Notice of Privacy Practices

Effective date: [to be confirmed]

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Overview

Coastal Primary Care & Wellness (“Coastal,” “we,” “us”) is required by law to protect the privacy of your protected health information, to give you this notice describing our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

Protected health information means information that identifies you and relates to your health, your care, or payment for your care.

Treatment, payment & operations

We may use and share your information without your written authorization for the following purposes:

• Treatment — to provide, coordinate, or manage your care, including sharing information with laboratories, pharmacies, specialists, and other providers involved in your treatment.
• Payment — to bill and collect for the care you receive, including membership billing and processing payments.
• Health care operations — to run our practice, review quality of care, train staff, and carry out administrative activities.

Uses requiring your authorization

Certain uses and disclosures require your written authorization, and you may revoke that authorization at any time in writing. These include most uses of psychotherapy notes, most marketing communications, and any sale of your protected health information.

Any use or disclosure not described in this notice will be made only with your written authorization.

Other permitted disclosures

Federal law permits or requires us to share information in certain other circumstances, including public health and safety activities, reporting suspected abuse or neglect, health oversight activities, judicial and administrative proceedings, certain law enforcement requests, workers’ compensation claims, and where required by law.

Your rights

You have the following rights regarding your protected health information:

• Get a copy of your health and claims records, usually within 30 days of your request.
• Ask us to correct records you believe are incorrect or incomplete.
• Request confidential communications — for example, asking us to contact you at a specific number or address.
• Ask us to limit what we use or share. We are not required to agree in every case, but if you pay for a service in full out of pocket, you may ask us not to share that information with a health plan.
• Get a list of disclosures we have made of your information.
• Get a paper copy of this notice, even if you agreed to receive it electronically.
• Choose someone to act for you — a legal guardian or someone with medical power of attorney may exercise these rights on your behalf.
• Be notified of a breach of unsecured protected health information.

Our responsibilities

We are required by law to maintain the privacy and security of your protected health information, to notify you promptly if a breach occurs that may have compromised it, and to follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we may in writing.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer using the details below, or with the U.S. Department of Health and Human Services Office for Civil Rights.

We will not retaliate against you for filing a complaint.

Changes to this notice

We may change this notice, and the changes will apply to all information we hold about you. The revised notice will be available at our office and on this page, with the effective date shown at the top.

Privacy Officer

Coastal Primary Care and Wellness, LLC has designated a Privacy Officer responsible for this notice and for handling privacy requests and complaints.

Coastal Primary Care and Wellness, LLC
Attn: Privacy Officer
Email: info@coastalprimarycare.com
Fax: 813-742-4942

Contact Us

To exercise any of the rights described above, contact our Privacy Officer using the details in the section above. For general, non-medical questions you can reach the practice at info@coastalprimarycare.com or 813-678-6063.

Please do not include protected health information in an email or web form.