Locations in Lee, Collier, Charlotte
This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.
Protected health information (PHI), about you, is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present or future physical or mental health condition and related healthcare services.
Our practice is required to follow specific rules on maintaining the confidentiality of your PHI, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your PHI. It also describes how we follow applicable rules and use and disclose your PHI to provide your treatment, obtain payment for services you receive, manage our healthcare operations and for other purposes that are permitted or required by law.
Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. Please feel free to discuss any questions with our staff.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices – We are required to follow the terms of this notice. We reserve the right to change the terms of our notice, at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment. The Notice will also be posted in a conspicuous location within the practice, and if such is maintained by the practice, on it’s web site.
You have the right to authorize other use and disclosure – This means you have the right to authorize any use or disclosure of PHI that is not specified within this notice. For example, we would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization, at any time, in writing, except to the extent that your healthcare provider, or our practice has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to request an alternative means of confidential communication – This means you have the right to ask us to contact you about medical matters using an alternative method (i.e., email, telephone), and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. We will follow all reasonable requests.
You have the right to inspect and copy your PHI – This means you may inspect, and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.
You have the right to request a restriction of your PHI – This means you may ask us, in writing, not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You will have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of- pocket. We are not permitted to deny this specific type of requested restriction.
You may have the right to request an amendment to your protected health information – This means you may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny your request.
You have the right to request a disclosure accountability – This means that you may request a listing of disclosures that we have made, of your PHI, to entities or persons outside of our office.
You have the right to receive a privacy breach notice – You have the right to receive written notification if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required.
If you have questions regarding your privacy rights, please feel free to contact our Privacy Manager. Contact information is provided on the following page under Privacy Complaints.
Following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.
Treatment – We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose PHI to other Healthcare Providers who may be involved in your care and treatment.
Special Notices – We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health-related benefits and services offered by our office, for fund-raising activities, or with respect to a group health plan, to disclose information to the health plan sponsor. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.
Payment – Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as, making a determination of eligibility or coverage for insurance benefits.
Healthcare Operations – We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions and patient safety activities.
Health Information Organization – The practice may elect to use a health information organization, or other such organization to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.
To Others Involved in Your Healthcare – Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person, that you identify, your PHI that directly relates to that person’s involvement in your healthcare. 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 general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.
Other Permitted and Required Uses and Disclosures – We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker’s compensation; when an inmate in a correctional facility; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.
You have the right to complain to us, or directly to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying the Privacy Manager at: 239.324.4888 or by email at firstname.lastname@example.org
We will not retaliate against you for filing a complaint.
Effective Date: 8/2013 Publication Date: 9/2013 Server/HIPAA /2013NoticeofPrivacy 9.13
Terms & Conditions
The information and any reference materials posted here by Malkani Retina Center is intended solely for the information of the reader. Such information should NOT be considered or construed as medical advice or used for treatment purposes and is NOT intended to replace consultation with a qualified medical professional. This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual.
Through this site and linkages to other sites, Malkani Retina Center provides general information for educational purposes only. The information provided in this site, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider.
Malkani Retina Center is not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site. This site is intended as an educational service and is not a substitute for seeking the care of a qualified healthcare professional.
IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN.
If you believe you have any other health problem, or if you have any questions regarding your health or a medical condition, you should promptly consult your physician or other healthcare provider. Never disregard medical or professional advice, or delay seeking it, because of something you read on this site or a linked website. Never rely on information on this website in place of seeking professional medical advice. You should also ask your physician or other healthcare provider to assist you in interpreting any information in this site or in the linked websites, or in applying the information to your individual case. Medical information changes constantly, therefore the information provided on the site should not be considered current, complete or exhaustive, nor should you rely on such information to recommend a course of treatment for you or any other individual. Reliance on any information provided on this site is solely at your own risk.
Please note that communication via the Internet and electronic mail may not be secure, and Malkani Retina Center cannot guarantee the security or confidentiality of any information which is transmitted. Because electronic mail may be delayed by hours or days, please do not rely on this mode of communication to convey urgent information.
Disclaimer of warranty
While we try to keep the information on the web site as accurate as possible, we disclaim any warranty concerning its accuracy, timeliness and completeness, and any other warranty, express or implied, including warranties of merchantability or fitness for a particular purpose.
Limitation of liability
The user assumes all responsibility and risk for the use of this web site and the Internet in general. Under no circumstances shall Malkani Retina Center, or its employees, agents, or representatives, or its affiliates, including without limitation Malkani Retina Center, or anyone else involved in creating or maintaining this web site be liable for any direct, indirect, incidental, special or consequential damages, lost profits, or other damages whatsoever including, without limitation, damages that result from: the use or inability to use or access the web site and/or any other web sites which are linked to this site; reliance by a member or visitor on any information obtained via the web site; or mistakes, omissions, interruptions, deletion of files, viruses, errors, defects, or any failure of performance, communications failure, theft, destruction or unauthorized access. In states which do not allow the above limitations of liability, liability shall be limited to the greatest extent permitted by law.
By choosing to use the Malkani Retina Center web site, you acknowledge and agree to these terms and conditions. In its sole discretion, Malkani Retina Center may from time-to-time revise these terms and conditions by updating this posting.
If you would like to request a refund for outstanding credit balances on your account, please follow the process below to ensure proper handling and timely processing of the requested refund:
Please call the office at (239) 324-4888, to begin the process of requesting the refund. Please let the operator know your call is regarding a refund and which insurance carrier you have to be directed to the appropriate personnel.
Upon acknowledgement by business office personnel, the account in question will be reviewed in detail prior to processing the refund.
After we process the refund, it can take your bank up to 30 days to release the funds to you.
*Note – If it is determined that there are other outstanding balances on the account apart from the charges in question, the requested refund will be reduced by such amounts and processed accordingly.
Please allow up to 4 to 6 weeks from the time the refund is requested to receive the refund.