New Patients
If you would like to make an appointment with one of our physicians,
please call 407-894-4474, and press number 4 when the voice prompt begins.
If your appointment has already been made, read on:
Please arrive 20 minutes prior to your appointment time to allow for paperwork and registration time.
TO REDUCE YOUR WAIT TIME ONCE YOU ARRIVE AT THE OFFICE, please print out, complete and bring the following forms with you to your first visit.CLICK ON THE LINKS BELOW TO OPEN / PRINT YOUR NEW PATIENT PAPERWORK:
(after printing this paperwork, please fill it out prior to arriving at our office)
Click here - Patient Info / Registration Forms
Click here - Authorization for Release of Information Form
In addition, please remember to to bring your:
- Drivers License / photo ID
- Insurance Card(s)
- List of Medications (or bring the medication bottles themselves)
- Any applicable lab reports or other paperwork from your referring physician
NOTICE TO PATIENTS OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY THIS PROVIDER AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE REVIEW IT CAREFULLY
Effective April 14, 2003
Under the HIPAA Privacy Regulations issued on December 28, 2000, and as modified on August 14, 2002, this Provider and all similar health care providers are required by federal law to maintain the privacy of your protected health information ("PHI"). Florida Heart Group, PA (hereinafter "Provider") provides you with this Privacy Notice to inform you of your rights under the HIPAA Privacy Regulations as required under the regulations.
Treatment, Payment & Operations
Please be advised that Provider may use your PHI in rendering treatment to you. For example, we are permitted to use your PHI in providing you with medical care when you visit our office or we treat you in a hospital or nursing facility. Under federal law, we may disclose your PHI to you, or pursuant to your consent, we can disclose your PHI to third parties for treatment (for example a specialist we refer you to). We can disclose your PHI for payment (for example we will disclose your PHI to your insurance provider in order to be reimbursed for our services rendered to you). We will also disclose your PHI when required by the Secretary of Health & Human Services.
Required Disclosures
Unless disclosure is required under federal, state law, or certain other exceptions, including law enforcement, we are prohibited from disclosing your PHI without your consent. As specified in the HIPAA Privacy Regulations, our practice may use or disclose your PHI in accordance with the specific requirements of the HIPAA rules without the need to obtain your consent or authorization. These permitted uses and disclosures include those:
- Required by law,
- Required for public health purposes,
- Regarding victims of abuse, neglect or domestic violence,
- Required for health oversight activities,
- Required in the course of any judicial or administrative proceeding,
- Required for a law enforcement purpose to a law enforcement official,
- Regarding decedents, as required by a coroner or medical examiner, or to a funeral director,
- Disclosure is required by an organ procurement organization,
- For research purposes,
- If disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public,
- For specialized government functions (including military or veterans' activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, and correctional institutions and other law enforcement custodial situations),
- For workers' compensation purposes.
Right to Opt Out
Under certain circumstances, the Provider may release your PHI to third parties unless you tell us not to. Two of the circumstances include:
- Facility directories; and
- Notifying people involved in your care, such as family members or others involved in your care or the payment for your care, including information about your condition or disclosures to help identify, locate or describe the health condition of the patient. Such disclosures may be in coordination with disaster relief efforts.
- If you do not want us to release information under these circumstances, you must tell us.
Appointments
We may also contact you via mail or phone to remind you of appointments with our office or to discuss treatment alternatives. We may also leave a message on your voice mail or answering system.
Authorizations
In the event our practice wishes to disclose your PHI to another entity other than those discussed above, we are required to obtain your authorization. We would seek to obtain your authorization if we desire to release your PHI for reasons other than treatment, payment, or for our practice's operations. For example, if we desired to participate in outside research or a drug study, we would need your written authorization prior to being permitted to release your PHI to such outside research facility or drug manufacturer. If you provide us with an authorization, you can revoke the authorization at any time by sending us a written revocation. However, if we have already released such information pursuant to your prior authorization, the revocation will be effective only for all future disclosures.
Right to Access, Copy & Inspect
Please be further advised that you have the ability to access, copy, and inspect and amend your medical information that we maintain. Additionally, if you desire, we can provide you with an accounting of all disclosures that we have made of your PHI to third parties, except disclosures for treatment, payment, or health care operations.
Privacy Officer
If you have a dispute with our practice regarding our use of your PHI or a disclosure by us, please contact:
Mark R. Milunski, MD
Privacy Officer
Florida Heart Group, PA
1613 N Mills Avenue
Orlando, Florida 32803
(407) 894-4474
We have designated this person to serve as our Privacy Officer. Please contact him or her to file a dispute and/or discuss your concerns about our Privacy Policy or our use of your PHI. Additionally, you have the right to file a complaint with the Secretary of Health and Human Services if you believe we have violated your rights under the HIPAA Privacy Regulations.
We are prohibited by law from retaliating against you if you make a complaint under this Privacy Notice.
Restrictions on Use
Finally, please be advised that you have the right to request restrictions on certain use and disclosures of your PHI to carry out treatment, payment or health care operations or disclosures by us of your PHI to a family member, relative or a close personal friend. However, we are not required by federal law to agree to your requested restriction. If you request a copy of your PHI, you also have the ability to request that we send it to an alternative location (different address) an by alternative means. Additionally, if you have received this notice in an electronic form and you would like a paper copy, please contact our Privacy Officer.
Changes in Policy
As required to changes in the HIPAA Privacy Regulations or other laws or to better protect your PHI, the Provider reserves the right to change its Privacy Policy without notice to its patients. You may obtain a copy of any revisions in the Notice of Privacy Practices by requesting one from the Privacy Officer.
If you have any questions regarding this Privacy Notice, please direct them to our Privacy Officer at the address or phone number listed above.
