Notice of Privacy Practices

If you have any questions about this Notice, please contact our Privacy Office through the Compliance & Privacy Hotline 1-800-569-9720 or by mail at P.O. Box 95000, Lakeland, FL 33804-5000 • www.WatsonClinic.com
Your Information.
 
Your Rights.
 
Our Responsibilities.

 
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.
Click here to download a printable PDF of this document.

 Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.


Get an electronic or paper copy of your medical record.
  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Contact Release of Information at 863-904-2652.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record.
  • You can ask us to correct health information about you that you think is incorrect or incomplete. 
  • You must give us your request in writing and a reason supporting your requested amendment. Contact Release of Information at 863-904-2652. We can give you a form to use to make your amendment request.
  • We may say "no" to your request, but we'll tell you why in writing within 60 days.

Request confidential communications.
  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say "yes" to all reasonable requests.

Ask us to limit what we use or share.
  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
  • We are not required to agree to your request, and we may say "no." For example, we may refuse your request for a restriction if it would affect care.
  • If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.

Get a list of those with whom we've shared information.
  • You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you asked us to make), except if required by regulation. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice.
  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you.
  • If someone is your legal guardian or you have given someone medical power of attorney, that person can generally exercise your rights and make choices about your health information. A copy of this document must be provided to the Privacy Office.
  • We will take reasonable steps to make sure the person has this authority and can act for you before we take any action.
  • Information will be shared after death as permitted by HIPAA.

File a complaint if you feel your rights are violated.
  • You can complain if you feel we have violated your rights by contacting us by calling the Compliance and Privacy Hotline at 1-800-569-9720.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, SW, Washington, D.C. 20201, calling 1-877-696-6775, or click here.
  • We will not retaliate against you for filing a complaint.

 Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. We will follow your instructions if feasible or otherwise required by law.


In these cases, you have both the right and choice to tell us to:
  • Share information with your family, close friends, or others involved in your care.
  • Share information in a disaster relief situation.
  • Contact you for fundraising efforts.

  • If you are not able to tell us your preference, for example if you are unconscious or not present, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

Unless you give us written permission, except as otherwise provided in this notice or applicable law, we will not:
  • Sell your information, or
  • In most cases share your psychotherapy notes, or
  • Use or share your information for marketing purposes (except we may communicate with you face-to-face, provide nominal promotional gifts, and provide appointment reminders or other health-related information, possible treatment alternatives, benefits and services that may be useful or of interest to you.)

In the case of fundraising: 
  • We may contact you and use certain limited information for fundraising efforts, but you can tell us not to contact you again by writing the Privacy Officer.

 Our Uses and Disclosures

We typically use or share your health information to: 


Treat you.
  • We can use your health information and share it with others who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization and for other healthcare operations.
  • We can use and share your health information to run our practice, improve your care, contact you and for other healthcare operations purposes. We may use it to conduct training programs, including programs for outside students and observers. We can share your information with our business associates as described on this form.
Examples: We use health information about you to manage your treatment and services. We may use it to create de-identified health information to use for all lawful purposes.

Bill for your services.
  • We can use and share your health information, including your contact information, to contact, bill and get payment from you, your guarantor, health plan(s), and any other entity or individual responsible for payment, and for other payment purposes, including accounting, debt-collection and related financial communication.
Example: We give information about you to your health insurance plan so it will pay for your services.

Electronic Health Information Exchange
  • Health information exchange (HIE) allows doctors, hospitals, and other healthcare providers, as well as health plans and other entities, to share health information about patients electronically. This is done for several purposes, including, but not limited to, treatment, quality assurance, state law reporting requirements, healthcare operations, and payment. Watson Clinic physicians and staff, hospitals, and other healthcare providers may share and receive your healthcare information electronically through various health information exchange connections with other healthcare providers and payors. HIE networks and organizations are required to comply with laws and rules that protect the privacy and security of your health information.
Example: We may exchange your information electronically with providers and other covered entities including, but not limited to, hospitals and surgery centers, for treatment, payment or healthcare operations purposes.
 
  • OPTING OUT of HIE: You have the ability to change your mind and OPT OUT of HIE by using the OPT OUT form located on the Clinic’s Release of Information page and mailing it to the Privacy Office address on this notice, or requesting the form at a reception desk at any Clinic locations. We will consider all requests, but there are some circumstances where we will still be required to share your information electronically. For example, even if you opt out, we will still need to submit claims electronically if required by your health plan.  

How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information click here.

Help with public health and safety issues.
We can share health information about you for certain situations such as:
  • Preventing disease.
  • Helping with product recalls.
  • Reporting adverse reactions to medications.
  • Reporting suspected abuse, neglect, or domestic violence.
  • Preventing or reducing a serious threat to anyone's health or safety.

Do research.
  • We can use or share your information for health research as permitted by applicable laws and rules.

Comply with the law.
  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with Federal privacy law.

Respond to organ and tissue donation requests.
  • We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director.
  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers' compensation, law enforcement, and other government requests.
We can use or share health information about you:
  • For workers' compensation claims.
  • For law enforcement purposes or with a law enforcement official, or certain information relating to inmates.
  • With health oversight agencies for activities authorized by law.
  • For special government functions such as military, national security, and presidential protective services.

Respond to lawsuits and legal actions.
  • We can share health information about you in response to a court or administrative order, or in response to a subpoena. We can also share information when a protective order is in place. 

Business Associates 

  • There are some healthcare-related, communication, billing, payment and healthcare-operation services provided through contracts with third parties, called “business associates,” that may use the information to perform certain services. Examples include software, messaging, or technology vendors we may utilize to provide technical support and communication services, attorneys providing legal services to us, accountants, billing, account-servicing and collection companies, consultants and others. When such a service is contracted, we may share your protected health information with such business associates and may allow our business associates to use, create, receive, maintain or transmit your information on our behalf in order for the business associate to provide services to us, or for the proper management and administration of the business associate. Business associates must protect any health information they receive from, or create and maintain on behalf of the Provider. In addition, business associates may re-disclose your health information to subcontractors in order for the subcontractors to provide services to the business associate. The subcontractors will be subject to the same restrictions and conditions that apply to the business associate. Whenever such an arrangement involves the use or disclosure of your information, we will have a written contract that contains terms designed to protect the privacy of your information.
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     Our Responsibilities

    • We are required by law to maintain the privacy and security of your protected health information.
    • We try to keep your data secure, but we cannot guarantee that nothing will go wrong. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
    • We must 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 can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
    • We will comply with Florida Law. We will obtain your written consent for certain disclosures if your consent is required under state law. For example, Florida requires us to obtain your written consent to disclose for payment purposes, so we will ask for your written permission to use and disclose your information for certain purposes allowed in this document.

    For more information, click here.

    Changes to the Terms of This Notice
    We can change the terms of this notice and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

    The effective date of this Notice is February 3, 2020.  

    This Notice of Privacy Practices applies to the following organizations:

    Watson Clinic LLP
    P.O. Box 95000
    Lakeland, FL 33804-5000
    Compliance & Privacy Hotline: 1-800-569-9720

 NONDISCRIMINATION NOTICE

Watson Clinic LLP (Clinic) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Clinic does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.


The Clinic provides free aids and services to people with disabilities to communicate effectively with us, such as:

  • Qualified sign language interpreters.
  • Written information in other formats (large print, audio, accessible electronic formats, other formats.)
  • Provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages.

  • If you need the above services, please call 863-904-3080.

     

    If you believe that the Clinic has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by contacting:
     
    Patient Advocate  
    1600 Lakeland Hills Boulevard
    Lakeland, FL 33805  
    Phone: 863-680-7269
    Fax: 863-616-2460
    PatientAdvocate@WatsonClinic.com
        

    You can file a grievance in person, by phone, fax, mail or email.

    You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available by clicking here, or by mail or phone at:
        
    U.S. Department of Health and Human Services  
    200 Independence Avenue, SW
    Room 509F, HHH Building
    Washington, DC 20201
    1-800-368-1019, 800-537-7697 (TDD)

    Complaint forms are available by clicking here.