PSYCHOLOGICAL MANAGEMENT GROUP

Main: (813) 963-1016

Fax: (813) 988-4005

7402 North 56th Street
Building 100, Suite 102
Tampa, FL 33617-7735

©2017 by Psychological Management Group

PRIVACY POLICY

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.

Our practice is dedicated to protecting  your medical information.  We are required by law to maintain the  privacy of protected health information and to provide you with this  Notice of our legal duties and privacy practices with respect to  protected health information. This Notice of Privacy Practices  describes how we may use and disclose your protected health  information to carry out treatment, payment or health care  operations and for other purposes that are permitted or required by  law.  It also describes your rights to access and control your  protected health information. Protected health information is  information about you, including demographic information, that may  identify you and that relates to your past, present or future  physical or mental health or condition and related health care  services.


HOW YOUR MEDICAL INFORMATION WILL BE  USED AND DISCLOSED:

We will use your medical information as  part of rendering patient care.  For example, your medical  information may be used by the doctor or nurse treating you, by the  business office to process your payment for the services rendered  and in order to support the business activities of the practice,  including, but not limited to, use by administrative personnel  reviewing the quality of the care you receive, employee review activities, or training of clinical students.


We may also use and/or disclose your  information in accordance with federal and state laws for the  following purposes:

Abuse or Neglect. We may disclose your medical information  when it concerns abuse, neglect or violence to you in accordance  with federal and state law.

Legal Proceedings. We may disclose your medical information  in the course of certain judicial or administrative proceedings.

Business Associates. We may disclose your health information  to a business associate with whom we contract to provide services on  our behalf.  To protect your health information, we require our  business associates to appropriately safeguard the health  information of our patients.


AUTHORIZATIONS:

We will not use or disclose your medical  information for any other purpose without your written  authorization.  Once given, you may revoke your authorization in  writing at any time.  To request a Revocation of Authorization form,  you may contact: (813) 963-1016.


YOUR RIGHTS REGARDING YOUR MEDICAL  INFORMATION:

You have the following rights with  respect to your medical information:

You may ask us to restrict certain uses  and disclosures of your medical information.  We are not required to  agree to your request, but if we do, we will honor it.  You  have the right to receive communications from us in a confidential  manner.  Generally, you may inspect and copy your  medical information.  This right is subject to certain specific  exceptions, and you may be charged a reasonable fee for any copies  of your records.


You may ask us to amend your medical  information.  We may deny your request for certain specific  reasons.  If we deny your request, we will provide you with a  written explanation for the denial and information regarding further  rights you may have at that point.  You have the right to receive an  accounting of the disclosures of your medical information made by  our practice during the last six years (or following April 14,  2003), except for disclosures for treatment, payment or healthcare  operations, disclosures which you authorized and certain other  specific disclosure types. You may request a paper copy of this  Notice of Privacy Practices for Protected Health Information.


You have the right to complain to us  and/or to the United States Department of Health and Human Services  if you believe that we have violated your privacy rights.  If you  choose to file a complaint, you will not be retaliated against in  any way.  If you would like further information  regarding your rights or regarding the uses and disclosures of your  medical information, you may contact our Privacy Officer at the  address and phone number on the back of this brochure. 


REVISION OF NOTICE OF PRIVACY  PRACTICES

We reserve the right to change the terms  of this Notice, making any revision applicable to all the protected  health information we maintain.  If we revise the terms of this  Notice, we will post a revised notice at our office and will make  paper copies of the revised Notice of Privacy Practices available  upon request.