Notice of Privacy Practices

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully.

This Notice describes the privacy practices of Wendover OB/GYN and Infertility (“Wendover”) and the physicians, licensed health care personnel, employees, staff, office personnel, students, and trainees who provide services to patients at Wendover OB/Gyn & Infertility.

Protected Health Information

Under federal law, your health information is protected and confidential. Protected health information includes information about your symptoms, test results, diagnosis, treatment, and related medical information. Your health information also includes payment, billing, and insurance information.

How We Use Your Protected Health Information

We use your health information for treatment, to obtain payment, and for health care operations, including administrative purposes and evaluation of the quality of care that you receive. Under some circumstances, we may be required to use or disclose the information without your consent.

Examples of Treatment, Payment, and Health Care Operations

Treatment: We will use and disclose your health information to provide you with medical treatment or services. For example, nurses, physicians, and other members of our treatment team will record information in your record and use it to determine the most appropriate course of care. We also may disclose the information to other health care providers who may pride treatment to you, to pharmacists who are filling your prescriptions, and to family members who are helping with your care.

Payment: We will use and disclose your health information for payment purposes. This includes: eligibility or coverage for benefits, billing, claims, collection activities, review of services provided, utilization review, and disclosures to consumer reporting agencies. For example, we may need to obtain authorization from your insurance company before providing certain types of treatment. We will submit bills and maintain records of payments from your health plan.

Health Care Operations: We will use and disclose your health information to:

· Conduct quality assessment and improvement activities.

· Review the competence or qualification of health care professionals, evaluate practitioner performance, conduct training programs for students, trainees, practitioners or non-health care professionals.

· Conduct accreditation, certification, licensing or credentialing activities.

· Conduct activities related to the creation, renewal, or replacement of a contract of health insurance or other benefits.

· Conduct or arrange for medical review, legal services, and auditing functions.

· Provide for business planning and development.

· Provide for business management and administration.

 For example we may use or disclose your protected health information for credentialing purposes.

Notification/Location Purposes/Individuals involved in your care

· Unless you object:

· Under limited circumstances, we may disclose information to notify or locate your relatives or to assist disaster relief agencies.

· We may also disclose your information to individuals (friends and family) who are involved in your medical care.

· Other Uses and Disclosures Permitted Without Authorization

· Required by law: We may be required by law to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.

· Public Health Activities: As required by law, we may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.

· Health Oversight: We may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.

· Judicial and Administrative Proceedings: We may disclose information in response to an appropriate subpoena or court order.

· Law Enforcement Purposes: Subject to certain restrictions, we may disclose information required by law enforcement officials.

· Deaths: We may report information regarding deaths to coroners, medical examiners, funeral directors, and organ donation agencies.

Discrimination is Against the Law

Our medical group complies with applicable Federal civil rights laws and does not discriminate
on the basis of race, color, national origin, age, disability, or sex. Our medical group does not
exclude people or treat them differently because of race, color, national origin, age, disability, or
sex.

Our medical group: 

  • 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
    • Information written in other languages

If you need these services, contact our Civil Rights Coordinator.

If you believe that our medical group 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 with our Chief Compliance Officer, 4010 W. Boy Scout Blvd, Suite 500, Tampа,
FL 33607, (561) 300-2410, Fax (800) 877-4284, EthicsandCompliance@unifiedhc.com.

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance,
our Civil Rights Coordinator is available to help you.

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 at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.