PRIVACY NOTICE (HIPAA)Authorization for the Disclosure of Protected Health Information for Treatment, or Healthcare Operations (164.508(a))
We know your privacy is important and we’re committed to keeping your medical information confidential. We keep records of the care we provide and may receive records from other providers. These records help us deliver quality care, get payment for our services, and meet our legal obligations.
We’re required by law to protect your health information and inform you about how we use and share it. This notice explains how we handle your medical information and your rights regarding it.
If you have any questions, please contact us at our Private Office at the providers number (954-694-7292 )
I understand that as part of my care, Brain Health Psychiatry originates and maintains health records describing my health history, symptoms, examination, and test results, diagnosis, treatment, and any future care or treatment. I understand that this information serves as:
How We May Use or Disclose Your Health Information
Treatment: We may use or share your health information to provide medical care, including with other healthcare providers and pharmacists.
Payment: We may use and disclose your information to get payment for the services we provide, such as sending information to your insurance company.
Appointment Reminders: We will use the contact information you provide to remind you of appointments or discuss treatment alternatives and health-related benefits.
Healthcare Operations: We may use and disclose your information to improve the quality of care, for staff training, legal services, audits, and business management.
Notification and Communication with Family: We may share your information with family members or others involved in your care, especially in emergencies.
Required by Law: We will use and disclose your information as required by law, such as reporting abuse or responding to legal proceedings.
Public Health: We may disclose your information to public health authorities for activities like controlling disease and reporting adverse reactions to medications.
Health Oversight Activities: We may disclose your information to oversight agencies for audits, investigations, and inspections.
Judicial and Administrative Proceedings: We may disclose your information in response to court orders or subpoenas.
Law Enforcement: We may disclose your information to law enforcement as required by law, such as complying with a court order or warrant.
Public Safety/National Security: We may disclose your information to prevent or lessen serious threats to health or safety and for national security purposes.
Workers Compensation: We may disclose your information to comply with workers compensation laws.
Minors: We may disclose information about minors to their parents or guardians as required by law.
Sale of PHI: We will not disclose your information in exchange for payment without your authorization.
Marketing: We will obtain your authorization before using your information for marketing purposes if financial remuneration is involved.
With Authorization: Any other uses and disclosures of your information will only be made with your written authorization.
Your Health Information Rights
Right to Request Special Privacy Protections: You can request restrictions on certain uses and disclosures of your health information. We reserve the right to accept or reject your request unless you paid out-of-pocket for the service.
Right to Request Confidential Communications: You can request that we communicate with you in a specific way or at a specific location. We will comply with all reasonable requests.
Right to Inspect and Copy: You have the right to inspect and copy your health information, with limited exceptions. We may charge a reasonable fee for copies.
Right to Amend or Supplement: You can request that we amend your health information if you believe it is incorrect or incomplete. We are not required to agree, but we will inform you of our decision.
Right to an Accounting of Disclosures: You have the right to receive a list of certain disclosures we have made of your health information for up to six years.
Right to an Electronic Copy of Electronic Medical Records: If your health information is maintained electronically, you can request an electronic copy be given to you or sent to another entity.
Right to Be Notified of a Breach: You have the right to be notified if there is a breach of your unsecured health information.
Paper Copy: You have the right to obtain a paper copy of this notice upon request.
To Be Notified of a Breach: You have the right to be notified if there is a breach of your unsecured health information.
Right to Restrict Disclosures to Health Plans: You have the right to request a restriction on the disclosure of your health information to your health plan for items or services you paid for out-of-pocket in full.
You have the right to request restrictions as to how my protected health information may be used or disclosed to carry out treatment, payment, or healthcare operations, and that Brain Health Psychiatry is not required by law to agree to the restrictions requested;
You may revoke this consent in writing at any time, except to the extent that Brain Health Psychiatry has already taken action in reliance thereon.
When We Wont Use or Share Your Health Information
Except as described, we wont use or share your patient health information without your written permission. You can revoke your permission in writing at any time.
INSURANCE AND UNCOVERED SERVICES
If using insurance, you accept responsibility for any charges not covered by your plan. If your insurance has not been verified, is out of network, or your deductible has not been met, you will pay the full amount at your visit. You authorize payment of medical benefits to Brain Health Psychiatry and the release of any diagnostic, medical, psychiatric, and/or substance abuse information to your insurer that is needed to process your claims.
If you have any concerns about this Notice of Privacy Practices or how we handle your health information, please contact our Privacy Officer listed at the top of this notice. You will not face any penalties for filing a complaint. To report your concerns, you can also reach us through the following methods:
- Email: Info@brainhealthpsych.com
- Phone: 954-694-7292
- Mail:7401 Wiles Road Suite 151
- Coral Springs, FL 33067
- Your feedback is important to us, and we are committed to addressing your concerns promptly and respectfully.