY, P.A. POLICY REGARDING HEALTH INFORMATION

We understand that information about you and your health is personal and confidential. We are committed to protecting health information about you. We create a medical record of the care and services you receive at Sarasota Neurology, P.A.. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated at Sarasota Neurology, P.A.. This notice will tell you about the ways in which we will use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of health information.

We are required by law to: (1) make sure that health information that identifies you is kept private; (2) give you this notice of our legal duties and privacy practices

with respect to health information about you; (3) follow the terms of Sarasota Neurology, P.A. privacy notice that is currently in effect.

HOW WE USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are committed to use and disclose information will fall within one of the categories.

1. For Treatment: We use health information about you to provide you with medical treatment or services. We disclose health information about you to physicians, nurses, therapists, technicians, health care students, or other Sarasota Neurology, P.A. personnel who are involved in taking care of you at Sarasota Neurology, P.A. Different departments/ Sarasota Neurology, P.A. may also share health information about you in order to coordinate the different things you need, such as prescriptions, lab work, physical therapy and x-rays. We also may disclose health information about you to people outside Sarasota Neurology, P.A. who may be involved in your medical care, such as health care professionals, health care facilities, home health agencies, authorized family members or others we use to provide services that are part of your follow-up or ongoing care. Information about you may also be disclosed to physicians who provide on-call coverage for Sarasota Neurology, P.A. and V. Daniel Kassicieh, D.O.

2. For Payment: We use and disclose health information about you so that treatment and services you receive through Sarasota Neurology, P.A. may be billed to and payment may be collected from an insurance company (health plan), a third party, or from you. For example, we may need to give your health plan information about treatment you received so your health plan will pay us or reimburse you for the treatment or tests performed. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine if your plan will cover the treatment.

3. For Health Care Operations: We may use and disclose health information about you for Sarasota Neurology, P.A. operations. These uses and disclosures are necessary to run Sarasota Neurology, P.A. and make sure that all of our patients receive quality care. For example, we may disclose information to physicians, nurses, technicians, students, and other personnel for review and learning purposes. We may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many Sarasota Neurology, P.A. patients to decide what additional services Sarasota Neurology, P.A. should offer, what services are not needed, and whether certain new treatments are effective. We may also combine the health information we have with health information from other centers to compare how we are doing and see where we can make improvements in the care and services we offer. When performing research we will remove information that identifies you in any way from this set of health information so others may use it to study health care and health care delivery without learning who specific patients are of Sarasota Neurology, P.A. Sometimes insurance companies and other third parties conduct audits to confirm that appropriate claims and payments were submitted. We may use and disclose your health information as part of these audits.

4. Appointment Reminders: We may use and disclose limited information that is necessary to contact you as a reminder that you have an appointment for treatment or medical care at Sarasota Neurology, P.A.

5. Health-Related Products and Services: We may use health information to tell you, now or in the future, about the health-related products or services that may be of interest to you.

6. Individuals Involved in Your Care or Payment for Your Care: We may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

7. Research: Under certain circumstances we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who receive one medication to those who received another for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information. The research needs will be balanced with patients’ need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process. However, we may disclose health information about you to people preparing to conduct a research project in order to help them look for patients with specific medical needs. In this circumstance, the health information they review does not leave Sarasota Neurology, P.A. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are.

8. As Required by Law: We will disclose health information about you when required to do so by federal, state, or local law.

9. To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent harm.

10. Organ and Tissue Donation: In the event of death and as required by law, we will release health information necessary to facilitate organ and/or tissue donation and transplantation.

11. Military and Veterans: If you are a member of the Armed Forces, we may release health information about you as required by military authorities. We may also release health information about foreign military personnel to the appropriate military authority.

12. Workers’ Compensation: We may release health information about you for Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

13. Public Health Risks: We may disclose health information about you for public health records and follow-up. These disclosures occur in order to (1) prevent or control disease, injury, or disability; (2) report child abuse or neglect; (3) report reactions to medications or problems with products; (4) notify people of recalls of products they may be using; (5) notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; (6) notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or if required or authorized by law.

14. Health Oversight Activities: We may disclose health information to an agency, authorized by law, to oversee health care activities. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

15. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to obtain your written authorization to release the information or to obtain an order protecting the information requested.

16. Law Enforcement: We may release health information if asked to do so by a law enforcement official (1) if an order, subpoena, warrant, or summons is issued by a court; (2) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (3) about a death we believe may be the result of criminal conduct; (4) about criminal conduct at the Institute; (5) in emergency circumstances to report a crime; the location of the crime or victim; or the identity, description, or location of the person who committed the crime.

17. Coroners, Medical Examiners, and Funeral Directors: We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information to funeral directors as necessary to carry out their duties.

18. National Security and Intelligence Activities: We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

19. Inmates: If you are an inmate of a correctional institution, we may release medical information about you to the correctional institution. This release would be necessary (1) for the Institute to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding health information we maintain about you:

1. Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your care. Usually this includes medical and billing records but does not include psychotherapy notes. To inspect and copy your health information, you must submit your request in writing. If you request a copy of the information, we will generally charge a fee for the cost of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. If you make this request, Sarasota Neurology, P.A. administration will review your request and the denial.

2. Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend this information if misinformation or incomplete information can be substantiated and validated. You have the right to request an amendment for as long as the health information is kept by or for Sarasota Neurology, P.A. To request an amendment, your request must be made in writing and submitted to the Medical Records Department. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (2) is not part of the medical information kept by or for Sarasota Neurology, P.A.; (3) is not part of the information which you would be permitted to inspect and copy; or (4) is accurate and complete.

3. Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures” (a list of disclosures we have made of health information about you), although Sarasota Neurology, P.A. is not required to do so. To request this list or accounting of disclosures, you must submit your request in writing to the Medical Records Department of Sarasota Neurology, P.A. Your request must state a time period that may not be longer than six years and may not include dates before September 7, 2002. The first list you request within a 12-month period will be $1.00 per page. For additional lists, we may charge you additional fees.

4. Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or was already provided prior to your request. To request restrictions, you must make your request in writing to the Sarasota Neurology, P.A. Medical Records Department. In your request you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

5. Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to Sarasota Neurology, P.A.. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

6. Right to a Paper Copy of This Notice: You may obtain a copy of this notice on this web site, www.DrKassicieh.com.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a current HIPAA policy notice in our office.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with Sarasota Neurology, P.A. or with the Secretary of the Department of Health and Human Services. To file a complaint with Sarasota Neurology, P.A., contact V. Daniel Kassicieh, D.O., Administrator and Privacy Officer at Sarasota Neurology, P.A.. All complaints must be submitted in writing to the Sarasota Neurology, P.A. address. You will not be penalized for filing a complaint.

OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this notice or the laws that apply will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission and we agree with your request, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain our records of the care that we have provided to you.