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HIPAA compliance and your rights

What we can do with your medical information?

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. This Notice applies to all of the medical records we receive and maintain. Your personal doctor or health care provider may have different policies or notices regarding the doctors use and disclosure of your medical information created in the doctors office or clinic.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully. It also describes our obligations and your rights regarding the use and disclosure of medical information to the extent applicable.

We are required by law to:

How We May Use and Disclose Medical Information About You?

The following categories describe different ways that we use and disclose medical information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information willfall within one of the categories.

For Operations.

We may use and disclose medical information about you for center operations.These uses and disclosures are necessary to run your course of treatment. For example, we may use medical information in connection with conducting or arranging for medical review, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general administrative activities.

As Required By Law.

We will disclose medical information about you when required to do so by federal, state or local law. For example, we may disclose medical informationwhen required by a court order in a litigation proceeding such as a malpractice action.

To Avert a Serious Threat to Health or Safety.

We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety ofthe public or another person. Any disclosure, however, would only be to someoneable to help prevent the threat.

Special Situations.

Disclosure to the State. Information may be disclosed to another health plan maintained by the State for purposes of facilitating claims payments under that plan. In addition, medical information may be disclosed to State personnelsolely for purposes of administering benefits under the Plan and/or System.

Organ and Tissue Donation.

If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organor tissue donation and transplantation.

Military and Veterans.

If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

Workers Compensation.

We may release medical information about you for workers compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following:

Health Oversight Activities.

We may disclose 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.

Lawsuits and Disputes.

If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We mayalso disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement.

We may release medical information if asked to do so by a law enforcement official:

Coroners, Medical Examiners and Funeral Directors.

We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.

National Security and Intelligence Activities.

We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.


If you are an inmate of a correctional institution or under the custody of alaw enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary

Your 6 Rights Regarding Medical Information About You.

You have the following rights regarding medical information we maintain about you:

You have the right to inspect and copy medical information that may be used to make decisions about your benefits. To inspect and copy medical informationthat may be used to make decisions about you, you must submit your request in writing to your Executive Director. If you request a copy of the information,we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.

Right to Amend.

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the system.

To request an amendment, your request must be made in writing and submitted to your Executive Director. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

Right to an Accounting of Disclosures.

You have the right to request an accounting of disclosures where such disclosure was made for any purpose other than treatment, payment, or healthcare operations.

To request this list or accounting of disclosures, you must submit yourrequest in writing to your Treatment Center. Your request must state a timeperiod which may not be longer than six years. Your request should indicate inwhat form you want the list for example, paper or electronic.

Right to Request Restrictions.

You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care orthe payment for your care, like a family member or friend. We are not required to agree to your request. To request restrictions, you must make your requestin writing to your Treatment Center. In your request, you must tell us

Right to Request Confidential Communications.

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request inwriting to your Treatment Center. We will not ask you the reason for yourrequest. We will accommodate all reasonable requests. Your request must specifyhow or where you wish to be contacted.

Right to a Paper Copy of This Notice.

You have the right to a paper copy of this Notice. You may ask us to giveyou a copy of this Notice at any time. Even if you have agreed to receive thisNotice electronically, you are still entitled to a paper copy of thisNotice.

Changes to This Notice

We reserve the right to change this notice. We reserve the right to 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. We will post acopy of the current notice on our website. The notice will contain on the first page, in the bottom last column of the website footer, the effective date.


If you believe your privacy rights have been violated, you may file a complaint with At Cost Rx, or the Secretary of the Department of Health and Human Services. To file a complaint with your treatment location, contact At Cost Rx. All complaints must be submitted in writing.

Privacy Officer: Aaron Howard, 16970 San Carlos Blvd Suite 110, Fort Myers Florida, 33908

If you have any questions about this Notice, please email: