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.

Viera Fertility (“our Clinic”) takes the protection of your personal information seriously.  Our Clinic is required by law to maintain the privacy of Protected Health Information (PHI). PHI is information that may identify you and that relates to your past, present, or future physical or mental health or condition; the provision of health care products and services to you; or the payment for such services.  This Notice will tell about the ways in which our Clinic may use or disclose your medical information and describes your rights with respect to your PHI as required by law.  We are required to follow the terms of this Notice as well as any changes to it that may be in effect.  We reserve the right to change our practices, and any updated Notice will be posted on our website and available at our office location.  Upon request, we will provide additional copies of our current Notice to you.  

Uses and Disclosures of Your PHI 

For each category listed, the Notice outlines uses and disclosures included in the category, but it does not list every potential use or disclosure.  Except where prohibited by federal or state laws that require special privacy protections, we may use and disclose your PHI for treatment, payment and healthcare operations without your prior authorization, as follows:

  • Treatment. Your medical information may be used or disclosed to provide and coordinate the medical treatment or services you receive. We may also share your medical information with health care providers and their staff outside our Clinic, such as pharmacies and hospitals. We may also use your medical information to contact you to provide appointment reminders or to give you information about treatment options or other health related benefits and services that may interest you.
  • Payment. Your medical information may be used and disclosed so that the treatment and services received at our Clinic may be billed and payment may be collected from you, your insurance company, and/or a third party. We will comply with your request not to disclose your health information to your insurance company if the information relates solely to a healthcare item or service for which you have paid out of pocket and in full to us.
  • Health Care Operations. Your medical information may be used and disclosed for our Clinic’s health care operations. These uses and disclosures are necessary to run our Clinic and to monitor the quality of care our patients receive. 

Outlined below are additional situations in which our Clinic may disclose your PHI without your authorization.    

  • Business Associates.  We may share your medical information with outside companies that perform services for us such as accreditation, legal, computer, or auditing services. These outside companies are called “Business Associates” and are required by HIPAA and by contract to keep your medical information confidential.
  • Individuals Involved in Your Care. We may share your medical information with a family member, guardian or other individuals who are involved in your care, or who help pay for your care. If you have any objection to sharing your medical information in this way, please contact Our Clinic’s Privacy Officer, whose contact information is listed at the end of this Notice.
  • To You or Your Personal Representative.  We may disclose your PHI to you, or a representative appointed by you or designated by applicable law.
  • Disaster Relief. Your medical information may be disclosed to an entity assisting in a disaster relief effort so your family can be notified about your condition, status, and location.
  • Research. Under certain circumstances, your medical information may be used and disclosed for research purposes. All research projects involving patients’ medical information must be approved through a special review process to protect patient confidentiality.  A researcher may have access to information that identifies you only through the special review process, or with your written permission. In addition, researchers may contact patients regarding their interest in participating in certain research studies. Researchers may only contact you if they have been given approval to do so by the special review process. You will only become a part of one of these research projects if you agree to do so and sign a consent form.
  • Appointment Reminders. Your medical information may be used to contact you as a reminder of an appointment you have for treatment or medical care at our Clinic.
  • Treatment Alternatives. Your medical information may be used to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
  • Health-Related Benefits and Services. Your medical information may be used to tell you about health-related benefits or services that may be of interest to you.
  • As Required or Allowed by Law. Your medical information will be disclosed when we are required or allowed to do so by federal, state, or local authorities, laws, rules and/or regulations.
  • Judicial and Administrative Proceedings. Your medical information may be disclosed in response to a court or administration order, subpoena, discovery request, or other lawful process.
  • Law Enforcement. Your medical information may be disclosed for law enforcement purposes as authorized or required by law.  For example, our Clinic may disclose your PHI if necessary to report a crime.
  • To Prevent a Serious Threat to Health or Safety. We may use or share your medical information when necessary to prevent a serious threat to your health and safety and that of the public or another person.
  • Health Oversight Activities. We may disclose your medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
  • Organ and Tissue Donation. If you are an organ or tissue donor, your medical information may be released to organizations that handle organ procurement or organ, eye and tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
  • Public Health Purposes. Our Clinic may disclose your medical information for public health activities, such as activities:
  1. To prevent or control disease, injury or disability;
  2. To report births and deaths;
  3. To report reactions to medications or problems with products
  4. To notify people of recalls of products they may be using; or
  5. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
  • Abuse and Neglect.  Subject to certain limitations, our Clinic may disclose your PHI to an appropriate government authority that is authorized by law to receive reports of abuse, neglect, or domestic violence, or if our Clinic reasonably believes you are a victim of abuse or neglect.

Uses and Disclosures that Require Your Authorization

Our Clinic will not use or disclose your PHI for any purpose other than those described in this Notice, unless you give our Clinic your written authorization to do so.  Your PHI may not be used or disclosed for marketing purposes or sold by our Clinic without your prior written authorization.  If you sign a written authorization permitting uses and disclosures of your PHI other than those described in this Notice, you may revoke your authorization by submitting a written request to our Clinic’s Privacy Officer at any time.  However, our Clinic is unable to retract or invalidated any uses or disclosures that were made with your permission before you revoked your authorization.

Your Rights Regarding Your Medical Information: 

You have the following rights regarding your medical information.  All Requests Must Be Submitted in Writing to our Clinic’s Privacy Officer.  Please contact the Privacy Officer for additional information regarding any of these rights.  The contact information for the Privacy Officer can be found at the end of this Notice.

  • Right to Request Access to Your Medical Information. With certain exceptions, you have the right to see and get a copy of your medical information that may be used to make decisions about your care. To see or get a copy of your medical information, you must submit a written request. If you request a paper copy of your information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request. There is no fee to see your medical information.  Our Clinic may deny your request to inspect or copy your PHI in certain limited situations.  If you are denied access to your PHI, you will be notified in writing.  
  • Right to Request an Amendment of Your Medical Information. If you feel that the medical information, we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, you must submit a written request. Please be specific about the information that you believe is incorrect or incomplete.  In some situations, our Clinic may deny your request to amend your PHI.  If we deny your request, you will be notified in writing. 
  • Right to an Accounting of Disclosures. You have the right to request an accounting of certain types of disclosures of your PHI for a specified time period.  The accounting will not include all disclosures of your PHI.  For example, you do not have the right to request an accounting of disclosures of your PHI made (1) for purposes of treatment, payment and health care operations (2) to you and pursuant to your authorization; or (3) for other purposes for which federal law does not require us to provide an accounting.  Your request for an accounting should identify the time period for which you seek the accounting, such as six (6) months or two (2) calendar years. The first accounting you request in any 12-month period will be free. For additional accountings that you request within a 12-month period, we may charge you for the costs of providing the accounting. We will notify you of the cost in advance so that you can choose whether to withdraw or modify your request.
  • Right to Request Restrictions on How Your Medical Information is Used or Disclosed. You have a right to request that we change the way we use or disclose your medical information for certain purposes. To request restrictions, you must make your request in writing. In your request, you must tell us: 
  1. What information you want to limit;
  2. Whether you want to limit our use, disclosure or both;
  3. To whom you want the limits to apply, for example, disclosures to your spouse.

We are not required to agree to your request, except that we will not share your medical information with your health insurance company if you pay for the entire amount due for the services you receive (unless we are required by law to share the information with your health insurance company).

  • Right to Request Confidential Communication. You have the right to request that we communicate with you in a certain way or at a certain location that you think will be more confidential. For example: You can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
  • Right to Be Notified of Breach. We will notify you if we discover a breach of your unsecured protected health information.
  • Right to a Paper Copy of This Notice. You have the right to a copy of this notice. You may ask us to give you a copy at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

If you would like to exercise any of the rights described in this Notice, please contact our Clinic’s Privacy Officer, whose contact information is provided at the end of this Notice.  

ADDITIONAL INFORMATION CONCERNING THIS NOTICE:

  • Changes To This Notice. We reserve the right to change this notice and make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. Our Clinic will post a current copy of the notice with the effective date.
  • Complaints. You will not be penalized or retaliated against for filing a complaint. If you believe your rights have been violated, you may file a complaint with Our Clinic or with the Secretary of the Department of Health and Human Services.  

Please contact our Privacy Officer at the address and telephone number provided below:  

Viera Fertility
3160 Alzante Circle
Melbourne, FL 32940
321-751-4673

Effective: 2/29/2024