PRIVACY POLICY

The American Billing Service^® Privacy Policy
NOTICE OF PRIVACY INFORMATION PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Please contact D. B. Yarbrough, Legal Counsel, at phone number (407) 657-8221 if you have any questions regarding this notice. You may also forward your communication or inquiry to P.O. Box 4900, Winter Park, FL 32793.

• General description and purpose of notice.

  This notice describes our information privacy practices and that of all our employees and staff.

  Our employees and staff may share your health information with each other for purposes of billing, collections, and payment processing, as further described in this notice.

• Our policy regarding your health information.
  

  We are committed to preserving the privacy and confidentiality of your health information created and/or maintained at our facility. Certain state and federal laws and regulations require us to implement policies and procedures to safeguard the privacy of your health information.

  This notice will provide you with information regarding our privacy practices and applies to all of your health information created and/or maintained at our facility, including any information that we receive from other health care providers or facilities. The notice describes the ways in which we may use or disclose your health information and also describes your rights and our obligations regarding any such uses or disclosures. We will abide by the terms of this notice, including any future revisions that we may make to the notice as required or authorized by law.

  We reserve the right to change this notice and 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.

• Uses or disclosures of your health information.
  

  We may use or disclose your health information in one of following ways:

  • Pursuant to your written consent (for purposes of billing, payment or collections activities).
  • Pursuant to your written authorization (for purposes other than billing, payment or collections activities).
  • As permitted by law
  • As required by law

  The following describes each of the different ways that we may use or disclose your health information. Where appropriate, we have included examples of the different types of uses or disclosures. While not every use or disclosure is listed, we have included all of the ways in which we may make such uses or disclosures.

  • Uses or disclosures made pursuant to your written consent.

    We may use or disclose your health information for purposes of billing, payment, and collections activities upon obtaining your written consent. This consent is generally delivered to us by our physician clients, and is normally required to receive medical services.

    • Billing, payment, or collections activities.

      We may use or disclose your health information so that we may bill and collect payment from you, an insurance company, or another third party for the health care services you receive at our client's facility. For example, we may need to give information to your health plan regarding the services you received from our client's facility so that your health plan will pay us or reimburse you for the services.

  • Uses or disclosures made pursuant to your written authorization

    We may use or disclose your health information pursuant to your written authorization for purposes other than billing, payment, or collections activities, and for purposes which are permitted or required by law. You have the right to revoke a written authorization at any time as long as your revocation is provided to us in writing. If you revoke your written authorization, we will no longer use or disclose your health information for the purposes identified in the authorization. You understand that we are unable to retrieve any disclosures which we may have made pursuant to your authorization prior to its revocation.

    Examples of uses or disclosures that may require your written authorization include the following:

    • A request to provide certain health information to a pharmaceutical company for purposes of marketing.

    • A request to provide your health information to an attorney for use in a civil litigation claim.

    • A request to provide your health information for purposes of including you on a mailing list.

  • Uses or disclosures permitted by law

    Certain state and federal laws and regulations either require or permit us to make certain uses or disclosures of your health information without your permission. These uses or disclosures are generally made to meet public health reporting obligations or to ensure the health and safety of the public at large. The uses or disclosures which we may make pursuant to these laws and regulations include the following:

    • Public health activities

      We may use or disclose your health information to public health authorities that are authorized by law to receive and collect health information for the purpose of preventing or controlling disease, injury or disability. We may use or disclose your health information for the following purposes:

      • To report births and deaths.

      • To report suspected or actual abuse, neglect, or domestic violence involving a child or an adult.

      • To report adverse reactions to medications or problems with health care products.

      • To notify individuals of product recalls.

      • To notify an individual who may have been exposed to a disease or may be at risk for spreading or contracting a disease or condition.

    • Health oversight activities

      We may use or disclose your health information to a health oversight agency that is authorized by law to conduct health oversight activities. These oversight activities may include audits, investigations, inspections, or licensure and certification surveys. These activities are necessary for the government to monitor the persons or organizations that provide health care to individuals and to ensure compliance with applicable state and federal laws and regulations.

    • Judicial or administrative proceedings

      We may use or disclose your health information to courts or administrative agencies charged with the authority to hear and resolve lawsuits or disputes. We may disclose your health information pursuant to a court order, a subpoena, a discovery request, or other lawful process issued by a judge or other person involved in the dispute, but only if efforts have been made to (i) notify you of the request for disclosure or (ii) obtain an order protecting your health information.

    • Worker’s compensation

      We may use or disclose your health information to worker’s compensation programs when your health condition arises out of a work-related illness or injury.

    • Law Enforcement officials

      We may use or disclose your health information in response to a request received from a law enforcement official for the following purposes:

      • In response to a court order, subpoena, warrant, summons or similar lawful process.

      • To identify or locate a suspect, fugitive, material witness, or missing person.

      • Regarding a victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement.

      • To report a death that we believe may be the result of criminal conduct.

      • To report criminal conduct at our facility.

      • In emergency situations, to report a crime–the location of the crime and possible victims; or the identity, description, or location of the individual who committed the crime.

    • To avert a serious threat to health or safety

      We may use or disclose your health information when necessary to prevent a serious threat to the health or safety of you or other individuals. Any such use or disclosure would be made solely to the individual(s) or organization(s) that have the ability and/or authority to assist in preventing the threat.

    • Military and veterans

      If you are a member of the armed forces, we may use or disclose your health information as required by military command authorities.

    • National security and intelligence activities

      We may use or disclose your health information to authorized federal officials for purposes of intelligence, counterintelligence, and other national security activities, as authorized by law.

    • Inmates

      If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may use or disclose your health information to the correctional institution or to the law enforcement official as may be necessary (i) for the institution to provide you with health care; (ii) to protect the health or safety of you or another person; or (iii) for the safety and security of the correctional institution.

  • Uses or disclosures required by law

    We may use or disclose your information where such uses or disclosures are required by federal, state or local law.

• Your rights regarding your health information

  You have the following rights regarding your health information which we create and/or maintain:

  • 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. Generally, 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 to the Director of Operations. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

    We may deny your request to inspect and copy your health information in certain limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed. Another licensed health care professional selected by our facility will review your request and the denial. The person conducting the review will not be the person who initially denied your request. We will comply with the outcome of this review.

  • Right to request an amendment

    If you feel that the health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our facility.

    To request an amendment, your request must be made in writing and submitted to Director of Operations. In addition, you must provide us with 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:

    • ...was not created by us, unless the person or entity that created the information is no longer available to make the amendment.

    • ...is not part of the health information kept by or for our facility.

    • ...is not part of the information which you would be permitted to inspect and copy.

    • ...is accurate and complete.

  • Right to an accounting of disclosures

    You have the right to request an accounting of the disclosures which we have made of your health information. This accounting will not include disclosures of health information that we made for purposes of treatment, payment, or health care operations.

    To request an accounting of disclosures, you must submit your request in writing to Director of Operations. Your request must state a time period which may not be longer than six (6) years prior to the date of your request and may not include dates before April 14, 2003.Your request should indicate in what form you want to receive the accounting (for example, on paper or via electronic means. The first accounting that you request within a twelve (12)-month period will be free. For additional accountings, we may charge you for the costs of providing the accounting. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.

  • 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, such as a family member or friend, who is involved in your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular treatment that you received.

    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 emergency treatment to you.

    To request restrictions, you must make your request in writing to Director of Operations. In your request, you must tell us (a) what information you want to limit; (b) whether you want to limit our use, disclosure or both; and (c) to whom you want the limits to apply (for example, disclosures to a family member).

  • Right to request confidential communications

    You have the right to request that we communicate with you about your health care 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 Director of Operations. 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.

  • Right to a paper copy of this notice

    You have the right to receive a paper copy of this notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

    To obtain a paper copy of this notice, contact Social Services.

• Complaints

  If you believe your privacy rights have been violated, you may file a complaint with our facility or with the secretary of the Department of Health and Human Services.

  Address: Office of Civil Rights, Department of Health and Human Services, 61 Forsyth Street SW Ste 3B 70, Atlanta, GA 30323

  Phone: 1-800-368-1019

  To file a complaint with our facility, contact the Director of Operations. All complaints must be submitted in writing.

  You will NOT be penalized for filing a complaint.