HIPPA Privacy Statement

“THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMAITON. PLEASE REVIEW IT CAREFULLY.”

USE AND DISCLOSURE OF HEALTH INFORMATION

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED by FISCHER, SCHEMMER, & SILBIGER, M.D., P.A.:

To Conduct Health Care Operations, Fischer, Schemmer, & Silbiger, M.D., P.A. may use or disclose health information for its own operations to facilitate the administration of the Fischer, Schemmer, & Silbiger, M.D., P.A. health plan and, as necessary, to provide coverage and services to all of Fischer, Schemmer, & Silbiger, M.D., P.A. ‘s participants. Health care operations include such activities as:

  • Appointments
    Upon arrival to our office you will normally be directed to our Patient Reservation area. Your name will be called by one of our staff members when it is time for your exam.
  • Treatment
    We may use or disclose your PHI to coordinate, manage your health care and relates services. We may use your PHI to write prescriptions and therefore may need to disclose you PHI to a pharmacy. Our doctors, technicians, and office staff may use or disclose your PHI in order to treat you or to assist in your treatment. We may provide your PHI to the physician who referred you to use for care to ensure that physician has the needed information to treat you. Others examples of who it may be necessary to disclose your PHI information to include, a hospital, outpatient facility, nursing facility.
  • Contacting Individuals
    We may provide reminders or other information to Individuals, a statement that Individuals may be contacted for appointment reminders, for information on other health services, or for raising funds for Fischer, Schemmer, & Silbiger, M.D., P.A. You have the opportunity to opt-out of any fundraising activity by contacting the Office Manager at the office of Fischer, Schemmer, & Silbiger, M.D., P.A.
  • Payment
    We may use or disclose your health information to make payment to or collect payment from third parties, such as other health plans or providers, for the care you receive. We are required by law to maintain the confidentiality of your health information identifies you as well as your health status. We are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect the time.
  • Accreditation, certification, licensing or credentialing activities.
    Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
    We may use or disclose your health information to provide you with information on health-related benefits and services.

When Legally Required, Fischer, Schemmer, & Silbiger, M.D., P.A. will disclose your health information when it is required to do so by any federal, state or local law.

Fischer, Schemmer, & Silbiger, M.D., P.A. may disclose your health information to a health oversight agency for authorized activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Fischer, Schemmer, & Silbiger, M.D., P.A., however, may not disclose your health information if you are the subject of an investigation and the investigation does not arise out of or is not directly related to your receipt of health care or public benefits.

As permitted or required by state law, Fischer, Schemmer, & Silbiger, M.D., P.A. may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena.

As permitted or required by state law, Fischer, Schemmer, & Silbiger, M.D., P.A. may disclose your health information to a law enforcement official for certain law enforcement purposes, including, but not limited to, if Fischer, Schemmer, & Silbiger, M.D., P.A. has a suspicion that your death was the result of criminal conduct or in an emergency to report a crime.

Consistent with applicable law and ethical standards of conduct, disclose your health information if Fischer, Schemmer, & Silbiger, M.D., P.A., in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

In certain circumstances, federal regulations require Fischer, Schemmer, & Silbiger, M.D., P.A. to use or disclose your health information to facilitate specified government functions related to the military and veterans, national security and intelligence activities, protective services for the president and others, and correctional institutions and inmates.

Fischer, Schemmer, & Silbiger, M.D., P.A. may release your health information to the extent necessary to comply with laws related to worker’s compensation or similar programs.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than as stated above, Fischer, Schemmer, & Silbiger, M.D., P.A. will not disclose your health information other than with your written authorization. If you authorize Fischer, Schemmer, & Silbiger, M.D., P.A. to use or disclose your health information, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

You have the following rights regarding your health information that Fischer, Schemmer, & Silbiger, M.D., P.A. maintains:

Right to Request Restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on Fischer, Schemmer, & Silbiger, M.D., P.A.’s disclosure of your health information to someone involved in the payment of your care. However, Fischer, Schemmer, & Silbiger, M.D., P.A. is not required to agree to your request. If you wish to make a request for restrictions, please contact the Office Manager at Fischer, Schemmer, & Silbiger, M.D., P.A. at 863-294-5457.

You may request Fischer, Schemmer, & Silbiger, M.D., P.A to restrict disclosure of protected health information about the individual to a health plan if:

  • The disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and
  • The protected health information pertains solely to a health care item or service for which the individual, or person other than the health plan on behalf of the individual, has paid the covered entity in full.”

Right to Receive Confidential Communications. You have the right to request that Fischer, Schemmer, & Silbiger, M.D., P.A. communicate with you in a certain way if you feel the disclosure of your health information could endanger you. For example, you may ask that Fischer, Schemmer, & Silbiger, M.D., P.A., only communicate with you at a certain telephone number or by email. If you wish to receive confidential communications, please make your request in writing to the Fischer, Schemmer, & Silbiger, M.D., P.A. Contact Person at Fischer, Schemmer, & Silbiger, M.D., P.A. 215 1st Street N., Suite 200 Winter Haven, Fl. 33881, Attention Office Manager or fax to 863-401-3272. Fischer, Schemmer, & Silbiger, M.D., P.A. will attempt to honor your reasonable requests for confidential communications. Right to Inspect and Copy Your Health Information. You have the right to inspect and copy your health information. A request to inspect and copy records containing your health information must be made in writing to the Office Manager at Fischer, Schemmer, & Silbiger, M.D., P.A. 215 1st Street N., Suite 200 Winter Haven, Fl. 33881 or fax your written request to 863-401-3272.

Right to Amend Your Health Information. If you believe that your health information records are inaccurate or incomplete, you may request that Fischer, Schemmer, & Silbiger, M.D., P.A. amend the records. That request may be made as long as the information is maintained by Fischer, Schemmer, & Silbiger, M.D., P.A. A request for an amendment of records must be made in writing to the Office Manager at Fischer, Schemmer, & Silbiger, M.D., P.A., 215 1st Street N., Suite 200 Winter Haven, Fl. 33881 or fax your written request to 863-401-3272. Fischer, Schemmer, & Silbiger, M.D., P.A. may deny the request if it does not include a reason to support the amendment. The request also may be denied if your health information records were not created by Fischer, Schemmer, & Silbiger, M.D., P.A.., if the health information you are requesting to amend is not part of Fischer, Schemmer, & Silbiger, M.D., P.A.’s records, if the health information you wish to amend falls within an exception to the health information you are permitted to inspect and copy, or if Fischer, Schemmer, & Silbiger, M.D., P.A. determines the records containing your health information are accurate and complete.

Right to Notification of Security Breach. Fischer, Schemmer, & Silbiger, M.D., P.A. is required by law to protect and maintain the privacy of PHI, to provide Individuals with Notice of affected individuals following a breach of unsecured protected health information.

Right to an Accounting. You have the right to request a list of disclosures of your health information made by Fischer, Schemmer, & Silbiger, M.D., P.A. The request must be made in writing to the Office Manager at Fischer, Schemmer, & Silbiger, M.D., P.A., 215 1st Street N., Suite 200 Winter Haven, Fl. 33881, or fax your written request to 863-401-3272. The request should specify the time period for which you are requesting the information. Accounting requests may not be made for periods of time going back more than six (6) years. You may request specific methods of communication of your PHI to you. (eg. Specific phone number, no post cards, etc.)

Right to a Paper Copy of this Notice. You have a right to request and receive a paper copy of this Notice at any time, even if you have received this Notice previously or agreed to receive the Notice electronically. To obtain a paper copy, please contact the Fischer, Schemmer, & Silbiger, M.D., P.A. at 863-294-5457. You also may obtain a copy of the current version of Fischer, Schemmer, & Silbiger, M.D., P.A.’s Notice at its Web site, http://eyecarefss.com/hipaa.asp

DUTIES OF FISCHER, SCHEMMER, & SILBIGER, M.D., P.A.

Fischer, Schemmer, & Silbiger, M.D., P.A. is required by law to maintain the privacy of your health information as set forth in this Notice and to provide you this Notice of its duties and privacy practices. Fischer, Schemmer, & Silbiger, M.D., P.A. is required to abide by the terms of this Notice, which may be amended from time to time. Fischer, Schemmer, & Silbiger, M.D., P.A. reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains. If Fischer, Schemmer, & Silbiger, M.D., P.A. changes its policies and procedures, Fischer, Schemmer, & Silbiger, M.D., P.A. will revise the Notice and will provide a copy of the revised Notice to you within 60 days of the change. You have the right to express complaints to Fischer, Schemmer, & Silbiger, M.D., P.A. and to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. Any complaints to Fischer, Schemmer, & Silbiger, M.D., P.A. should be made in writing to the Office Manager at Fischer, Schemmer, & Silbiger, M.D., P.A., 215 1st Street N. Suite 200 Winter Haven, Fl. 33881 or fax your written request to 863-401-3272. Fischer, Schemmer, & Silbiger, M.D., P.A. encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

Contact Person

Fischer, Schemmer, & Silbiger, M.D., P.A. has designated their Office Manager, as their contact person for all issues regarding patient privacy and your privacy rights. You may contact her at 215 First Street N., Suite 200, Winter Haven FL 33881 or at 863-294-5457.

Effective Date

Last updated April 30, 2013.