HIPAA Notice

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.

Our commitment to your privacy: La Clinique Privée (“La Clinique Privée”) is dedicated to maintaining the privacy of your health information. In conducting our business, we will create records regarding your treatment and the services we provide. We are required by law to maintain the confidentiality of protected health information that identifies you (“PHI”). We also are required by law to provide you with this Notice of our legal duties and the privacy practices that we maintain concerning PHI.

We realize that these laws are complicated, but we must provide you with the following information:

How we may use and disclose PHI;
Your privacy rights in PHI; and
Our obligations concerning the use and disclosure of PHI.

The terms of this Notice apply to all records containing PHI that are created or retained by La Clinique Privée. La Clinique Privée is required to abide by the terms of this Notice currently in effect. We reserve the right to revise or amend this Notice. Any revision or amendment to this Notice will be effective for all of your records that La Clinique Privée has created or maintained in the past, and for any records that we may create or maintain in the future. We will make any revised or amended notice available electronically on our website and either by e-mail, if you have agreed to receive electronic communications.

If you have questions about this Notice, please contact: La Clinique Privée, at 8585 Sunset Drive, Suite 107 Miami, FL, 33143 United States, or at +1 (305) 339-9313, or by email at [email protected].

How We May Use and Disclose Your PHI:

Treatment: La Clinique Privée may use your PHI to treat you. For example, our physicians may ask about your health history in order to treat you. Many of the people who work at La Clinique Privée, including, but not limited to, our physicians, may use or disclose your PHI in order to treat you or to assist others in your treatment.

Payment: La Clinique Privée may use and disclose PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to inquire whether you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover or pay for treatment.

Health Care Operations: La Clinique Privée may use and disclose PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, La Clinique Privée may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for La Clinique Privée. La Clinique Privée may also disclose PHI to another health care provider for the health care operations activities of that entity if it also has or had a relationship with you and the PHI pertains to that relationship.

Appointment Reminders: La Clinique Privée may use and disclose PHI to contact you and remind you of an appointment.

Treatment Options and Health-Related Benefits and Services: La Clinique Privée may use and disclose PHI to inform you of potential treatment options or alternatives. La Clinique Privée may use and disclose PHI to inform you of health-related benefits or services that may be of interest to you.

Disclosures Required by Law: La Clinique Privée will use and disclose PHI when we are required to do so by federal, state, or local law.

Psychotherapy Notes: Psychotherapy notes have additional protections and, in certain cases, are subject to additional requirements and restrictions related to disclosures to you and third parties. La Clinique Privée does not create or maintain psychotherapy notes.

You Have the Right and Choice to Agree to, or Prohibit or Restrict the Use or Disclosure of PHI in Certain Situations:

Specifically, La Clinique Privée may share PHI with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort. If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

Use and Disclosure of Your PHI in Certain Circumstances:

The following are situations where we may use or disclose PHI:

Public Health and Safety Issues: La Clinique Privée may share PHI about you for certain situations such as:

Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety

Health Oversight Activities: La Clinique Privée may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

Compliance with Law, Lawsuits, and Similar Proceedings: La Clinique Privée will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that La Clinique Privée is complying with federal privacy law. La Clinique Privée may use and disclose PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. La Clinique Privée also may disclose PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

Law Enforcement: La Clinique Privée may release PHI if asked to do so by a law enforcement official:

Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement,
Concerning a death we believe has resulted from criminal conduct,
Regarding criminal conduct at our offices,
In response to a warrant, summons, court order, subpoena or similar legal process,
To identify/locate a suspect, material witness, fugitive or missing person,
In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

Organ Procurement, Coroners, Medical Examiners, and Funeral Directors: La Clinique Privée may release PHI to organ procurement organizations, a coroner, or medical examiner. We also may release PHI to funeral directors as necessary for their duties.

Under certain circumstances, we may use and disclose PHI for research. Before we use or disclose PHI for research, the project will go through a special approval process. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of the PHI.

Serious Threats to Health or Safety: La Clinique Privée may use and disclose PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

National Security: La Clinique Privée may disclose PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose PHI to federal officials in order to protect the president, other officials, or foreign heads of state, or to conduct investigations.

Workers’ Compensation: La Clinique Privée may disclose PHI for workers’ compensation claims.

Your Rights Regarding Your PHI:

You have the following rights regarding the PHI that we maintain about you:

Confidential Communications: You have the right to request that La Clinique Privée communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to [email protected] specifying the requested method of contact, or the location where you wish to be contacted. La Clinique Privée will accommodate reasonable requests. You do not need to give a reason for your request.

Requesting Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose to someone involved in your care or the payment for your care, like a family member or friend.

To request a restriction, you must make your request in writing to La Clinique Privée. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of PHI to a health plan for payment or health care operation purposes, and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

If you paid out-of-pocket (or in full) for a specific item or service, you have the right to ask that your PHI with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.

Inspection and Copies: You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to [email protected] in order to inspect and/or obtain a copy of your PHI. La Clinique Privée may charge a fee for the costs of copying, mailing, labor, and supplies associated with your request. La Clinique Privée may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial.

Amendment: You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for La Clinique Privée. To request an amendment, your request must be made in writing and submitted to [email protected]. You must provide us with a reason that supports your request for amendment. La Clinique Privée will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is accurate and complete; not part of the PHI kept by or for the practice; not part of the PHI which you would be permitted to inspect and copy; or not created by La Clinique Privée, unless the individual or entity that created the information is not available to amend the information.

Accounting of Disclosures: All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain disclosures La Clinique Privée has made of your PHI. In order to obtain an accounting of disclosures, you must submit your request in writing to [email protected]. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six years from the date of disclosure and may not include dates before [Effective Date]. The first list you request within a 12-month period is free of charge, but La Clinique Privée may charge you for additional lists within the same 12-month period. La Clinique Privée will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

Right to a Paper Copy of This Notice: You are entitled to receive a paper copy of this Notice of Privacy Practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact La Clinique Privée at +1 (305) 339-9313.

Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with La Clinique Privée or with the Secretary of the Department of Health and Human Services. To file a complaint with La Clinique Privée, contact [email protected]. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Right to Provide an Authorization for Other Uses and Disclosures: La Clinique Privée will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note we are required to retain records of your care.

If you have any questions regarding this notice or our health information privacy policies, please contact La Clinique Privée at +1 (305) 339-9313 or [email protected].

This notice was published and becomes effective on [1 August 2024].