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Active Family Health Center Notice of
Privacy Practices
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.
Active Family Health Center is required, by law, to maintain
the privacy and confidentiality of your protected health
information and to provide our patients with notice of our legal
duties and privacy practices with respect to your protected health
information.
Disclosure of Your Health Care Information
Treatment
We may disclose your health care information to other healthcare
professionals within our practice for the purpose of treatment,
payment or healthcare operations. (example)
On occasion, it may be necessary to seek consultation
regarding your condition from other health care providers
associated with Active Family Health Center.?
It is our policy to provide a substitute health care
provider, authorized by Active Family Health Center to provide
assessment and/or treatment to our patients, without advanced
notice, in the event of your primary health care provider's
absence due to vacation, sickness, or other emergency
situation.?
Payment
We may disclose your health information to your insurance provider
for the purpose of payment or health care operations.
Workers' Compensation
We may disclose your health information as necessary to comply
with State Workers? Compensation Laws.
Emergencies
We may disclose your health information to notify or assist in
notifying a family member, or another person responsible for your
care about your medical condition or in the event of an emergency
or of your death.
Public Health
As required by law, we may disclose your health information to
public health authorities for purposes related to: preventing or
controlling disease, injury or disability, reporting child abuse
or neglect, reporting domestic violence, reporting to the Food and
Drug Administration problems with products and reactions to
medications, and reporting disease or infection exposure.
Judicial and Administrative Proceedings.
We may disclose your health information in the course of any
administrative or judicial proceeding.
Law Enforcement.
We may disclose your health information to a law enforcement
official for purposes such as identifying or locating a suspect,
fugitive, material witness or missing person, complying with a
court order or subpoena, and other law enforcement purposes.
Deceased Persons.
We may disclose your health information to coroners or medical
examiners.
Organ Donation.
We may disclose your health information to organizations involved
in procuring, banking, or transplanting organs and tissues.
Research.
We may disclose your health information to researchers conducting
research that has been approved by an Institutional Review Board.
Public Safety.
It may be necessary to disclose your health information to
appropriate persons in order to prevent or lessen a serious and
imminent threat to the health or safety of a particular person or
to the general public.
Specialized Government Agencies.
We may disclose your health information for military, national
security, prisoner and government benefits purposes.
Change of Ownership.
In the event that Active Family Health Center is sold or merged
with another organization, your health information/record will
become the property of the new owner.
Your Health Information Rights
- You have the right to request restrictions on certain uses
and disclosures of your health information. Please be advised,
however, that Active Family Health Center is not required to
agree to the restriction that you requested.
- You have the right to have your health information received
or communicated through an alternative method or sent to an
alternative location other than the usual method of
communication or delivery, upon your request.
- You have the right to inspect and copy your health
information.
- You have a right to request that Active Family Health Center
amend your protected health information. Please be advised,
however, that Active Family Health Center is not required to
agree to amend your protected health information. If your
request to amend your health information has been denied, you
will be provided with an explanation of our denial reason(s)and
information about how you can disagree with the denial.
- You have a right to receive an accounting of disclosures of
your protected health information made by Active Family Health
Center.
- You have a right to a paper copy of this Notice of Privacy
Practices at any time upon request.
Changes to this Notice of Privacy Practices
Active Family Health Center reserves the right to amend this
Notice of Privacy Practices at any time in the future, and will
make the new provisions effective for all information that it
maintains. Until such amendment is made, Active Family Health
Center is required by law to comply with this Notice.
Active Family Health Center is required by law to maintain the
privacy of your health information and to provide you with notice
of its legal duties and privacy practices with respect to your
health information. If you have questions about any part of this
notice or if you want more information about your privacy rights,
please contact: Dr. Eric Cohen by calling this office at
561.641.1111. If Dr. Eric Cohen is not available, you may make an
appointment for a personal conference in person or by telephone
within 2 working days.
Complaints
Complaints about your Privacy rights, or how Active Family Health
Center has handled your health information should be directed to
Dr. Eric Cohen, by calling this office at 561.641.1111 If Dr. Eric
Cohen is not available, you may make an appointment for a personal
conference in person or by telephone within 2 working days.
If you are not satisfied with the manner in which this office
handles your complaint, you may submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
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