PREMIER CONCIERGE MEDICAL SOLUTIONS, PLLC
HIPAA Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY PREMIER CONCIERGE MEDICAL SOLUTIONS, PLLC AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The terms of this Notice of Privacy Practices (“Notice”) apply to Premier Concierge Medical Solutions, LLC and its employees (collectively, “PCMS”). PCMS will share your protected health information (“PHI”) as necessary to carry out treatment, payment, and health care operations of PCMS as permitted by law.
We are required by law to maintain the privacy of our patients' PHI and to provide patients with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice for as long as it remains in effect. We reserve the right to change the terms of this Notice as necessary and to make a new notice of privacy practices effective for all PHI we maintain. We are required to notify you in the event of a breach of your unsecured or compromised PHI. We are also required to inform you that there may be a provision of state law that relates to the privacy of your health information that may be more stringent than a standard or requirement under the Federal Health Insurance Portability and Accountability Act (“HIPAA”). A copy of any revised Notice of Privacy Practices or information pertaining to a specific state law may be obtained by emailing a request using the contact details at the end of this Notice.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION:
Authorization and Consent: Except as outlined below, we will not use or disclose your PHI for any purpose other than treatment, payment or health care operations unless you have signed a form authorizing such use or disclosure. You have the right to revoke your authorization in writing, with such revocation being effective once we actually receive the writing; however, such revocation shall not be effective to the extent that we have taken any action in reliance on your prior authorization.
Uses and Disclosures for Treatment: We will make uses and disclosures of your PHI as necessary for your treatment. Doctors or other health care professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to your course of treatment that may include procedures, medications, tests, medical history, etc.
Uses and Disclosures for Payment: PCMS is a cash pay only program and does not accept or bill your health insurance company. For billing purposes, we will indicate necessary personal information about you and state the service or treatment you received in the bill you receive from PCMS for payment to be made by you or the person responsible for making payment on your behalf.
Uses and Disclosures for Health Care Operations: We will make uses and disclosures of your PHI as necessary, and as permitted by law, for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, PCMS may use and disclose your PHI for purposes of improving clinical treatment and care.
Individuals Involved In Your Care: To the extent applicable, PCMS may from time to time disclose your PHI to your designated family, friends or any others who are involved in your care or in payment of your care in order to facilitate such person's involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and PCMS determines that a limited disclosure may be in your best interest, we may share limited PHI with such individuals without the need of your approval or consent. We may also disclose limited PHI to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
Business Associates: Certain aspects and components of our services are performed through contracts with outside third parties, such as, but not limited to, patient portal and management software platforms, telecommunications online services (e.g., two-way video conferencing, messaging, etc.), compliance auditing, outcomes data collection, accounting services, and legal services, among others. At times it may be necessary for PCMS to share some or all of your PHI to one or more of these third-party business associates who assist us with our health care operations. In all cases, we require such third parties to appropriately safeguard the confidentiality, privacy, and integrity of your PHI.
Appointments and Services: We may contact you to provide appointment updates or information about your treatment or other health-related benefits and services that may be of interest to you. You have the right to request, and we will honor reasonable requests by you, to receive communications regarding your PHI from us by alternative means or mailed to alternative addresses. For instance, if you wish to your appointment reminders to not be left on voicemail or sent to a particular email or mailing address, we will accommodate reasonable requests. In this respect, you must provide an appropriate alternative address or method of contact. You also have the right to request that we not send you any future marketing materials and we will use our best efforts to honor such request. You must make such requests in writing, include your name and address, and send your written request to the PCMS email provided at the bottom of this Notice.
Research: In limited circumstances, we may use and disclose your PHI for research purposes. In all cases where your specific authorization is not obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board which oversees the research or by representations of the researchers that limit their use and disclosure of your PHI.
Fundraising: We may use your information to contact you for fundraising purposes. We may disclose this contact information to a related foundation so that the foundation may contact you for similar purposes. If you do not want us or the foundation to contact you for fundraising efforts, you must send a written request to us at the PCMS email provided at the bottom of this Notice.
Other Uses and Disclosures: We are permitted and/or required by law to make certain other uses and disclosures of your PHI without requiring your consent or authorization for any one or more of the following:
Any purpose required by law;
Public health activities such as required reporting of immunizations, disease, injury, birth and death, or in connection with public health investigations;
To the Food and Drug Administration to report adverse events, product defects, or to participate in product recalls;
To a government oversight agency conducting audits, investigations, civil or criminal proceedings;
Court or administrative ordered subpoena or discovery requests;
To law enforcement officials as required by law if we believe you have been a victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law;
To coroners and/or funeral directors consistent with law;
If necessary to arrange an organ or tissue donation from you or a transplant for you;
To establish, assert or defend our legal rights in any legal, administrative, enforcement or other proceeding;
If you are a member of the military, we may also release your PHI for national security or intelligence activities; or
To workers’ compensation agencies for workers; compensation benefit determination.
DISCLOSURES REQUIRING AUTHORIZATION:
Psychotherapy Notes: We must obtain your specific written authorization prior to disclosing any psychotherapy notes unless otherwise permitted by law. However, there are certain purposes for which we may disclose psychotherapy notes, without obtaining your written authorization, including, but not limited to, the following: (1) to carry out certain treatment, payment or healthcare operations (e.g., use for the purposes of your treatment, for our own training, and to defend ourselves in a legal action or other proceeding brought by you), (2) to the Secretary of the Department of Health and Human Services to determine our compliance with the law, (3) as required by law, (4) for health oversight activities authorized by law, (5) to medical examiners or coroners as permitted by state law, or (6) for the purposes of preventing or lessening a serious or imminent threat to the health or safety of a person or the public.
Genetic Information: We must obtain your specific written authorization prior to using or disclosing your genetic information for treatment, payment or health care operations purposes. We may use or disclose your genetic information, or the genetic information of your child (if applicable), without your written authorization only where it would be permitted by law.
Marketing: We must obtain your authorization for any use or disclosure of your PHI for marketing, except if the communication is in the form of (1) a face-to-face communication with you, or (2) a promotional gift of a nominal value.
Sale, Sharing and Disclosure of PHI: PCMS does not sell your PHI to any data brokers or third parties. If this changes, PCMS must obtain your authorization for the sale of your PHI and identify the specific pieces of PHI subject to any such sale prior to making any such disclosure of your PHI in exchange for any direct or indirect remuneration; except that, your authorization is not required where the purpose of the exchange is for any one or more of the following:
Public health activities;
Research purposes, provided that we receive only a reasonable, cost-based fee to cover the cost to prepare and transmit the information for research purposes;
Health care operations involving the sale, transfer, merger or consolidation of all or part of our business and for related due diligence;
Payment we make to any business associate we engage to assist with our operations and provide their services where such business associate has a need to access and use your PHI in order to performing the services for and on our behalf; in such case(s), the payment is strictly made to them to perform such services for us and not a “sale” of your PHI;
Providing you with a copy of your PHI or an accounting of disclosures of your PHI;
Disclosures required by law;
Disclosures of your PHI for any other purpose permitted by and in accordance with the HIPAA Privacy Rule, as long as the only remuneration we receive is a reasonable, cost-based fee to cover the cost to prepare and transmit your PHI for such purpose or is a fee otherwise expressly permitted by other law; or,
Any other exceptions allowed by the Department of Health and Human Services.
RIGHTS THAT YOU HAVE REGARDING YOUR PROTECTED HEALTH INFORMATION:
Access to Your Protected Health Information: You have the right to copy and/or inspect the PHI we retain on your behalf. For PHI that we maintain in any electronic designated record set, you may request a copy of such health information in a reasonable electronic format, if readily producible. Requests for access must be made in writing and signed by you or your legal representative. You will be charged a reasonable copying fee and actual postage and supply costs for your PHI. If you request additional copies, you will be charged a fee for copying and postage.
Amendments to Your Protected Health Information: You have the right to request in writing that your PHI of which we maintain be amended or corrected. We are not obligated to make requested amendments, but we will give each request careful consideration. All amendment requests, must be in writing, signed by you or your legal representative, and must state the reasons for the amendment or correction request. If an amendment or correction request is made, we may notify others, including our business associates, who work with us if we believe that such notification is necessary.
Accounting for Disclosures of Your Protected Health Information: You have the right to receive an accounting of certain disclosures made by us of your PHI. Requests must be made in writing and signed by you or your legal representative. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. You will be notified of the fee at the time of your request.
Restrictions on Use and Disclosure of Your Protected Health Information: You have the right to request restrictions on uses and disclosures of your PHI for treatment, payment, or health care operations. We are not required to agree to most restriction requests but will attempt to accommodate reasonable requests when appropriate. If we agree to any discretionary restrictions, we reserve the right to remove such restrictions as we deem appropriate. We will notify you if we remove a restriction imposed in accordance with this paragraph. You also have the right to withdraw, in writing, any restriction by communicating your desire to do so to us.
Right to Notice of Breach: We take the confidentiality of our patients’ PHI seriously, and we are required by law to protect the privacy and security of your PHI through appropriate safeguards. We will notify you in the event a breach occurs involving a compromise to your PHI and inform you of what steps you may need to take to protect yourself.
Paper Copy of this Notice: You have a right, even if you have agreed to receive notices electronically, to obtain a paper copy of this Notice. To do so, please submit a request using the contact details below.
Contact Details: For written requests, please send an email to conciergedoc428@gmail.com.
Concerns: If you believe we violated any of your privacy rights, please do let us know by telephone call or by sending an email to us using the below contact details:
Premier Concierge Medical Solutions, PLLC
Attn: Dr. Neil Nahmias
Email: conciergedoc428@gmail.com
Telephone: (941) 352-2773
Complaints: If you believe we violated any of your privacy rights with respect to your PHI, you have the right to file a complaint with the Secretary of the U.S. Department of Health and Human Services at the below address:
The U.S. Department of Health & Human Services
Hubert H. Humphrey Building
200 Independence Avenue S.W.
Washington, D.C. 20201
Toll Free Call Center: 1-877-696-6775.