Established Pursuant to the Health Insurance Portability and Accountability Act (“HIPAA”)
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.
Understanding Your Health Record/Information
Each time you visit Jacksonville Breathe Free (or any hospital, physician, or other health care provider) a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
- Basis for planning your care and treatment
- Means of communication among the many health professionals who contribute to your cure
- Legal document describing the care you received
- Means by which you or a third-party payer can verify that services billed were actually provided
- A tool in the education of health professionals
- A source of data for the medical research
- A source of information for public health officials charged with improving the health of the nation
- A source of data for facility planning and marketing
- A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to:
- Ensure its accuracy
- Better understand who, what, when, where, and why others may access your health information
- Make more informed decisions when authorizing disclosure to others
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522; however, you must make such a request in writing.
- Obtain a paper copy-of the notice of privacy practices upon request.
- Inspect and obtain a copy of your health record as provided for in 45 CFR 164.524; however, you must make such a request in writing.
- Amend your health record as provided in 45 CFR 164.526; however, you must make the request to amend your health record in writing and provide a reason for the requested amendment.
- • Obtain an accounting of disclosures of your health information as provided in
45 CFR 164.528; however, you must make such a request in writing.
- Request communications of your health information by alternative means or at alternative locations.
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
Our Responsibilities
Jacksonville Breathe Free is required by law to:
- Maintain the privacy of your health information
- Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
- Abide by the terms of this notice
- Notify you if we are unable to agree to a requested restriction
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post a copy of such changes and make a copy available to you upon request.
We will not use or disclose your health information without your authorization, except as described in this notice.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact Compliance Officer, Dr. Henry Nguyen at (909) 466-8400. Our address is 8241 Rochester Ave, Suite 130, Rancho Cucamonga, CA 91730. If you believe your privacy rights have been violated, you can file a complaint with our Compliance Officer or with the Secretary of Health and Human Services. You may file a complaint with our Compliance Officer by providing a written complaint at the address listed above. There will be no retaliation for filing a complaint.
Examples of Disclosures for Treatment, Payment, and Health Operations
We will use your health information for treatment.
For Example: information obtained by a nurse, physician, or other member of your healthcare team will be recorded and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team_ Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.
We will also provide your physician or a subsequent healthcare provider who has or will be treating you (including, but not limited to, your family doctor, the physician who referred you to us, hospitals, other physicians or health care professionals involved in your treatment) with copies of certain or all of your records and reports that should assist him or her in treating you_
We will use your health information for payment
For Example: A bill may be sent to you or a third-party payer (such as an insurance company, Medicaid, or-Medicare). The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. If requested by your third-party payer, we will provide them with access to your specific medical records in order to facilitate payment.
We will use your health information for regular health operations.
For Example: Members of our medical staff, employees, of ENT and Sinus Center, Inc. and/or public health officials may use information in your health record to assess the care and outcomes in your case and others like it.
Business Associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the area of radiology, certain laboratory tests, dictation services, record storage facilities, and a copy service we may use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do. and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information_
Directory: Unless you notify us that you object, we may use your name, location in the facility, and general condition for directory purposes. This information may be provided to people who ask for you by name.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
Communication with Family: Health professionals (including our physicians and nurses), using their best judgement, may disclose to a family member, or other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. If you designate any other person authorized to obtain information concerning you, we may disclose such information.
Research: We may disclose information to researchers when their research is in compliance with all applicable laws and further in compliance with established protocols to ensure the privacy of your health information.
Funeral Directors/ Government Officials: We may disclose health information to funeral directors or government officials consistent with applicable law to carry out their duties.
Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you_
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food supplements, products and product defects, or post marketing surveillance information to enable produce recalls, repairs, or replacement.
Workers` Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers` compensation or other similar programs established by law.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
Medical and Legal Review: We may disclose health information in connection with any review of your treatment by any medical or legal authority, including our attorneys. Such disclosure may include consultation with our legal counsel, and any such disclosures potentially in whole or in part would be subject to the attorney-client privilege as established by law.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or request for medical records allowed under the laws of the State of California.
Written Permission: If you execute any written document authorizing disclosure above and beyond that provided above, we may honor such request
Reports to oversight officials- Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.
Information Collection
Jacksonville Breathe Free collects information from the users of the Site at several different points on the Site. For example, we collect and/or request information when a user:
1) Submits the “Contact Us” or “Book Appointment” forms on the www.jacksonvillebreathefree.com Site
2) Sends an E-mail to one of the email accounts listed on the “Contact Us” page
In order to fulfill the requests of Site users in the above instances, the user may be requested to provide contact information. If we have trouble processing an appointment request, question or e-mail, this contact information will be used by Jacksonville Breathe Free to contact the user.
Gathering and Sharing of Information, Links to External and Co-Branded Websites
We monitor traffic patterns on the Site and gather broad demographic information for aggregate use to analyze trends and administer the Site in order to improve its layout and design and to permit Site personalization and streamlining to create the best experience we can for our users. In order to perform analysis permitting such personalization and improvement of site design and user experience, we may employ suitable third parties with whom we share the information necessary to accomplish these objectives. These statistics include no personally identifying information.
Where appropriate, we share aggregated statistical information with our business partners. These statistics include no personally identifying information.
Additionally, we provide Site users with Jacksonville Breathe Free’s approved unique offers or services which may be of value to our users. In such instances, we will use a user’s name and address with to notify the user of the unique offer or service. We will not share a user’s contact information with third parties and you will always be provided with the opportunity to unsubscribe from any such list.
We may provide personal identifying information in special cases such as enforcement of our Terms of Site Use, or as required by law or legal process to protect and defend the rights and safety of our Site and its users. This includes exchanging information with other companies for purposes of fraud and credit risk reduction.
Our Site may also contains links to external Internet sites, which may be operated by an external party and they may have privacy practices that differ from those here at www.jacksonvillebreathefree.com. When you click on links that take you to such external sites, you will be subject to their privacy policies, and we encourage you to become familiar with that party’s privacy policies as these may differ from those utilized on our Site. Please note that this privacy statement applies solely to information collected by Jacksonville Breathe Free on our Site and, while we strongly support the protection of privacy on the Internet, we cannot be responsible for the privacy practices of other Websites, uses of the information collected by other Websites, or the content of those other Websites.
Consent
By using our Site, the user agrees to the terms and conditions set forth in this Internet Privacy Statement and the Site Terms of Use INCLUDING ALL LIMITATIONS OF DAMAGES PROVISIONS which are an integral part hereof and the user consents to the collection and use of this information by Jacksonville Breathe Free as disclosed in this Internet Privacy Statement. We may revise this Internet Privacy Statement or the Site Terms of Use at any time by updating these postings. By using this Site you agree to be bound by any such revisions in effect at the time of use and should therefore periodically visit this page and the Site Terms of Use page to determine the then current policies applicable to users of the Site.
Security Information
Strong precautions are taken to protect the information of the users of our Site. When users submit sensitive information via the Site, that Information is protected both online and off-line.
While we use encryption to protect user information online, we also protect user-information off-line. All of the information of our Site’s users is maintained in a restricted section in our offices. Only those of our employees who need the information to perform a specific job (for example, our account or customer service representatives) are granted access to personally identifiable information. Furthermore, our employees are kept up-to-date on our security and privacy practices.
If you have any questions about the security at our Site, you can send an e-mail to info@jacksonvillebreathefree.com.
Cookies
Cookies are routinely used by most websites including Jacksonville Breathe Free’s. A cookie is a piece of data stored on a user’s hard drive through the Web browser program containing information about the user which enables us to track and personalize the Site to enhance your experience. For instance, by setting a cookie on our Site, we can provide you with storage of personal preferences between visits. However, if a user rejects the cookie, they may still use our Site although we will be unable to provide our users with the personalized experience we can offer using the cookie data. If you have any questions about our use of cookies, please contact us info@jacksonvillebreathefree.com.
Surveys & Contests
From time-to-time we may request information from the users of the Site via surveys or contests. Participation in these surveys or contests is completely voluntary, and the users of the Site have a choice whether or not to disclose this information. Information requested may include contact information (such as your name and shipping address), and demographic information (such as zip code, age level, etc.). We use such information to notify contest winners, award prizes, and for analyzing the Site traffic to improve the user’s experience on the Site.
Special Offers, Account Updates and Opting Out
Jacksonville Breathe Free occasionally sends our customers and the users of the Site announcements and updates, which contain important information about the Site and service offerings which we believe to be of value to our customers and users. In order to do this, we may enhance or merge the information we collect on the Site with data from third parties for purposes of marketing products or services to our customers and users.
We may communicate with the users of the Site via e-mail, telephone, mail, or fax in order to provide requested services, content, product information, notification of special offers, or in regard to customer service issues relating to an account. The users of the Site are always given the opportunity to ‘opt-out’ of having their online information used for purposes not directly related to the Site at the point at which we ask for the information or when they receive an online requested promotional communication.
For example, our e-mail messages have an “unsubscribe” feature for users of the Site that don’t want to be notified about special offers in the future. Users can simply “Reply” back to the e-mail message and type “unsubscribe” in the subject field. Upon receipt of the reply, we will remove that e-mail address from our e-mail list. If a user has more than one e-mail address, he or she should include the other addresses as well to ensure proper updating of their account information
Website Privacy Policy
We understand and value your privacy. Jacksonville Breathe Free does not sell or distribute contact information. All data collected through any website form is used only to provide you with better customer service.
At Jacksonville Breathe Free, we leverage Google’s cookie based technology to group users into re-marketing audiences who have expressed an interest in our procedures by accessing key pages throughout our website. We do not collect any personally identifying information with this cookie. Audience members may be shown Jacksonville Breathe Free text and/or image ads on any Google or 3rd party Internet sites for a limited period of time. Visitors may opt out of re-marketing by visiting Google’s Ads Settings.
Users of the Site can always update the personally identifying information that they have provided to Jacksonville Breathe Free simply by emailing us at info@jacksonvillebreathefree.com.
