1. MIGUEL E. TREVINO, MD, PA, TIMOTHY L. LIGHT, DO and BENJAMIN R. DEVRIES, DO may use and disclose protected health information for treatment, Payment and healthcare operations. Examples of these include, but are not limited to, requested pre-school, life insurance, or sports physicals, referral to nursing homes, foster care homes, home health agencies and/or referral to insurance companies for claims including coordination of benefits with other insurers; and collection agencies. Healthcare operations include, but are not limited to, internal quality control and assurance including auditing of records.
2. MIGUEL E. TREVINO, MD, PA, TIMOTHY L. LIGHT, DO and BENJAMIN R. DEVRIES, DO is permitted or required to use or disclose protected health information without the individual’s written consent or authorization in certain circumstances. Two examples of such are for public health requirements or court orders.
3. MIGUEL E. TREVINO, MD, PA, TIMOTHY L. LIGHT, DO and BENJAMIN R. DEVRIES, DO will not make any other use or disclosure of a patient’s protected health information without the individual’s written authorization. Such authorizations may be revoked at any time. Revocation must be written.
4. MIGUEL E. TREVINO, MD, PA, TIMOTHY L. LIGHT, DO and BENJAMIN R. DEVRIES, DO may at times contact the patient to provide appointment reminders or information regarding treatment alternatives or other health related benefits and services that may be of interest to the individual.
5. MIGUEL E. TREVINO, MD, PA, TIMOTHY L. LIGHT, DO and BENJAMIN R. DEVRIES, DO will abide by the terms of this notice of the notice currently in effect at the time of the disclosure.
6. MIGUEL E. TREVINO, MD, PA, TIMOTHY L. LIGHT, DO and BENJAMIN R. DEVRIES, DO reserves the right to change the terms of its notice and to make new notice provisions effective for all protected health information of the patient. Copies may also be obtained at any time at our office.
7. MIGUEL E. TREVINO, MD, PA, TIMOTHY L. LIGHT, DO and BENJAMIN R. DEVRIES, DO will provide each patient with a copy of any revisions of its Notice of Information Practice at the time of their next visit, or at their last known address if there is a need to use or disclose any protected information of the patient. Copies may be obtained at our office any time.
8. MIGUEL E. TREVINO, MD, PA, TIMOTHY L. LIGHT, DO and BENJAMIN R. DEVRIES, DO Any person/patient may file a complaint to the Practice and to the Secretary of Health and Human Services if they believe their rights have been violated. To file a complaint with the practice, please contact the Privacy Office at the following address and/or phone number: (1573 South Fort Harrison Avenue, Clearwater, FL 33756, Phone (727) 584-8777). All complaints will be addressed and the results will be reported to the Corporate Compliance Officer.
9. MIGUEL E. TREVINO, MD, PA, TIMOTHY L. LIGHT, DO and BENJAMIN R. DEVRIES, DO The title and telephone number of a person in the office to contact for further information is the Office Manager at (727) 584-8777 ext 209.
10. The effective date of this Notice of December 1, 2002.
You have the right to file a written complaint with our office, or with the Department of Health and Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of TIMOTHY L. LIGHT, DO/Dr. Miguel E. Trevino MD, PA/Dr. Benjamin R DeVries DO We will not retaliate against you for filing a complaint.
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services, Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202)619-0257 or Toll Free: 1-877-696-6775