The Disclaimer Statement
With your consent, the practice is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.
A nurse obtains treatment information about you and records it in a health record. During the course of your treatment, the doctor determines a need to consult with another specialist in the area. The doctor will share the information with such specialist and obtain input.
We submit a request for payment to your health insurance company. The health insurance company requests information from us regarding medical care given. We will provide information to them about you and the care given.
We obtain services from our insurers or other business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such insurers or other business associates as necessary to obtain these services.
The health record we maintain and billing records are the physical property of the practice. The information
in it, however, belongs to you. You have a right to:
If you want to exercise any of the above rights, please contact this office in person or in writing, during normal hours. We will provide you with assistance on the steps to take to exercise your rights. You have the right to review this Notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes.
The practice is required to:
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact:
1093 Wickham Road, West Melbourne, FL 32904-1652
phone: (321) 674-3900
Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to the above address. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services.
Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.
Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care if you do not object or in an emergency.
We may disclose to the FDA your protected health information relating to adverse events with respect to products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.
As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.
If you are an inmate of a correctional institution, we may disclose to the institution, or its agents, your protected health information necessary for your health and the health and safety of other individuals.
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecutions, or to the extent an individual is in the custody of law enforcement.
Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.
Other uses and disclosures besides those identified in this Notice will be made only as otherwise authorized by law or with your written authorization and you may revoke the authorization as previously provided.
If we maintain a website that provides information about our entity, this Notice will be on the website.
Please note that the information contained within this Website is provided for informational and educational purposes only and should be used only in consultation with an oral and maxillofacial surgeon of your choice. The use of this Website does not imply nor establish any type of doctor/patient relationship. No diagnosis or treatment is being provided by the use of this Website. The use of this Website does not constitute nor offer any specific medical, dental or surgical advice whatsoever to anyone and is not intended for that use. Dr. Grenevicki currently practices in the state of Florida and the use of this site is not intended to solicit patients from other states. This Website takes no responsibility with regards to misinterpretation of the information provided within this Website or any consequences resulting from the use of this Website. This Website takes no responsibility for any websites that may be linked to this Website nor imply any relationships or endorsements to any linked Website.back to top
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© Copyright 2003 The Institute of Facial Surgery (IOFS). All rights reserved.
Updated 3/06/2010 v3.00