You Have Several Rights Regarding PHI About You.
You have the following rights regarding your health information. You may exercise each of these rights, in writing, by providing us with a completed form that you can obtain from the Privacy Officer, who can be reached by calling (954) 341-9381. In some instances, we may charge you for the cost(s) associated with providing you with the requested information. You may request to see and receive a copy of PHI about you by contacting: Privacy Officer, PDQ Care Inc., 3130 N W 111 Avenue, Coral Springs, FL 33065.
Right to Inspect and Copy. You have the right to see and obtain a copy of your health records and other health information that may be used to make decisions about you. Immediate access to your records is not guaranteed. In certain limited circumstances, we may deny your request and you have a right to review such denial.
Right to Amend. You have the right to ask us to amend health information that we maintain about you if you believe that the information about you is wrong or incomplete. We may deny your request if it was not properly submitted or for other reasons. If we deny your request, you may have a statement reflecting your disagreement added to your file.
Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of you health information made by us. We may charge a reasonable fee for the second request made by you within the same twelve (12) months. This accounting will not include certain disclosures of PHI including those that we made to you or for purposes of treatment, payment or health care operations, incidental disclosures, or pursuant to a written authorization that you have signed.
Right to Request Restrictions. You have the right to request a restriction or limitation on how we use or disclose your health information. You also have a right to restrict disclosures for family members or others who are involved in your health care or payment for your care. Please note that while we will consider your request, we are not required to agree to any restriction.
Right to Request Confidential Communications. You have the right to request that we communicate with you in certain ways or at certain locations (for example, by sending information to a P. O. box rather than your home). We will accommodate all reasonable requests.
Right to a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.
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Questions and Complaints.
If you have any questions regarding this Notice or wish to receive additional information about our privacy practices, please contact our Privacy Officer who can be reached by calling (954) 341-9381. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services (1-800-368-1019). All complaints must be submitted in writing.
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