Notice of Privacy 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.
American Family Care, Inc. and AFC Physicians of Florida, PA, American
Family Care Florida, LLC, AFC Physicians of Tennessee, PC, American Family
Care Tennessee, LLC, AFC Physicians of Georgia, PC, American Family Care
Georgia, LLC, AFC Physicians of Georgia Primary Care, PC. are required
by law to maintain the privacy of your Protected Health Information (PHI).
American Family Care and its Affiliated Entities provide clinically integrated
services and consist of an organized health care arrangement (OCHA).This
Notice describes how we will treat your PHI and how we may use and disclose
your PHI to carry out treatment, payment or health care operations and
for other purposes that are permitted or required by law. We may share
your health information for treatment, payment and health operations as
described in this Notice. This Notice also describes your rights to access
and control your PHI. PHI is information about you, including demographic
information, that may identify you and that relates to your past, present
or future physical or mental health or condition and related health care services.
American Family Care, Inc. is required by law to maintain the privacy of
your Protected Health Information (PHI). American Family Care and its
Affiliated Entities provide clinically integrated services and consist
of an organized health care arrangement (OCHA).This Notice describes how
we will treat your PHI and how we may use and disclose your PHI to carry
out treatment, payment or health care operations and for other purposes
that are permitted or required by law. We may share your health information
for treatment, payment and health operations as described in this Notice.
This Notice also describes your rights to access and control your PHI.
PHI is information about you, including demographic information, that
may identify you and that relates to your past, present or future physical
or mental health or condition and related health care services.
Uses and Disclosures of Protected Health Information.
Your PHI may be used and disclosed by the physician, our office staff
and others outside of our offices that are involved in your care and treatment
for the purpose of providing health care services to you, to pay your
health care bills, to support the operation of the business, and any other
use required by law. We may disclose PHI to family members, close friends
or others concerned with your care and treatment.
Treatment:
We will use and disclose your PHI to provide, coordinate, or manage your
health care and any related services. This includes the coordination or
management of your health care with a third party. For example, your PHI
may be provided to a physician to whom you have been referred or are receiving
treatment from to ensure that the physician has the necessary information
to diagnose or treat you.
Payment:
Your PHI will be used to obtain payment for your health care services.
For example, we may provide PHI to your insurance company to obtain authorization
and payment for services rendered. We may contact the Guarantor for your
visit in order to obtain payment.
Healthcare Operations:
We may use or disclose your PHI in order to support our business activities.
These activities include, but are not limited to business associates,
quality assessment activities, internal investigations, performance reviews,
and training employees. In addition, we will use a sign-in sheet at the
registration desk where you will be asked to provide your name and insurance
company. We may also call you by name in the waiting room when the physician
is ready to see you. We may use or disclose your PHI to contact you to
remind you of an appointment, to notify you of test results, to inform
you of health-related services that may be of interest to you, and to
check on your treatment, progress, and satisfaction with our services.
We may use or disclose your PHI in the following situations without your
authorization: As required by Law, for Public Health issues, Communicable
Diseases, Health Oversight, Abuse or Neglect, Food and Drug Administration
requirements, Legal proceedings, Law Enforcement, Coroners, Funeral Directors,
Organ Donation, Preliminary Research Identification, Research with an
IRB waiver, Criminal Activity, Military Activity, to avert a serious and
imminent threat to a person or the public, National Security, to comply
with Worker’s Compensation laws, Inmates, Disaster Relief and other
Required Uses and Disclosures. Under the law, we must make disclosures
to you and when required by the Secretary of the Department of Health
and Human Services.
Other permitted and required uses and disclosures, such as for marketing
or sale of your PHI to third parties, will be made only with your authorization.
Once given, you may withdraw authorization at any time in writing delivered
to the address given below.
You have the right to inspect and copy your protected health information.
Under federal law, you may not inspect or copy psychotherapy notes, information
compiled in anticipation of, or use in, a legal proceeding, and PHI that
is otherwise prohibited.
You have the right to request a restriction of your protected health information.
This means you may ask us not to use or disclose any part of your PHI
for the purposes of treatment, payment or health care operations. Your
request must be in writing, delivered to the address given below, and
state the specific restriction requested and to whom you want the restriction
to apply. If you have paid for your services in full and ask us not to
disclose your visit to your insurance company, we will honor that request.
We are not required to agree to any other restriction that you may request
and if we believe it is in your best interest to permit use and disclosure
of your PHI, it will not be restricted. You then have the right to use
another health care professional.
You have the right to receive confidential communications from us by alternative
means, or at an alternative location by notifying us in writing, delivered
to the address given below.
You have the right to obtain a paper copy of this notice from us, upon
request to the Clinic Manager or our Privacy Officer.
You may have the right to ask us to amend your protected health information.
If we deny your written request for amendment, you have the right to deliver
a statement of disagreement with us at the address given below and we
may prepare a rebuttal to your statement and will provide you with a copy
of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have
made, if any, of your protected health information. Your request must
be in writing, delivered to the address given below. We are required to
notify you if your unsecured PHI is involved in a reportable breach.
You may complain to us or to the Secretary of Health and Human Services
if you believe your privacy rights have been violated. Or, you may file
a complaint with us by mail or by contacting our Privacy Officer at (205)
380-5530. We will not retaliate against you for filing a complaint.
American Family Care reserves the right to change the terms of this notice.
Any change will apply to all PHI that we maintain. We post our current
policy at each location and on our website. All written requests must
be delivered to the Clinic Manager or mailed to HIPAA Privacy Officer.
American Family Care, 3700 Cahaba Beach Road, Birmingham, Alabama 35242.