-
At McKinley Medical we are committed to treating and using protected health information (“PHI”) about you responsibly. This Notice of Privacy Practices (“Notice”) describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your PHI. This Notice has been updated in accordance with the HIPAA Omnibus Rule effective March 26, 2013. It applies to all PHI as defined by federal regulations.
Understanding Your Health Record/Information. Each time you visit McKinley Medical; a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information may be used or disclosed to: Plan your care and treatment. Communicate with other providers who contribute to your care. Serve as a legal document. Receive payment from you, your plan, or your health insurer. Assess and continually work to improve the care we render and the outcomes we achieve. Comply with state and federal laws that require us to disclose your health information.
Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.
Your Health Information Rights, although your health record is the physical property of McKinley Medical, the information belongs to you. You have the right to request to:
* Access, inspect and copy your health record. You have the right to inspect and/or request a paper copy of your medical record. If the McKinley Medical office where you receive services maintains an electronic medical record (“EMR”), you have the right to access your health record in a machine readable electronic format. You have the right to request an electronic copy of your medical record be given to you or transmitted to another individual or entity. McKinley Medical may charge you a reasonable, cost-based fee for the labor and supplies associated with copying or transmitting the electronic PHI.
* Amend your health record which you believe is not correct or complete. McKinley Medical is not required to agree to the amendment if you ask us to amend information that is in our opinion: (i) accurate and complete; (ii) not part of the PHI kept by or for McKinley Medical; (iii) not part of the PHI which you would be permitted to inspect and copy; or (iv) not created by McKinley Medical, unless the individual or entity that created the information is not available to amend the information. If we deny your request, you may submit a written statement of disagreement of reasonable length. Your statement of disagreement will be included in your medical record, but we may also include a rebuttal statement.
* Obtain a written accounting of certain non-routine disclosures of your PHI. We are not required to list certain disclosures, including (i) disclosures made for treatment, payment, and health care operations purposes, (ii) disclosures made with your authorization, (iii) disclosures made to create a limited data set, and (iv) disclosures made directly to you. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years prior to the date of your request. If the McKinley Medical office where you receive services maintains your medical records in an EMR system, you may request that the accounting include disclosures for treatment, payment and health care operations for the three (3) years prior to the date of such request. You must submit your request in writing to the Privacy Officer at mckinleymedical904@gmail.com. The first list you request within a 12-month period is free of charge, but McKinley Medical may charge you for additional lists within the same 12-month period. McKinley Medical will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
* Communications of your health information by alternative means (e.g. e-mail) or at alternative locations (e.g. post office box).
* Place a restriction to certain uses and disclosures of your information. In most cases McKinley Medical is not required to agree to these additional restrictions, but if McKinley Medical does, McKinley Medical will abide by the agreement (except in certain circumstances where disclosure is required or permitted, such as an emergency, for public health activities, or when disclosure is required by law). McKinley Medical must comply with a request to restrict the disclosure of PHI to a health plan for purposes of carrying out payment or health care operations if the PHI pertains solely to a health care item or service for which we have been paid out of pocket in full.
* Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
* Obtain a copy of your health care information in paper or a machine readable electronic format.
Our Responsibilities McKinley Medical is required to:
* Maintain the privacy of your health information.
* Provide you with this Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
* Abide by the terms of the Notice currently in effect
* Notify you in writing if we are unable to agree to a requested restriction.
* Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
* Notify you in writing of a breach where your unsecured PHI has been accessed, acquired, used or disclosed to an unauthorized person. “Unsecured PHI” refers to PHI that is not secured through the use of technologies or methodologies that render the PHI unusable, unreadable, or indecipherable to unauthorized individuals. We reserve the right to change our practices and to make the new provisions effective for all PHI we maintain. Should our information practices change, such revised Notices will be made available to you. We will not use or disclose your health information without your written authorization, except as described in this Notice.
For More Information or to Report a Problem If have questions and would like additional information, you may contact the McKinley Medical owner at :
McKinley Medical
245 Riverside Ave, Ste 100-056
Jacksonville, FL 32202
Telephone: (904) 658-1114
www.mckinley-medical.com
If you believe your privacy rights have been violated, you can file a written complaint with McKinley Medicals owner or with the Office for Civil Rights, U.S. Department of Health and Human Services. Upon request, the Privacy Office will provide you with the address. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights.
Treatment: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your medical record and used to determine the course of treatment that should work best for you. To promote quality care, McKinley Medical operates an EMR. This is an electronic system that keeps health information about you. McKinley Medical may also provide a subsequent healthcare provider with health information about you (e.g., copies of various reports) that should assist him or her in treating you in the future. McKinley Medical may also disclose health information about you to, and obtain your health information from, electronic health information networks in which community healthcare providers may participate to facilitate the provision of care to patients such as yourself. McKinley Medical may use a prescription hub which provides electronic access to your medication history. This will assist McKinley Medical health care providers in understanding what other medications may have been prescribed for you by other providers.
Payment: A bill will be sent to you. The information on or accompanying the bill may include information that identifies you, diagnosis, procedures, and supplies used.
Health Care Operations: We may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.
Business Associates: We may contract with third parties to provide services on our behalf and disclose your health information to our business associate so that they can perform the job we’ve asked them to do. We require the business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
Communication from Offices: We may call your home or other designated location and leave a message on voice mail, in person, or by encrypted e-mail, in reference to any items that assist McKinley Medical in carrying out Treatment, Payment and Health Care Operations, such as appointment reminders, insurance items and any call pertaining to your clinical care. We may mail to your home or other designated location any items that assist McKinley Medical in carrying out Treatment, Payment and Health Care Operations, such as appointment reminders, patient satisfaction surveys and patient statements.
Communication with Family/Personal Friends: Health professionals, using their best judgment, may disclose toa 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 payment related to your care. When a family member(s) or a friend(s) accompany you into the exam room, it is considered implied consent that a disclosure of your PHI is acceptable.
Open treatment areas: Sometimes patient care is provided in an open treatment area. While special care is taken to maintain patient privacy, others may overhear some patient information while receiving treatment. Should you be uncomfortable with this, please bring this to the attention of McKinley Medical Owner.
To Avert a Serious Threat to Health or Safety: We may use your health information or share it with others when necessary to prevent a serious threat to your health or safety, or the health or safety of another person or the public.
Research: We may disclose 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 PHI. Even without that special approval, we may permit researchers to look at PHI to help them prepare for research, for example, to allow them to identify patients who may be included in their research project, as long as they do not remove, or take a copy of, any PHI. We may use and disclose a limited data set that does not contain specific readily identifiable information about you for research. But we will only disclose the limited data set if we enter into a data use agreement with the recipient who must agree to (1) use the data set only for the purposes for which it was provided, (2) ensure the security of the data, and (3) not identify the information or use it to contact any individual. McKinley Medical may use a single compound authorization to combine conditioned and unconditioned authorizations for research (e.g. participation in research studies, creation or maintenance of a research database or repository), provided the authorization: (i) clearly differentiates between the conditioned (provision of research related treatment is conditioned on the provision of a written authorization) and unconditioned research components; and (ii) provides the individual with an opportunity to opt in to the unconditioned research activities.
Coroners, Medical Examiners and Funeral Director: In the unfortunate event of your death, we may disclose your health information to a coroner or medical examiner. This may be necessary, for example, to determine the cause of death. We may also release this information to funeral directors as necessary to carry out their duties
Deceased Individuals: In the unfortunate event of your death, we are permitted to disclose your PHI to your personal representative and your family members and others who were involved in the care or payment for your care prior to your death, unless inconsistent with any prior expressed preference that you provided to us. PHI excludes any information regarding a person who has been deceased for more than 50 years.
Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations, federally funded registries, or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Marketing: We may contact you by mail, e-mail or text to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. However, we must obtain your prior written authorization for any marketing of products and services that are funded by third parties. You have the right to opt-out by notifying us in writing.
Health Oversight Activities: We may release your health information to government agencies authorized to conduct audits, investigations, and inspections of our facility. These government agencies monitor the operation of the health care system, government benefit programs, such as Medicare and Medicaid, and compliance with government regulatory programs and civil rights laws.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law. Inmates and Correctional Institutions: If you are an inmate or you are detained by a law enforcement officer, we may disclose your health information to the prison officers or law enforcement officers if necessary to provide you with health care, or to maintain safety at the place where you are confined.
Lawsuits and Disputes: We may disclose your health information if we are ordered to do so by a court that is handling a lawsuit or other dispute. We may also disclose your information in response to a subpoena, discovery request, or other lawful request by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain a court order protecting the information from further disclosure. As Required by Law: We may use or disclose your health information if we are required by law to do so.
-
Financial Policies
1. All payments will be collected prior to seeing the provider on the day of your visit. If you are unable to pay prior to your appointment, your visit may be rescheduled.
Cancellation Policy
Be mindful please. Appointments you select are reserved especially for you. Late cancellations / no shows deny others the opportunity to schedule care.
Prescription Refill Policies
1. Patients can request prescription refills (originally prescribed by a McKinley Medical Provider) through their pharmacy, which can then be requested via e-prescribe.
2. The office will need 48 hours for all prescription refills.
3. If your insurance company requires a prior authorization for a medication, please allow 14 business days for the company to complete the prior authorization process. If a McKinley Medical Provider cannot complete the prior authorization process you will be notified to follow up with your primary care provider for further assistance.
4. All thyroid patients needing refills will need to be seen at least once a year unless otherwise noted by your physician.
5. All diabetic patients will need to be seen in 3-6 month intervals, in order for prescriptions to be refilled, unless otherwise indicated by the physician.
6. If we are unable to refill your medication, please contact your primary care physician
-
For Use & Disclosure of Protected Health Information
In connection with the medical services I am receiving from McKinley Medical, I consent to and authorize the above named physicians and group to use and disclose any and all Protected Health Information (PHI) necessary to carry out treatment, payment, and health care operations (TPO) related to my medical care, unless noted below. Medical records may include results or tests for HIV antibody, substance abuse or treatment in regard to either of the aforementioned .
I have read and understand the Notice of Privacy Practices that offer a more complete description of such uses and disclosures. Copies of these Privacy Practices referenced are available on McKinley Medical’s website. McKinley Medical reserves the right to review and change its Notice of Privacy Practice any time.
McKinley Medical may call my home, office or cell and leave a message in reference to appointment reminders, insurance/billing and health care unless the patient specifies otherwise.
I have the right to request that this practice restrict how they use or disclose my protected health information (PHI) to carry out treatment, payment and health care operations (TPO). However, this office is not required to agree to my requested restrictions, but if they do, the office is bound by this agreement.
-
You are requesting McKinley Medical telemedicine services. Telemedicine is the practice of medicine that involves the use of electronic communications to diagnose or treat patients who are in different locations from their healthcare providers. Telemedicine can be used for diagnosing, treating, and prescribing medication.
When using the services, you will be treated by and will enter into a clinician-patient relationship with a provider of McKinley Medical who is licensed in your state. Your provider is an autonomous practice Advanced Registered Nurse Practitioner (APRN) who will be providing care without a supervising physician (ie. MD). The autonomous practice APRN will provide primary care services only (defined by statute 64B9-4.021) Responsibility for your comprehensive care shall always remain with your local clinician or primary care physician. If your provider can no longer adequately provide services via telehealth, you may be referred to see your primary care provider in person or go to your local emergency department.
The expected benefits of using telemedicine include:
• Improved and quicker access to medical care through reduced travel and visit time
• Ability to access care from any location, and
• More efficient medical evaluation and management
The potential risks associated with using telemedicine may include:
• Delays in medical evaluation and treatment due to failures of technology, such as a disconnected phone call
• Information may be lost due to technical failures, and
• In rare cases, a lack of access to complete medical information may result in adverse drug interactions, allergic reactions, or other judgment errors
The inability to have direct, physical contact with your healthcare provider is the primary difference between telemedicine and in-person health care. The alternative to telemedicine is receiving care in a traditional in-person care setting.
In receiving the services, you understand and agree:
1. It is necessary for you to provide complete and accurate medical history and you will update your medical health records periodically, but no less than once a year.
2. You cannot use McKinley Medical’s telehealth services to get prescriptions for DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse.
3. You cannot use McKinley Medical’s telehealth services for life threatening emergencies. If you think you are experiencing a medical emergency, you need to call 911 or go immediately to the closest emergency room.
4. There is no guarantee that you will be treated by a McKinley Medical provider. The McKinley Medical providers reserve the right to deny care for potential misuse of services or for any other reason if, in the professional judgment of the McKinley Medical provider, the provision of the service is not medically or ethically appropriate.
5. There is no guarantee that you will be given a prescription by the McKinley Medical provider.
6. 6. You are required to pay all visit fees at the time you schedule a visit.
Your use of this service is voluntary and you have the right to withdraw your consent to the services at any time by ending this session. If you choose to end your session, your right to future McKinley Medical telehealth services will not be affected.
You are acknowledging that you understand the statements above and consent, on your own behalf or on behalf of your minor dependents, to receive services by a McKinley Medical provider.
-
Per Florida Statute 381.026, Florida law requires that your health care provider or healthcare facility recognize your rights while you are receiving medical care and that you respect the health care provider's or health care facility's right to expect certain behavior on the part of patients. You may request a copy of the full text of this law from your healthcare provider or health care facility. A summary of your rights and responsibilities follows:
Patient Rights:
A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.
A patient has the right to receive a prompt and reasonable response to questions and requests.
A patient has the right to know who is providing medical services and who is responsible for his or her care.
A patient has the right to know what patient support services are available, including if an interpreter is available if he or she does not speak English.
A patient has the right to know what rules and regulations apply to his or her conduct.
A patient has the right to be given by the health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
A patient has the right to refuse any treatment, except as otherwise provided by law.
A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care.
A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.
A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment.
A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.
A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency.
Patient Responsibilities:
A patient is responsible for providing to the health care provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
A patient is responsible for reporting unexpected changes in his or her condition to the health care provider.
A patient is responsible for reporting to the health care provider whether he or she understands a planned course of action and what is expected of him or her.
A patient is responsible for following the treatment plan recommended by the health care provider.
A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the health care provider or health care facility.
A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider's instructions.
A patient is responsible for assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
A patient is responsible for following health care facility rules and regulations affecting patient care and conduct.