Summary of Privacy Practices

Pulmonary Associates of Brandon
910 Oakfield Drive, Suite 102
Brandon, Florida 33511
Phone: (813) 681-4413

This summary of our privacy practices contains a condensed version of our Notice of Privacy Practices. Our full length Notice is available at the front desk.

Date of Last Revision: February 1, 2008
Effective Date: February 1, 2008

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.

We understand that your medical information is personal to you, and we are committed to protecting the information about you. As our patient, we create medical records about your health, our care for you, and the services and/or items we provide to you as our patient. Under the federal regulation, known as HIPAA (Health Insurance Portability and Accountability Act of 1996), we are required to make sure that your protected health information (PHI) is kept private. HIPAA requires that we provide you with a detailed notice in writing of our privacy practices. Our practice is dedicated to maintaining the privacy of your individual PHI.

We reserve the right to revise this notice. If and when revision occurs, we will post a copy in our offices and provide you with a copy upon your request.

How will we use or disclose your information?
Here are a few examples:

• For medical care and treatment
• For billing, claims management, and collection of payments for our services
• In emergency situations
• For appointment and recall reminders
• For research
• For Worker’s Compensation programs
• For disclosures required by law
• For public health activities and risks
• For healthcare oversight activities
• To coroners, medical examiners, and funeral directors
• For organ and tissue donations
• For specialized government functions

If you believe that your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the Practice, please contact the Practice Administrator, Mr. John Evans at 813-681-4413 ext. 210. All complaints must be in writing. You will not be penalized for filing a complaint.

You have certain rights regarding the information we maintain about you.
These rights include:

• The right to inspect and copy
• The right to amend
• The right to request restrictions
• The right to request confidential communications
• The right to receive an accounting of disclosures
• The right to a copy of our Privacy Notice
• The right to file a complaint

For more information about these rights, please see the detailed Notice of Privacy Practices, available upon request at the front desk.