NOTICE OF PATIENT PRIVACY PRACTICES Sample Clauses

NOTICE OF PATIENT PRIVACY PRACTICES. This notice describes how your medical information may be used and disclosed, as well as your access to this information. Please review this notice carefully. Practice is required by law to provide You with this Notice so that You will understand how we may use or share your information from your Designated Record Set. The Designated Record Set includes financial and health information referred to in this Notice as “Protected Health Information” (“PHI”) or simply “health information.” We are required to adhere to the terms outlined in this Notice. If You have any questions about this Notice, please let us know. Each time You are seen by our Practice, a record of your care is made that contains health and financial information. Typically, this record contains information about your condition, the treatment we provide, and payment for these services. We may use and/or disclose this information in order to: • Plan your care and treatment • Communicate with other health professionals involved in your care • Document the care You receive • Educate heath professionals • Provide information for medical research • Provide information to public health officials • Evaluate and improve the care we provide • Obtain payment for the care we provide Understanding what is in your record and how your health information is used helps You to: • Ensure it is accurate • Better understand who may access your health information • Make more informed decisions when authorizing disclosure to others How We May Use and Disclose Your PHI The following categories describe the ways that we use and disclose health 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 will fall into one of these categories.
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NOTICE OF PATIENT PRIVACY PRACTICES. This notice describes how your medical information may be used and disclosed, as well as your access to this information. Please review this notice carefully. Practice is required by law to provide you with this Notice so that you will understand how we may use or share your information from your Designated Record Set. The Designated Record Set includes financial and health information referred to in this Notice as “Protected Health Information” (“PHI”) or simply “health information.” We are required to adhere to the terms outlined in this Notice. If you have any questions about this Notice, please let us know.
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NOTICE OF PATIENT PRIVACY PRACTICES. Effective July 2021
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NOTICE OF PATIENT PRIVACY PRACTICES. I understand that as a patient of Heart of Florida Health Center, all information collected will be kept confidential under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. I acknowledge that I have received the Notice of Privacy Practices from Heart of Florida Health Center. Patients who are covered by certain managed care health plans need to assign Heart of Florida health Center as their Primary Care Physician at the time of their appointment. Patient may coordinate with insurance plan for re-assignment and be seen with a confirmation number provided by the insurance company. If re-assignment is not completed in 30 days patient will be billed for the full fee of their office visit. Most importantly no referrals nor prior authorizations can be processed until assignment is completed. Form HCA-02 10/01/2020 2 | P a g e HEART OF FLORIDA HEALTH CENTER SLIDING FEE APPLICATION Heart of Florida Health Center is a Non-Profit Organization that receives a defined amount of Federal funding to supplement the cost of providing Medical/Dental care to patients who are eligible to participate in the sliding fee scale program. Eligible patients will also qualify for reduced cost prescriptions. To determine your eligibility for this federally funded program, verification of your income is required. You must update this information at least annually to continue your participation in the program. This information is only used to calculate your discount and is kept confidential. Patient Name: Social Security - - DOB I would like to apply for Heart of Florida Health Center Sliding Fee: Yes No Household Size # of Adults #of Children Total # A Household constitutes any group of individuals, with or without children, living under the same roof that pool resources for monthly expenses. Persons may or may not be related. Children if Full Time Students over 18 may be used if still claiming on annual income taxes. 1.
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Related to NOTICE OF PATIENT PRIVACY PRACTICES

  • Notice of Privacy Practices Business Associate shall abide by the limitations of Covered Entity’s Notice of which it has knowledge. Any use or disclosure permitted by this Agreement may be amended by changes to Covered Entity’s Notice; provided, however, that the amended Notice shall not affect permitted uses and disclosures on which Business Associate relied prior to receiving notice of such amended Notice.

  • Privacy Notification (1) The authority to request the above personal information from a seller of goods or services or a lessor of real or personal property, and the authority to maintain such information, is found in Section 5 of the State Tax Law. Disclosure of this information by the seller or lessor to the State is mandatory. The principal purpose for which the information is collected is to enable the State to identify individuals, businesses and others who have been delinquent in filing tax returns or may have understated their tax liabilities and to generally identify persons affected by the taxes administered by the Commissioner of Taxation and Finance. The information will be used for tax administration purposes and for any other purpose authorized by law. (2) The personal information is requested by the purchasing unit of the agency contracting to purchase the goods or services or lease the real or personal property covered by this contract or lease. The information is maintained in the Statewide Financial System by the Vendor Management Unit within the Bureau of State Expenditures, Office of the State Comptroller, 000 Xxxxx Xxxxxx, Xxxxxx, Xxx Xxxx 00000.

  • SAFETY PRACTICES (a) i Employees requiring glasses must wear glasses, preferably with safety lenses instead of contact lenses while on the job site. ii W.C.B. approved safety footwear must be worn at all times while on the job site. iii Employee attire will be in conformance with W.C.B. Regulation and the Employer’s policy.

  • Privacy Act Notice the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an XXX, Xxxxxx MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.

  • Privacy Statement The Parties agree to keep all information related to the signing and fulfillment of this Agreement confidential, and not to disclose it to any third parties, except for subcontractors involved in this agreement, unless prior written consent is obtained from the other Party. Should subcontractors be engaged under this agreement, they are required to adhere to its terms and conditions.

  • Data Practices The Parties acknowledge that this Agreement is subject to the requirements of Minnesota’s Government Data Practices Act, Minnesota Statutes, Section 13.01

  • Privacy Policies Each party will make available a Privacy Policy that complies with Law. Xxxxxx’s Privacy Policy explains how and for what purposes Stripe collects, uses, retains, discloses and safeguards the Personal Data you provide to Stripe.

  • Medicaid Notification of Termination Requirements Party shall follow the Department of Vermont Health Access Managed-Care-Organization enrollee-notification requirements, to include the requirement that Party provide timely notice of any termination of its practice.

  • CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS 1. The Contractor certifies that it will provide a drug-free workplace by: a. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Contractor’s workplace and specifying the actions that will be taken against employees for violation of such prohibition;

  • Policies and Practices The employment relationship between the Parties shall be governed by this Agreement and the policies and practices established by the Company and the Board of Directors (hereinafter referred to as the “Board”). In the event that the terms of this Agreement differ from or are in conflict with the Company’s policies or practices or the Company’s Employee Handbook, this Agreement shall control.

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