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.
I. Who We Are
Practice, Facility, and Health Professionals in this notice are members of the Solaris Health Affiliated Covered Entity (ACE). An Affiliated Covered Entity is a group of organizations under common ownership or control that designate themselves as a single Affiliated Covered Entity for compliance with the Health Insurance Portability and Accountability Act (“HIPAA”).
The members of the ACE will share PHI with each other for treatment, payment, and health care operations as permitted by HIPAA and this Notice. For a complete list of the members of the ACE, please contact the Privacy Office.
II. Our Privacy Obligations
We understand that your health information is personal and are committed to protecting your privacy. By law, we must maintain the privacy of your Protected Health Information, provide you with this Notice, and notify you in case of a breach of unsecured Protected Health Information.
III. Permissible Uses and Disclosures Without Your Written Authorization
In some cases, we must obtain your written authorization to use or disclose your Protected Health Information. However, unless it is considered Highly Confidential Information (see Section IV.B), we may use and disclose it without your authorization for certain purposes.
If you are unavailable before a disclosure (e.g., a family member calls on your behalf), we may use our professional judgment to determine whether disclosure is in your best interest.
IV. Uses and Disclosures Requiring Your Written Authorization
For any purpose beyond those described in Section III, we will only use or disclose your Protected Health Information with your written authorization.
A. Marketing
We must obtain your written authorization before using your Protected Health Information for marketing purposes under HIPAA privacy rules. We will not accept payment from third parties for marketing communications unless permitted by law or authorized by you.
B. Sale of Protected Health Information
We will not sell your Protected Health Information without your written authorization.
C. Uses and Disclosures of Highly Confidential Information
Special privacy protections apply to certain health information, including records related to alcohol/drug abuse treatment, HIV/AIDS, genetic testing, sexual assault, domestic abuse, and child abuse. We generally do not maintain this information, but if we need to disclose it beyond legally permitted purposes, we must obtain your authorization.
D. Revocation of Authorization
You may revoke your authorization at any time by submitting a written revocation statement to the Privacy Office.
V. Your Individual Rights
A. Further Information & Complaints
If you need more information about your privacy rights or wish to file a complaint, contact our Privacy Office. You may also file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
B. Right to Request Additional Restrictions
You may request restrictions on how we use or disclose your Protected Health Information, but we are not required to agree unless your request restricts disclosure to a health plan for a service you paid for out-of-pocket in full.
C. Right to Receive Communications by Alternative Means or Locations
You may request to receive your Protected Health Information through alternative means or locations, and we will accommodate reasonable requests.
D. Right to Inspect and Copy Your Health Information
You may request access to your medical and billing records. In limited cases, we may deny access. If you request copies, we may charge a reasonable fee.
E. Right to Amend Your Records
You may request amendments to your medical or billing records. We will comply unless we believe the records are accurate and complete or special circumstances apply.
F. Right to Receive an Accounting of Disclosures
You may request an accounting of certain disclosures of your Protected Health Information for up to six years. If you request more than one within 12 months, we may charge a reasonable fee.
G. Right to Receive a Paper Copy of This Notice
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
VI. Effective Date and Changes to This Notice
A. Effective Date
This Notice is effective as of December 1, 2023.
B. Right to Change Terms
We may change this Notice at any time. If we do, the new terms will apply to all Protected Health Information we maintain, including prior information. We will post the updated Notice in our waiting room and on our website. You may also request a copy from the Privacy Office.
VII. Privacy Office Contact Information
If you have questions or need to contact the Privacy Office, you may reach us at:
Privacy Office
Advanced Urology Institute
26750 US Highway 19 North, Suite 200
Clearwater, FL 33761
Telephone: (727) 287-4586
Email: privacyofficer@auihealth.com
Solaris Privacy Office Email: privacyoffice@solarishp.com