•  Receive the care necessary to help regain or maintain his or her maximum state
of health and, if necessary, cope with death.

•  Expect personnel who care for the patient to be friendly, considerate, respectful,
and qualified through education and experience, as well as perform the services for
which they are responsible with the highest quality of service.

•  Expect full recognition of individuality, including personal privacy in treatment and
care. In addition, all communications and records will be kept confidential.

•  Complete information, to the extent known by the physician, regarding diagnosis,
treatment, procedure and prognosis, as well as alternative treatments or procedures
and the possible risks and side effects associated with treatment and procedure.

•  Be fully informed of the scope of services available at the facility, provisions for
after-hours and emergency care and related fees for services rendered.

•  Be a participant in decisions regarding the intensity and scope of treatment. If the
patient is unable to participate in those decisions, the patient’s rights shall be
exercised by the patient’s designated representative or other legally designated
person.

•  Make informed decisions regarding his or her care.

•  Refuse treatment to the extent permitted by law and be informed of the medical
consequences of such a refusal. The patient accepts responsibility for his or her
actions should he or she refuses treatment or not follows the instructions of the
physician or facility.

•  Approve or refuse the release of medical records to any individual outside the
facility, except in the case of transfer to another health facility, or as required by
law or third-party payment contract.

•  Be informed of any human experimentation or other research/educational
projects affecting his or her care or treatment and can refuse participation in such
experimentation or research without compromise to the patient’s usual care.

•  Express grievances/complaints and suggestions at any time.

•  Assistance in changing primary or specialty physicians or dentists if other qualified
physicians or dentists are available.

•  Provide patient access to and / or copies of his or her individual medical records.

•  Be informed as to the facility’s policy regarding advance directives/living wills.

•  Be fully informed before any transfer to another facility or organization and ensure
the receiving facility has accepted the patient transfer.

•  Express those spiritual beliefs and cultural practices that do not harm or interfere
with the planned course of medical therapy for the patient,

•  Expect the facility to agree to comply with Federal Civil Rights laws that assure it
will provide interpretation for individuals who are not proficient in English. The facility
presents information in manner and form, such as TUD, large print materials, Braille,
audio tapes and interpreters, that can be understood by hearing and sight impaired individuals.

•  Have an initial assessment and regular reassessment of pain.

•  Education of patients and families, when appropriate, regarding their roles in
managing pain, as well as potential limitations and side effects of pain treatment, if applicable.

•  Have their personal, cultural, spiritual and/or ethnic beliefs considered when communicating to them and their families about pain management and their
overall care.

•  Being considerate of other patients and personnel and for assisting in the control of noise, smoking and other distractions.

•  Respecting the property of others and the facility.

•  Reporting whether he or she clearly understands the planned course of treatment
and what is expected of him or her.

•  Keeping appointments and, when unable to do so for any reason, notifying the
facility and physician.

•  Providing caregivers with the most accurate and complete information regarding
present complaints, past illnesses and hospitalizations, medications, unexpected
changes in the patient’s condition or any other patient health matters.

•  Observing prescribed rules of the facility during his or her stay and treatment and,
if instructions are not followed, forfeiting the right to care at the facility and is
responsible for the outcome.

·    Promptly fulfilling his or her financial obligations to the facility.

•  Payment to facility for copies of the medical records the patient may request.

•  Identifying any patient safety concerns.

Patient Rights and Responsibilities was established with the expectation that observance of
these rights would contribute to more effective patient care and greater satisfaction for the
patient, family, physician and the facility caring for the patient, Patients shall have the
following rights without regard to age, race, sex, national origin, religion, culture, physical
handicap, personal values or belief systems.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” 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 healthcare services.

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, you can receive any revised Notice of Privacy Practices by contacting the facility where you were seen.  Just request that a revised copy be sent to you in the mail or ask for one at your next appointment.

How We May Use and Disclose Your Protected Health Information:

Your healthcare provider will use or disclose your protected health information as described in Section 1. Your protected health information may be used and disclosed by your healthcare provider, our office staff and others outside of our facility that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the operation of FL FITNESS & REHABILITATION.

Following are examples of the types of uses and disclosures of your protected healthcare information that FL FITNESS & REHABILITATION is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our facility.

Treatment:

We may use protected health information about you to provide you with treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or other personnel who are involved in your care, Different departments of our facility also may share protected health information about you in order to coordinate your needs, such as prescriptions, lab work and x-rays.  We also disclose protected health information about you to individuals outside of Fl Fitness & Rehabilitation who may be involved in your medical care, such as family members or others we use to provide to provide services that are part of your care.  When required, we will obtain your authorization before disclosing any of your information.  Only the minimal amount of information will be revealed during any disclosures.

Payment:

Your protected health information will be used, as needed, to obtain payment of your healthcare services.  This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and undertaking utilization review activities.  For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations:

We may use or disclose as-needed, your protected health information in order to support the business activities of your healthcare provider and FL FITNESS & REHABILITATION. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities.

For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel and others to:

•  Evaluate the performance of our staff

•  Assess the quality of care and outcomes in your case and similar cases

•  Learn how to improve our facilities and services

•  Determine how to continually improve the quality and effectiveness of the health care
we provide

In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician or therapist. We may also call you by name in the waiting room when your healthcare provider is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We will share your protected health information with third party ‘business associates” that may perform various activities (e.g., billing, transcription services) for FL FITNESS & REHABILITATION.  Whenever an arrangement between our facility and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health- related benefits and services that may be of interest to you.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization, or Opportunity to Object

You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.  If you are not present or able to agree or object to use or disclosure of the protected health information, then your healthcare provider may, using professional judgment to determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your healthcare will be disclosed.  We may use and disclose your protected health information in the following instances.

Facility Directories:

Unless you object, we will use and disclose in our facility directory your name, the location at which you are receiving care, your condition (in general terms) and your religious affiliation. All of This information, except religious affiliation, will be disclosed to people that ask for you by name. Members of the clergy will be told of your religious affiliation.

Others Involved in Your Healthcare:

Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.

Other Permitted and Required Uses and Disclosures That May

Be Made Without Your Authorization or Opportunity to Object

We may use or disclose your protected health information without your authorization in the following situations:

Required By Law:
 

We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

Public Health:

We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information; the disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases:

We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight:

We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.  Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other regulatory programs and civil rights laws. 

Abuse or Neglect:

We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect.  In addition, we may disclose your protected health information to the governmental entity or agency authorized to receive such information if we believe that you have been a victim of abuse, neglect, or domestic violence.  In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration:

We may disclose your protected health information to a person or company required by the Food and Drug Administration to; report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements or to-conduct post marketing surveillance, as required.

Legal Proceedings:

We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement:

We may disclose protected health information so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and those otherwise required by law (2) limited information requests for identification and location purposes (3) pertaining to victims of a crime (4) suspicion that death has occurred as a result of criminal conduct (5) in the event that a crime occurs on the premises of Fl Fitness & Rehabilitation and (6) medical emergency (not on Fl Fitness & Rehabilitation’s premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors and Organ Donation:

We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Research:

We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

Criminal Activity:

Consistent with applicable federal and state laws, we may disclose your protected health information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safely of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security:
When the appropriate conditions

Health Oversight:

We may disclose protected health information to a health apply, we may use or disclose protected health information of individuals who oversight agency for activities authorized by law, such as audits, investigations are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities (2) for the purpose of a determination by the government agencies that oversee the healthcare system, government benefit Department of Veterans Affairs of your eligibility for benefits or (3) to foreign programs, other government regulatory programs and civil rights laws, military authority if you are a member of that foreign military services.  We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the president or others legally authorized.

Workers Compensation:

Your protected health information may be disclosed by us as authorized to comply with worker's compensation laws and other similar legally established programs.

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 to investigate or determine our compliance with the requirements of Section 164.500 et.seq., Privacy of Individually Identifiable Health Information.

2. Your Rights

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

    You have the right to inspect and copy your protected health information

This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A ‘designated record set” contains medical and billing records and any other records that your healthcare provider and Fl Fitness & Rehabilitation use for making decisions about you.

Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding and protected health information that is subject to law that prohibits access to protected health information, Depending on the circumstances, a decision to deny access may be review able. Please contact our Medical Records Department if you have questions about access to your medical record. If you request a copy of the information, we may charge a fee for the costs of retrieving, copying, mailing and any other supplies associated with your request.

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 protected health information for the purposes of treatment, payment or healthcare operations.

You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your healthcare provider is not required to agree to restrictions you may request. If the healthcare provider believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your healthcare provider does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your healthcare provider.  You may have the right to have your healthcare provider amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Medical Records Department to determine ii you have a question about amending your medical record.  You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to obtain a paper copy of this notice from us. You have the right to a copy of this notice. You may ask us to give you a copy of this notice at any time. To request a copy of this notice, you must make your request in writing to the Privacy Officer.

3. Complaints

You may file a complaint with us or with the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint.

This notice was published and becomes effective on April 14, 2003.