Please call us at 813-933-1944 to set up a patient portal to access your medical information.
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. The privacy of your medical information is important to us.
Our Legal Duty
We are required by applicable Federal and State laws to maintain the privacy of your protected health information (‘PHI’). We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your PHI. We are required to notify affected individuals following a breach off on secured protected health information. We must follow the privacy practices described in this notice while it is in effect. This notice takes effect September 23, 2013 and will remain in effect until we replace it. We strongly recommend our patients to utilize patient portal services to send their medical information and communicate with the providers.
We reserve the right make the changes in our privacy practices provided that such changes are permitted by applicable law and new terms are effective for all protected health information that we maintained, including medical information we created or received before we made the changes. We will provide you with a revised Notice in person during your next office visit. You may also request a copy of our note (or any subsequent revised notice) at any time. You may request a copy of our notice (or any subsequent revised notice) at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
Uses and disclosures of health information
We may use and disclose your PHI about you for treatment, payment, and healthcare operations. Following are examples of the types of uses and disclosures of your protected healthcare information that may occur. These examples are not meant to be exhaustive, but to describe types of uses and disclosures that may be made by our office.
Treatment: We may use and disclosed your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party or to other physicians who may be treating you. For example, we would disclose your PHI to other physicians in order to diagnose or treat you.
Payment: Your PHI may be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as: making a determination of eligibility or coverage for insurance benefits.
Health care operations: We may use or disclose, as needed, your PHI in order to conduct certain business and operational activities. These activities include, but are not limited to quality assessments, reviewing the competence or qualification of healthcare professionals, and conducting training programs. For example, coast may use or disclose your health information in order to conduct an internal assessment of the quality of care we provided.
Business Associates: we will share your PHI with third party “business associates” that perform various activities (e.g. billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclose of your PHI, we will have a written contact that contains terms that will protect the privacy of your PHI.
Other involved in your health care: Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you in identify, your protected health information that directly relates to that person’s involvement in your care or payment related to your healthcare or needed for notification purposes. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care of your location, general condition or death. We may disclose your PHI following your death to a family member or close friend who was involved in your care or payment prior to your death, however, we will not disclose any information if we are aware that you would not have wanted disclosure of your PHI.
Marketing: We may use or disclose your PHI, as necessary, to provide you with information about treatment alternatives or other health- related benefits and services that may be of interest to you. For example, your name and address may be used to send you newsletter about our practice and the services we offer. In order to receive this information, we are required to obtain an authorization from you. Should you not wish to receive these marketing materials, you may opt out on the authorization or by advising us using the contact information listed at the end of this notice.
Uses and disclosures for which an authorization or an opportunity to agree or object is not required:
a. Research; Death; Organ Donation: We may use or disclose your PHI for research purposes in limited circumstances. We may disclose the PHI of a deceased person to a coroner, protected health examiner, funeral director, or organ procurement organization for certain purposes.
b. Public Health and Safety: We may disclose your PHI to the extent necessary to avert serious and eminent threat to your health or safety, or the health or safety of others. We may disclose your PHI to a government health agency authorized to oversee the healthcare system or government programs or its contractors, and to public health authorities for public health purposes.
c. Health Oversight: We may disclose your PHI to health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws.
d. Abuse or neglect: We may disclose your PHI to a government agency that is authorized by law to receive reports of abuse, neglect, or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
e. Food and drug administration: We may disclose your PHI to a person or company required by the food and drug administration to report adverse events, Product defects or problems, biologic product deviations; to track products to enable product recalls; to make repairs or replacement; or to conduct post marketing surveillance, as required.
f. Criminal activity: We may disclose your PHI, if we believe that the use or disclosure is necessary to prevent or lesson a serious and eminent threat to the Health and safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
g. Required by law: We may disclose or use your PHI when we are required to do so by law. For example, we must disclose your PHI to the US Department of Health and Human services upon request for purposes of determining whether we are in compliance with privacy laws. We may disclose your PHI when authorized by Worker's Compensation or similar laws. We may disclose your PHI in response to a court or administrative order, Subpoena, discovery request or other lawful process, under certain circumstances. Under limited circumstances, such as a court order, warrant or grand jury subpoena, we may disclose your PHI to law-enforcement officials.
h. Fugitive, material witness, crime victim, or missing person: We may disclose PHI of an inmate or other person in lawful custody to a law enforcement official or correctional institution under certain circumstances. We may disclose a PHI where necessary to assist law-enforcement officials to capture any individual who has admitted to participation in a crime or has escaped from lawful custody.
i. Specialized government activities: We may disclose your PHI for military, national security, and prisoner purposes.
Your protected health information rights
a. Access: You have the right to look at or get copies of your PHI, with limited exceptions. You may request electronic copies of your PHI contained in electronic health records or you may request in writing or electronically that another person receive an electronic copy of your records. If you request a copy of your electronic records, it will be provided in the format requested or in a mutually agreed-upon format. You may also request access by sending us a letter to the address at the end of this notice. We may charge you for the cost of any electronic media (such as USB flash drive) used to provide a copy of the electronic PHI or a reasonable cost-based fee to locate and copy your PHI that is not electronic and postage if you want the copies mail to you. If you prefer, we will prepare a summary or explanation of your PHI for a fee.
b. Accounting of Disclosures: You have the right to receive a list of instances in which we or our business associates disclosed your PHI for the purpose other than treatment, payment, healthcare operations and certain other activities after 11/01/2016. After November 01, 2016, the accounting will be provided for the past 6 years, if applicable. We will provide you with the date on which we made the disclosure, the name of the person or entity to whom we disclosed your PHI, a description of the PHII information we disclosed, the reason for the disclosure, and certain other information. If you request this list more than once in a 12-month period, we may charge you a reasonable, cost based fee for responding to these additional requests. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
c. Restriction Requests: You have the right to request that we place additional restrictions on our use or disclosure of your PHI. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement we may make a request for additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. We will not be bound unless our agreement is so memorialized in writing. You also have the right to restrict that we do not share your PHI with the health plan for payment or operations purposes if the PHI relates to services for which you paid in full. For example, rather than allow us to file a claim with your medical insurance carrier for treatment of a specific medical condition, you choose to pay for the treatment in full, then you can restrict us from sharing your PHI related to that specific service with your medical insurance plan.
d. Confidential Communication: You have the right to request that we communicate with you in confidence about your PHI by alternative means or to an alternative location. You must make your request in writing. We must accommodate your request if it is reasonable, specifies the alternative means or locations, and continue to permit us to bill and collect payment from you.
e. Amendment: You have the right to request that we amend your PHI. Your request must be in writing, and it must explain why the information should be amended. We may deny your request if we did not create the information you want amended or for certain other reason. If we deny your request, we will provide you a written explanation. You may respond with a written disagreement of the denial. We will make a reasonable effort to inform others, including people or entities you name, of the amendments (if applicable) and to include the changes in any future disclosures of the information.
Questions and complaints
If you want more information about our privacy practices or have questions or concerns, please contact us using the information below. If you believe that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI or in response to the request you made, you may complain to us using the contact information below. You also may submit a written complaint to the US Department of Health and Human Services upon request.
We support your right to protect the privacy of your PHI. We will not retaliate in anyway if you choose to file a complaint with us or with the US Department of Health and Human Services.
Name of Privacy Officer: Ms. Saleha J. Haneef
Brookshire Rheumatology and Wellness Center, Dr. Mohammed A. Ali MD PA
Notice Informing Patients About Nondiscrimination and Accessibility Requirements
Brookshire Rheumatology complies with applicable Federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, or sex. Brookshire Rheumatology does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Brookshire Rheumatology provides free language services to people whose primary language is not English, such as Qualified interpreters, Information written in other languages.
If you need these services, contact Ms. Linda Fennell, front desk of the practice location where you are being seen. If you believe that Brookshire Rheumatology has failed to provide these services or discriminated in another way based on race, color, national origin, age, disability, or sex, you can file a grievance with office manager contact phone 216-659-8372 or email email@example.com. More information is available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, 1-800-368-1019, 800-537-7697(TDD). Tagline Informing Individual with Limited English Proficiency of Language Assistance Services:
ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 813-933-1944.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 813-933-1944
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 813-933-1944.
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 813-933-1944.
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ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 813-933-1944.
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 813-933-1944.
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 813-933-1944.
ملحوظة - (رقم هاتف الصم والبكم 1:إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان .اتصل برقم (813) 933-1944.
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 813-933-1944.
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 813-933-1944.
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 813-933-1944. 번으로 전화해 주십시오.
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