Florida Kidney Physicians
NOTICE OF PRIVACY PRACTICES

EFFECTIVE DATE: December 1st, 2017

NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed as well as how you can get access to this information. Please review this information carefully. If you have any questions, please do not hesitate to contact Florida Kidney Physicians (FKP).

Florida Kidney Physicians, LLC  (the “Practice”) is dedicated to maintaining the privacy of your personal health information. Each time a patient visits an office of the Practice, a record is made that describes the treatments and services provided. Federal law outlines specific privacy protections and individual rights related to the information we maintain that identifies you as a patient. Protected health information includes demographic data and facts about your past, present and/or future physical or mental health. The Practice has put into place policies and procedures to help protect your health information. We are required to provide this notice outlining our legal duties and responsibilities related to the use and disclosure of patient identifiable health information (i.e. Privacy Practices), and examples of how your information may be used or disclosed. The Practice will abide by the terms of this notice and may revise this notice at any time. The new notice will be posted in the offices of the Practice in a prominent location. You may access a revised version on our  website, by calling an office of the Practice and requesting a revised copy be mailed to you, or by requesting a copy in-person at an office of the Practice. Revisions to this notice will be effective for all health information the Practice maintains- past, present and/or future.

The Practice may use your individually identifiable health information for the following purposes without your authorization:

1. Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This use includes the coordination or management of your health care with another provider. For instance, we may send a copy of your records to another physician so that you can be evaluated for a specific condition. In this regard, we disclose patient data to the Commonwell network as part of a query-based exchange for permissible treatment purposes.
2. Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us or another provider. This use may include providing your insurance company with the details of your treatment, sharing your payment information with other treatment providers, contacting you via telephone or through the mail about balances, or sending unpaid balances to a collection agency.
3. Health Care Operations: We may use and disclose health information to support business activities of your physician at the Practice. For example, your health information may be used to evaluate the quality of care provided, for state licensing, or to identify you by name when you visit an office of the Practice. You understand and acknowledge that the Practice will disclose information in accordance with the Health Information Portability and Accountability Act of 1996 (HIPAA) to our affiliates (namely Florida Kidney Physicians, LLC, and RCO Analytics, LLC) for the purposes of creating a population health care delivery model with the goals of improving the quality of health care and outcomes, reducing health care costs, and increasing savings to patients.
4. Appointment Reminders: The Practice may use your health information to remind you of appointments. A postcard may also be mailed to you for follow-up visit reminders.
5. Treatment Options: The Practice may use your health information to inform you of treatment options or other health-related services, which may be of interest to you.
6. Business Associates: The Practice may share your health information with other individuals or companies that perform various activities for or on behalf of the Practice, such as after-hours telephone answering, billing, or quality assurance. Our Business Associates agree to protect the privacy of your health information.
7. Research: The Practice may use your health information in conjunction with agents of the Practice who may be required to review your files, just as our employees are so permitted, to determine whether you qualify for a research project. If you qualify for a research project, you will first be asked to execute an authorization granting the Practice or research organization the right to use your protected health information.

The Practice may disclose your health information without your authorization when permitted or required by law, including:

• For public health activities, including reporting of certain communicable diseases
• To the Food and Drug Administration (FDA)
• For workers’ compensation or similar programs as required by law
• To authorities when abuse, neglect or domestic violence is suspected
• If you are an inmate of a correctional facility
• To health oversight agencies
• To your employer if we provide health care services to you at the request of the employer, whereupon we shall provide you written notice of release of such information
• For certain judicial and/or administrative proceedings pursuant to an administrative order
• For law enforcement purposes
• To a medical examiner, coroner or funeral director
• For the facilitation of organ, eye or tissue donation, if you are an organ donor
• For research purposes under strictly limited circumstances
• To avert a serious threat to your health and safety or that of others
• To follow various mandates for clinical quality metrics reporting, benchmarking and/or related matters
• For government purposes, such as military service or national security
• In the event of an emergency or for disaster relief
• In any other circumstances required by law
• On the sign-in sheet at the offices of the Practice

Unless you object, the Practice may also disclose your health information to family members and/or others involved in your care or payment for your care. The Practice may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person responsible for your care, general condition or death.

The Practice may leave messages for you at work or home about your visits. If you do not want the Practice to do so, please inform our Privacy Officer in writing. All other uses and/or disclosures of your health information to others will require a written, signed authorization from you. You have the right to revoke your authorization at any time, except to the extent the Practice has already acted on it. Should you require your records to be released, the Practice will provide you with an authorization form to complete and return to the address listed on it.

Your health record is the physical property of the Practice. The information contained in it belongs to you. Below is a list of your rights regarding individually identifiable health information.

All requests related to these items must be made in writing to the Practice’s Privacy Officer at the address listed below. The Practice will provide you with the appropriate forms to exercise these rights. The Practice will notify you in writing if your requests cannot be granted.

1. Restrictions on Use and Disclosure: You have the right to request restrictions on how we use and disclose your health information. This right includes requests to restrict disclosure of your health information only to certain individuals or entities involved in your care, such as family members and/or insurance companies. The Practice is not required to agree with your request. If the Practice agrees, we are bound to the agreement, unless disclosure is otherwise required or authorized by law.
2. Confidential Communications:You have the right to request that the Practice communicate with you in a particular manner or at a certain location. For example, you may request that we only contact you at home. The Practice will accommodate reasonable requests.
3. Access: You have the right to inspect or request a copy of records used to make decisions about your health care, including your medical chart and billing records. The office of the Practice will schedule appointments for record inspection. The Practice may charge a fee for providing you copies of your records. Under special circumstances, we may deny your request to inspect and/or copy your records. You may request review of such denial.
4. Record Amendments: You may have the right to request amendments to your health records created by and for the Practice, if you feel they are incorrect or incomplete. The Practice may accept or deny your request. If the request is denied, you have the right to provide a statement of disagreement or rebuttal statement.
5. Accounting of Disclosures: You have the right to receive an accounting of the disclosures, meaning you may request a list of certain disclosures the Practice has made of your records. Upon your request, the Practice will provide this information to you one time at no charge once each twelve (12) month period. Fees may be assessed for additional copies.
6. Copy of Notice:You have the right to request that the Practice provide you a paper copy of this Notice of Privacy Practices.

Complaints

You may complain to the Practice at the address below or to the Secretary of Health and Human Services (Office for Civil Rights/ U.S. Department of Health and Human Services) online at HHS.gov, if you believe your privacy rights have been violated by the Practice. You may file a complaint with the Practice by notifying the Privacy Officer of your complaint. The Practice will not retaliate against you for filing a complaint.

You may contact FKP at 1-813-910-0030 for Tampa Bay, FL and +1-954-463-0112 for Southeast, FL for more information about the complaint process. If you have any questions about this notice, please contact FKP as well.

• Florida Kidney Physicians, LLC
• Privacy Officer Tampa Bay, FL
• 12662 Telecom Drive
• Temple Terrace, FL 33637

• Florida Kidney Physicians, LLC
• Privacy Officer Southeast, FL
• 407 SE 9th St. Suite 101
• Fort Lauderdale, FL 33301