Notice of Privacy Practices

1. About this notice

2. Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

• Get a copy of your medical record. You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary, usually within 30 days of your request, and may charge a reasonable, cost-based fee.
• Ask us to correct your medical record. You can ask us to correct health information about you that you think is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.
• Request confidential communications. You can ask us to contact you in a specific way (for example, a home or office phone) or to send mail to a different address. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer for payment or operations, and we will say yes unless a law requires us to share it.
• Get a list of those with whom we have shared information. You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. It will include all disclosures except those about treatment, payment and health care operations, and certain others. We will provide one list a year for free and may charge a reasonable, cost-based fee for another within 12 months.
• Get a copy of this notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney or someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority before we take any action.
• File a complaint if you feel your rights are violated. You can complain to our Privacy Officer using the contact information at the end of this notice, or to the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.

3. Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us and we will follow your instructions.

• In these cases, you have both the right and choice to tell us to share information with your family, close friends, or others involved in your care, or to share information in a disaster relief situation. If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest, and we may share it when needed to lessen a serious and imminent threat to health or safety.
• In these cases, we never share your information unless you give us written permission: marketing purposes, sale of your information, and most sharing of psychotherapy notes.

4. Our uses and disclosures

We typically use or share your health information in the following ways.

• To treat you. We can use your health information and share it with other professionals who are treating you. Example: a doctor treating you for an injury asks another doctor about your overall health condition.
• To run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: we use health information about you to manage your treatment and services.
• To bill for your services. We can use and share your health information to bill and get payment from health plans or other entities. Example: if you use insurance, we give information about you to your health plan so it will pay for your services.

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes:

• Helping with public health and safety issues, such as preventing disease, reporting adverse reactions to medications, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone's health or safety
• Doing research
• Complying with the law, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law
• Responding to organ and tissue donation requests
• Working with a medical examiner or funeral director
• Addressing workers' compensation, law enforcement, and other government requests, as permitted by law
• Responding to lawsuits and legal actions, such as a court or administrative order or a subpoena

5. Substance use disorder treatment records (42 CFR Part 2)

In general, we may not tell anyone outside the clinic that you attend this program, or share any information identifying you as having a substance use disorder, unless you give us written consent, a court orders it under Part 2, or one of the narrow exceptions below applies.

• Your written consent. You may give a single written consent allowing us to use and disclose these records for treatment, payment and health care operations. Once you do, health care providers, health plans and their business associates who receive the records for those purposes may redisclose them as HIPAA permits, except in legal proceedings against you; anyone else who receives them may not pass them on without your written consent. You may revoke your consent at any time, except to the extent we have already acted on it.
• Legal proceedings. These records, and any testimony about them, may not be used against you in a civil, criminal, administrative or legislative proceeding unless you give specific written consent or a court issues an order meeting Part 2 requirements, together with a subpoena or similar legal mandate. A subpoena on its own is not enough.
• Medical emergencies. We may share information with medical personnel to treat a condition that poses an immediate threat to your health and requires immediate medical intervention.
• Suspected child abuse or neglect, and crimes. We may report suspected child abuse or neglect as Florida law requires, and we may report a crime committed on our premises or against our staff.
• Research, audits and evaluations, under the conditions Part 2 sets.
• Fundraising. We do not use these records for fundraising. If that ever changes, we will ask for your consent and give you a clear way to opt out.

You have the right to ask us not to disclose these records for treatment, payment or health care operations, and to a copy of this notice. Federal rules also give you a right to a list of the disclosures we have made with your consent; the rule that sets out exactly how that list must be produced has not taken effect yet, and we will follow it as soon as it does. Ask us in the meantime and we will tell you what we can.

If you believe your Part 2 rights have been violated, you may complain to our Privacy Officer or to the U.S. Department of Health and Human Services, using the contact details in the section on your rights above. Violations of Part 2 can carry civil and criminal penalties. We will not retaliate against you for complaining.

Anyone who receives these records from us is told in writing that federal law prohibits passing them on without your written consent, unless the law specifically allows it.

6. Calls to our scheduling line

Our scheduling line is answered by an automated (AI) assistant that can answer general questions about the clinic, book appointments and take messages. The assistant is provided by an outside company that works for us under a written business associate agreement and may only use what it hears to provide that service.

These calls are recorded and turned into text so we have an accurate record of what was arranged. The assistant tells you this at the start of the call. If you would rather not be recorded, or would rather speak to a person, say so and the call will be transferred, or call the front desk directly during open hours on (321) 751-1414.

Please keep details of substance use disorder treatment, and other sensitive medical details, for a person or for your visit rather than the automated assistant.

7. Florida law

Florida law places extra limits on sharing some health information, including patient medical records in general (Fla. Stat. 456.057), HIV test results (Fla. Stat. 381.004), mental health treatment records (Fla. Stat. 394.4615) and substance abuse treatment records (Fla. Stat. 397.501). When one of these laws is stricter than HIPAA, we follow the stricter law, which usually means we need your written consent before sharing that information unless the law specifically allows otherwise.

8. Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

9. Changes to the terms of this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on this website.

10. Privacy Officer

Privacy Officer
Eau Gallie Medical Center
1403 Highland Avenue
Melbourne, FL 32935
Phone: (321) 751-1414