Notice of Patient Privacy Practices
HIPAA Notice of Patient Privacy Practices for EBM Internal Medicine
EBM Internal Medicine believes your health information is personal and confidential. We are committed to keeping your health information private, and we are legally required to respect your confidentiality.
HIPAA is the Health Insurance Portability and Accountability Act, a Federal law that requires health providers to take certain steps to protect the privacy and security of patient health information.
The privacy part of the law goes into effect on April 14, 2003. HIPAA requires a health care provider to post the Notice of Patient Privacy Practices (NPPP) on its website.
The NPPP document describes how EBM Internal Medicine, Inc. uses and protects your health information.
If you have any questions about the Notice of Patient Privacy Practices, please contact EBM Internal Medicine, Inc. at:
Phone: (904) 674-2699
Email: minternalmedicine1@gmail.com 

 EBM Internal Medicine

NOTICE OF PATIENT PRIVACY PRACTICES
Effective Date: August 01, 2008
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED UNDER FEDERAL AND FLORIDA LAW AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

What type of medical information is covered by this Notice?

Medical information covered by this Notice is information that identifies you or could be used to identify you that is collected from you or created or received by EBM Internal Medicine and that relates to your past, present or future physical or mental health condition, including health care services provided to you and payment for such health care services.

If you have any questions about this notice, please contact EBM Internal Medicine at (904) 674-2699

Section A: Who Will Follow This Notice?
This notice describes EBM Internal Medicine’s practices regarding the use and disclosure of your medical information, including use and disclosure by:

• Any health care professional authorized to enter information into your medical chart maintained by EBM Internal Medicine.
• All departments of EBM Internal Medicine.
• Any member of a volunteer group we allow to help you while you are receiving health care services from EBM Internal Medicine.
• All employees, staff and other members of the EBM Internal Medicine workforce.
  This document will be used for EBM Internal Medicine entities as follows: Staff and Contracted Physicians. All these entities, sites and locations follow the terms of this notice.

Section B: Our Pledge Regarding Medical Information.
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at EBM Internal Medicine. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated or maintained by EBM Internal Medicine, whether made by EBM Internal Medicine personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
 We are required by law to:

• Use our best efforts to keep medical information that identifies you 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.

Section C: How We May Use and Disclose Medical Information About You.
The following categories describe different ways in which EBM Internal Medicine is permitted to use and disclose medical information. For each category of uses or disclosures we will explain what we mean and will provide you with one or more examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
Within one or more of the categories identified in Section C and Section D of this form, state and/or federal law may place restrictions on the manner in which specific types of medical information (e.g., substance abuse treatment, psychiatric treatment, human immunodeficiency virus status, etc.) may be used and/or to whom such medical information may be disclosed. In those instances where use and/or disclosure of specific medical information is restricted, we will seek appropriate authorization from you, your legal representative or a court of law/administrative tribunal before using or disclosing the restricted medical information.

• Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, and/or other members of the EBM Internal Medicine workforce who are involved in taking care of you at the hospital. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of EBM Internal Medicine also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to individuals outside of EBM Internal Medicine, such as family members, clergy or other health care providers, and other health care facilities, such as assisted living facilities, nursing homes, home health agencies, who may be involved in your medical care after you are discharged from Florida Hospital.
   
• Payment. We may use and disclose medical information about you so that the treatment and services you receive at EBM Internal Medicine 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 surgery you received at EBM Internal Medicine so your health plan will pay us or reimburse you for the surgery. 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 treatment.
   
• Health Care Operations. We may use and disclose medical information about you for EBM Internal Medicine’s operations. These uses and disclosures are necessary to operate EBM Internal Medicine and make sure that all of our patients receive appropriate care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our workforce in caring for you. We may also combine medical information about many patients to decide what additional services EBM Internal Medicine should offer, what services are not needed, and whether certain new treatments are effective. We may also combine the medical information we have with medical information from other entities to compare how we are doing and see where we can make improvements in the care and services 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 EBM Internal Medicine. For example, if you are a patient of EBM Internal Medicine, you may be notified by an EBM Internal Medicine representative of an appointment made on your behalf to facilitate your medical treatment and physical well-being (e.g., scheduled appointment for X-ray, etc.).
   
  • 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 you. For example, if you have been diagnosed with heart disease, you may receive information regarding treatment options that may be of interest to you.
   
  • 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.
   
  • Individuals Involved in Your Care or Payment for Your Care. Unless specifically precluded by state or federal law or unless you otherwise object, we may release medical information about you to a friend or family member who is involved in your medical care, and may also give information to someone who helps pay for your care. We may also tell your family or friends your condition. 
   
  • 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.

 Section D: Special Situations

• 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.
• Workers’ Compensation. Pursuant to Florida Law, 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 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;
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse (e.g., child abuse, elder abuse, etc.), 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, and your medical condition is at issue in the lawsuit or dispute, we may disclose medical information about you if we are a party to the lawsuit or dispute and in those instances where we are not a party to the lawsuit or dispute, in response to a subpoena duces tecum or court or administrative order.
• Law Enforcement. We may release medical information to law enforcement officials:
  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person unless the medical information pertains to a non-published patient;
  • About an individual who seeks or receives medical treatment for a gunshot wound or life-threatening injury which indicates an act of violence;
  • About a death we believe may be the result of criminal conduct at EBM Internal Medicine; and
  • About criminal conduct at EBM Internal Medicine; and
  • In 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 a 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 of EBM Internal Medicine to funeral directors as necessary to carry out their duties.
• 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 investigations.

Section E: 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 some of the 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. 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 medical information in certain circumstances. If you are denied access to medical information, in some cases, you may request that the denial be reviewed. Another licensed health care professional chosen by EBM Internal Medicine 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 EBM Internal Medicine. 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 you do not include a reason to support your 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 formation is no longer available to make the amendment;
  • Is not part of the medical information kept by or for EBM Internal Medicine; 
  • Is not part of the information which you would be permitted to inspect and copy; or
  • 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 EBM Internal Medicine made of medical information about you. Your request must state a time period which 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 you had.
   
  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.
  
  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.
   
• 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. 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 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. You may obtain a copy of this notice at our website,
  www.ebminternalmedicine.com.

To exercise the above rights, please contact the following individual to obtain a copy of the relevant form you will need to complete to make your request: Please contact EBM Internal Medicine, 904-674-2699.

Section F: 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 EBM Internal Medicine. The notice will contain the effective date.

In addition, each time you register at EBM Internal Medicine for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

Section G: Complaints

If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street, SW. Atlanta, GA 30303-8909. To file a complaint with EBM Internal Medicine, you may contact Ernst B Michel M.D. at 904-674-2699. All complaints must be submitted in writing to Ernst B. Michel, M.D. 5851 Timuquana Road Suite 303 & 304 Jacksonville, Florida 32210.

You will not be penalized for filing a complaint.

Section H: Other Uses of Medical Information

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.

Section I: Organized Health Care Arrangement

EBM Internal Medicine, the members of its Medical Staff (including your physician), and other health care providers affiliated with EBM Internal Medicine have agreed, as permitted by law, to share your health information among themselves for purposes of your treatment, payment or health care operations. This enables us to better address your health care needs.