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Notice of Privacy Practices Summary

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    Please review it carefully. This notice is provided in two layers: This top layer briefly summarizes how we use and disclose your protected health information, known as PHI, and the attached bottom layer provides further details of our privacy policies and procedures regarding the uses and disclosures of your PHI.

    2. How we may use and disclose your PHI.

    We use your PHI for treatment, to get paid for treatment, for administrative purposes, and to evaluate the quality of care that you receive. For example, your PHI may be shared with other providers to whom you are referred. Information may be shared by paper, mail, electronic mail, fax, or other methods. We may use or disclose your PHI without your authorization for several reasons allowed by federal and state laws. We will ask for your written authorization before using or disclosing any of your PHI for any other use. If you sign an authorization to disclose information, you have the right to revoke the authorization from any future uses and disclosures.

    3. Your rights.

    In most cases, you have the right to look at or receive a copy of your PHI. If you request copies, we may charge you a fee not to exceed $1 per page. You also have the right to request a list of certain types of PHI disclosures that we have made. If you believe your PHI is incorrect or information is missing, you have the right to request an amendment to your PHI.

    4. Our legal duty.

    The Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). We are required to protect your PHI; to provide you with this notice; to comply with the privacy practices as described in our notice; and seek your acknowledgment of receipt of this notice. We reserve the right to modify the terms of this notice. You may request a copy of the revised notice at any time by contacting Dr. Beatriz Amador at 305-926-8184.

    5. Privacy complaints.

    If you believe that your privacy rights have been violated or if you disagree with a decision we made about access to your PHI, you may file a written complaint with us and/or the U.S. Department of Health and Human Services.

    Acknowledgment of receipt of Notice of Privacy Practices: Please print and sign below to acknowledge that you have received both layers of the Notice of Privacy Practices.