Digestive Specialists, P.A.
The Whitman Building
8380 Riverwalk Park Blvd
Fort Myers, FL 33919
Mailing Address: P. O. Box 60517
Fort Myers, FL 33096
Telephone (239) 561-7337 Fax (239) 561-0244
NOTICE OF PRIVACY PRACTICES
Date: April 14, 2003
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.
FOLLOW THIS NOTICE
This notice describes
our practice and that of:
Any health care professional authorized to
enter information into your office chart;
All departments and units of this office
Any member of a volunteer group we allow to
help you while you are in the office;
Any medical student, intern, resident or
fellow that we allow to help you while you are in the office;
Any representative of an insurance carrier,
managed care organization, clinical research organization, data analysis
organization, or quality improvement organization that is participating
in a review of your medical care;
All employees, staff and other office
All other entities, sites and locations
where the health care professionals in this office practice and follow
the terms of this notice. In addition, these entities, sites and
locations may share medical information with each other for treatment,
payment or operations purposes as described in this notice.
REGARDING MEDICAL INFORMATION
We are required by law
make sure that medical information that
identifies you is kept private;
� give you this notice of our legal duties
and privacy practices with respect to medical information about you; and
� follow the terms of the notice that is
currently in effect.
Payment - We may use and
disclose medical information about you so that the treatment and
services you receive at the office, hospital, ambulatory surgery center,
nursing home or other site may be billed to and payment may be collected
from you, an insurance company or a third party. For example, we may
need to give your health plan information about the services you
received at the office, hospital or ambulatory surgery center, so that
your health plan will pay us or reimburse you for the services. We may
also tell your health plan about a treatment you are going to receive to
obtain prior approval or to determine whether your plan will cover the
Health Care Operations - We may
use and disclose medical information about you for office operations.
These uses and disclosures are necessary to run the office and make sure
that all of our patients receive quality care. For example, we may use
medical information to review our treatment and services and to evaluate
the performance of our staff in caring for you. We may also combine
medical information about many office patients to decide what additional
services the office should offer, what services are not needed, and
whether certain new treatments are effective. We may also disclose
information to doctors, nurses, technicians, medical students, and other
office personnel for review and learning purposes. We may also combine
the medical information we have with medical information from other
offices to compare how we are doing and see where we can make
improvements in the care and services that we offer. We may remove
information that identifies you from this set of medical information so
others may use it to study health care and health care delivery without
learning who the specific patients are.
Appointment Reminders - We may
use and disclose medical information to contact you as a reminder that
you have an appointment for treatment or medical care at the office.
Treatment Alternatives - We may
use and disclose medical information to tell you about or recommend
possible treatment options or alternatives that may be of interest to
Health-Related Benefits and Services
- We may use and disclose medical information to tell you about
health-related benefits or services that may be of interest to you.
Fundraising Activities - We may
use medical information about you to contact you in an effort to raise
money for a disease specific non-profit foundation affiliated with this
office and its operations. We may disclose medical information to a
non-profit foundation related to the office practice or a specific
disease condition so that the foundation may contact you in raising
money. We only would release contact information, such as your name,
address and phone number and the dates you received treatment or
services at the office. If you do not want the office to contact you
for fundraising efforts, you must notify the Practice Manager in
Ambulatory Surgery Center Directory
- We may include certain limited information about you in the ambulatory
surgery directory while you are a patient at the ambulatory surgery
center. This information may include your name, location in the
ambulatory surgery center, your general condition (e.g., fair, stable,
etc.) and your religious affiliation. The directory information, except
for your religious affiliation, may also be released to people who ask
for you by name. Your religious affiliation may be given to a member of
the clergy, such as a priest or rabbi, even if they don�t ask for you by
name. This is so your family, friends and clergy can visit you in the
ambulatory surgery center and generally know how you are doing.
Individuals Involved in Your Care or Payment for Your
Care - We may release medical information
about you to a friend or family member who is involved in your medical
care. We may also give information to someone who helps pay for your
care. We may also tell your family or friends your condition and that
you are in the hospital, ambulatory surgery center or office. In
addition, we may disclose medical information about you to an entity
assisting in a disaster relief effort so that your family can be
notified about your condition, status and location.
Research - Under certain
circumstances, we may use and disclose medical information about you for
research purposes. For example, a research project may involve
comparing the health and recovery of all patients who received one
medication to those who received another, for the same condition. All
research projects, however, are subject to a special approval process.
This process evaluates a proposed research project and its use of
medical information, trying to balance the research needs with patients'
need for privacy of their medical information. Before we use or
disclose medical information for research, the project will have been
approved through this research approval process. We may, however,
disclose medical information about you to people preparing to conduct a
research project, for example, to help them look for patients with
specific medical needs, so long as the medical information they review
does not leave the office. We will almost always ask for your specific
permission if the researcher will have access to your name, address or
other information that reveals who you are, or will be involved in your
care at the office.
As Required By Law - We will
disclose medical information about you when required to do so by
federal, state or local law.
To Avert a Serious Threat to Health or Safety
- We may use and disclose medical information about you when necessary
to prevent a serious threat to your health and safety or the health and
safety of the public or another person. Any disclosure, however, would
only be to someone able to help prevent the threat.
Organ and Tissue Donation - If
you are an organ donor, we may release medical information to
organizations that handle organ procurement or organ, eye or tissue
transplantation or to an organ donation bank, as necessary to facilitate
organ or tissue donation and transplantation.
Military and Veterans - If you
are a member of the armed forces, we may release medical information
about you as required by military command authorities. We may also
release medical information about foreign military personnel to the
appropriate foreign military authority.
If you are a member of the Armed Forces, we may disclose
medical information about you to the Department of Veterans Affairs upon
your separation or discharge from military services. This disclosure is
necessary for the Department of Veterans Affairs to determine whether
you are eligible for certain benefits.
Workers' Compensation - We may
release medical information about you for workers' compensation or
similar programs. These programs provide benefits for work-related
injuries or illness.
Public Health Risks - We may
disclose medical information about you for public health activities.
These activities generally include the following:
� To prevent or control disease, injury or disability;
� To report births and deaths;
� To report child abuse or neglect;
� To report reactions to medications or
problems with products;
� To notify people of recalls of products
they may be using;
To notify a person who may have been
exposed to a disease or may be at risk for contracting or spreading a
disease or condition; and,
� To notify the appropriate government
authority if we believe a patient has been the victim of abuse, neglect
or domestic violence. We will only make this disclosure if you agree or
when required or authorized by law.
Health Oversight Activities -
We may disclose medical information to a health oversight agency for
activities authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the health care
system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes - If you
are involved in a lawsuit or a dispute, we may disclose medical
information about you in response to a court or administrative order.
We may also disclose medical information about you in response to a
subpoena, discovery request, or other lawful process by someone else
involved in the dispute, but only if efforts have been made to tell you
about the request or to obtain an order protecting the information
Law Enforcement - We may
release medical information if asked to do so by a law-enforcement
� In response to a court order, subpoena,
warrant, summons or similar process;
� To identify or locate a suspect, fugitive,
material witness, or missing person;
the victim of a crime if, under certain limited circumstances, we are unable
to obtain the person's agreement;
� About a death we believe may be the result
of criminal conduct;
� About criminal conduct at the office or
ambulatory surgery center; and
emergency circumstances to report a crime; the location of the crime or victims;
or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors
- We may release medical information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person or
determine the cause of death. We may also release medical information
about patients to funeral directors as necessary to carry out their
National Security and Intelligence Activities
- We may release medical information about you to authorized federal
officials for intelligence, counterintelligence, and other national
security activities authorized by law.
Protective Services for the President and Others
- We may disclose medical information about you to authorized federal
officials so they may provide protection to the President, other
authorized persons or foreign heads of state or conduct special
Department of State - We may
use medical information about you to make decisions regarding your
medical suitability for a security clearance or service abroad. We may
also release your medical suitability determination to the officials in
the Department of State who need access to that information for these
Inmates - If you are an inmate
of a correctional institution or under the custody of a law enforcement
official, we may release medical information about you to the
correctional institution or law enforcement official. This release
would be necessary (1) for the institution to provide you with health
care; (2) to protect your health and safety or the health and safety of
others; or (3) for the safety and security of the correctional
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical
information we maintain about you:
Right to Inspect and Copy - You
have the right to inspect and copy medical information that may be used
to make decisions about your care. Usually, this includes medical and
billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used
to make decisions about you, you must submit your request in writing to
the Practice Manager. If you request a copy of the information, we may
charge a fee as permitted by state law for the costs of copying, mailing
or other supplies associated with your request.
We may deny your request to inspect and
copy in certain very limited circumstances. If you are denied access to
medical information, you may request that the denial be reviewed.
Another licensed health care professional chosen by the office will
review your request and the denial. The person conducting the review
will not be the person who denied your request. We will comply with the
outcome of the review.
Right to Amend - If you feel
that medical 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 the
To request an amendment, your request must
be made in writing and submitted to the Practice Manager. In addition,
you must provide 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
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 medical information kept
by or for the office;
� 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 disclosures." This is
a list of the disclosures we made of medical information about you.
To request this list or accounting of
disclosures, you must submit your request in writing to the Practice
Manager. Your request must state a time-period that may not be longer
than six years and may not include dates before April 14, 2003. Your
request should indicate in what form you want the list (for example, on
paper, electronically). The first list you request within a 12-month
period will be free. For additional lists, we may charge you for the
costs of providing the list. 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 medical
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 medical information we disclose about you to someone who is involved
in your care or the payment for your care, like a family member or
friend. For example, you could ask that we not use or disclose
information about a surgery that you had.
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 you emergency treatment.
To request restrictions, you must make your request in
writing to the Practice Manager. In your request, you must tell us (1)
what information you want to limit; (2) whether you want to limit our
use, disclosure or both; and (3) to whom you want the limits to apply,
for example, disclosures to your spouse.
Right to Request Confidential Communications
- You have the right to request that we communicate with you about
medical matters 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 the Practice Manager. 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
Right to a Paper Copy of This Notice
- You have the right to 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. For a paper copy of this notice, contact the
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the
right to make the revised or changed notice effective for medical
information we already have about you as well as any information we
receive in the future. We will post a copy of the current notice in the
office. The notice will contain on the first page, in the top
right-hand corner, the effective date. In addition, each time you
register at or are seen at the office for treatment or health care
services as an outpatient, we will offer you a copy of the current
notice in effect.
If you believe your privacy rights have been violated,
you may file a complaint with the office or with the Secretary of the
Department of Health and Human Services. To file a complaint with the
office, contact the Practice Manager, at 239-561-7337. All complaints must be submitted in
You will not be
penalized for filing a complaint.
OTHER USES OF
Other uses and disclosures of medical information not
covered by this notice or the laws that apply to us will be made only
with your written permission. If you provide us permission to use or
disclose medical information about you, you may revoke that permission,
in writing, at any time. If you revoke your permission, we will no
longer use or disclose medical information about you for the reasons
covered by your written authorization. You understand that we are unable
to take back any disclosures we have already made with your permission,
and that we are required to retain our records of the care that we
provided to you.