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 IT CAREFULLY.

Our Commitment to Your Privacy

Nova Medica Acute & Comprehensive Care ("Nova Medica," "we," "us" and "our") is required by law to maintain the privacy of your protected health information, to give you this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect. We understand that information about your health is personal, and we are committed to protecting it. This Notice explains how we may use and disclose your protected health information, describes your rights with respect to that information, and tells you how to exercise those rights.

Who Will Follow This Notice

This Notice applies to Nova Medica and to every member of our workforce, including our physicians, nurse practitioners, physician associates, nurses, radiologic technologists, laboratory staff, infusion staff, front desk and billing personnel, students, trainees and volunteers. It also applies to any independent clinician who provides care to you at our facility and who has agreed to follow this Notice. All of these individuals may share your health information with one another for the purposes of treatment, payment and health care operations, as described below.

Your Protected Health Information

“Protected health information,” or “PHI,” is information that identifies you and that relates to your past, present or future physical or mental health, the health care we provide to you, or payment for that care. Examples include your name, date of birth, address, insurance information, medical history, symptoms, examination findings, imaging and laboratory results, diagnoses, medications and treatment plans. We collect and maintain this information to provide your care and obtain payment for the services we provide. You have the rights regarding this information described in this Notice.

How We May Use and Disclose Your Health Information

The following categories describe the ways we may use and disclose your PHI without your written authorization. Not every use or disclosure within a category is listed, but each of the ways we are permitted to use and disclose your information falls into one of these categories.

Treatment

We use and disclose your PHI to provide, coordinate and manage your medical care. For example, a physician or nurse practitioner who examines you may share your information with our laboratory, imaging or infusion staff so that tests can be performed and treatment given. We may also disclose your PHI to other health care providers involved in your care, such as a specialist to whom we refer you, the physician who referred you to us, a hospital or emergency department to which you are transferred, or a pharmacy that fills your prescription.

Payment

We use and disclose your PHI so that the care you receive at Nova Medica can be billed to and paid by you, your health plan or another responsible party. For example, we may contact your insurer to confirm your coverage, to obtain prior authorization for a service, or to submit a claim. We may also disclose your PHI to another provider or health plan for that entity's own payment activities.

Health Care Operations

We use and disclose your PHI to run our practice and to make sure that our patients receive quality care. Examples include reviewing the quality of the care provided by our clinicians, training staff and students, conducting compliance and audit activities, obtaining legal and accounting services, managing our business, and planning for the future of the practice. We may also combine health information about many patients to decide what services to offer and whether new treatments are effective. We may remove information that identifies you so that the remaining information can be used without revealing who you are.

Appointment Reminders, Results and Health-Related Services

We may contact you by telephone, text message, email or mail to remind you of an appointment, to tell you that test results are available, to follow up after a visit, or to tell you about treatment alternatives or other health-related services that may be of interest to you. Messages left on voicemail or sent by text or email will be limited to the minimum information necessary. You may ask us to communicate with you in a particular way, as described under "Your Rights" below.

Individuals Involved in Your Care or Payment for Your Care

Unless you object, we may disclose your PHI to a family member, close friend or other person you identify who is involved in your care or in paying for your care. We may also disclose information to a person who is assisting you in an emergency, or to a disaster relief organization so that your family can be notified of your condition and location. If you are unable to agree or object because of your condition, we will use our professional judgment to decide whether disclosure is in your best interest.

Business Associates

We may disclose your PHI to outside companies or individuals who perform services on our behalf, such as billing companies, transcription services, laboratory and imaging service providers, information technology vendors, and legal or consulting firms. Each of these business associates is required by written contract to safeguard your information and to use it only for the purposes for which it was disclosed.

As Required by Law

We will disclose your PHI when federal, state or local law requires us to do so, including disclosures to the Secretary of the U.S. Department of Health and Human Services to determine our compliance with federal privacy rules.

Public Health and Safety

We may disclose your PHI for public health activities, such as reporting communicable diseases, births and deaths, adverse reactions to medications or medical devices, and product recalls. We may report suspected abuse, neglect or domestic violence to the appropriate government authority as required or permitted by law. We may also disclose PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of you, another person or the public.

Health Oversight Activities

We may disclose your PHI to government agencies that oversee the health care system, such as the Florida Department of Health, the Agency for Health Care Administration, licensing boards and Medicare or Medicaid auditors, for activities authorized by law such as audits, investigations, inspections and licensure.

Lawsuits, Disputes and Law Enforcement

We may disclose your PHI in response to a court or administrative order. We may also disclose PHI in response to a subpoena, discovery request or other lawful process, but only if efforts have been made to notify you of the request or to obtain a protective order. We may disclose PHI to law enforcement officials as required by law, including to report certain wounds or injuries, to identify or locate a suspect, fugitive, material witness or missing person, to report a crime on our premises, or in emergency circumstances to report a crime.

Coroners, Medical Examiners, Funeral Directors and Organ Donation

We may disclose PHI to a coroner or medical examiner to identify a deceased person or to determine a cause of death, and to funeral directors as necessary to carry out their duties. If you are an organ or tissue donor, we may disclose PHI to organizations that handle organ procurement or transplantation.

Research

Under certain circumstances, we may use or disclose your PHI for research, but only after the research has been approved by an institutional review board or privacy board that has established procedures to protect the privacy of your information, or with your written authorization.

Workers' Compensation

We may disclose your PHI as authorized by and to the extent necessary to comply with workers' compensation laws or similar programs that provide benefits for work-related injuries or illnesses.

Military, Veterans, National Security and Correctional Institutions

If you are a member of the armed forces, we may disclose your PHI as required by military command authorities. We may disclose PHI to authorized federal officials for intelligence, counterintelligence and national security activities, or for the protection of the President and other officials. If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may disclose PHI to the institution or official as necessary for your health and safety or the safety of others.

Uses and Disclosures That Require Your Written Authorization

Except as described in this Notice, we will not use or disclose your PHI without your written authorization. In particular, the following uses and disclosures will be made only with your written authorization:

•      Most uses and disclosures of psychotherapy notes, where such notes are maintained

•      Uses and disclosures of your PHI for marketing purposes

•      Any disclosure that constitutes a sale of your PHI

•      Uses and disclosures of records that receive additional protection under federal or Florida law—including certain mental health, substance use disorder, HIV, sexually transmitted infection and genetic information—when the applicable law requires your specific written consent or authorization

If you provide us with an authorization, you may revoke it in writing at any time. Your revocation will stop any further use or disclosure of your PHI for the purposes covered by the authorization, except where we have already acted in reliance on it.

Special Protections Under Florida and Federal Law

Certain types of health information receive additional protection under Florida law or other federal laws, and when those laws are more protective than HIPAA, we will follow the stricter requirement. This may include records relating to mental or behavioral health treatment, substance use disorder treatment, HIV testing or status, sexually transmitted infections, and genetic information. Where applicable law requires your specific written consent before information is used or disclosed, we will obtain it. Florida law also provides additional confidentiality protections for patient medical records, subject to disclosures permitted or required by law.

If you are a minor, Florida law permits you to consent to certain services on your own, and in those cases we may be required to protect the confidentiality of related records from your parent or guardian.

Substance Use Disorder Records Protected by 42 C.F.R. Part 2

If Nova Medica creates or maintains substance use disorder patient records that are subject to 42 C.F.R. Part 2 (“Part 2 records”), those records will receive the additional confidentiality protections required by Part 2. We will use and disclose Part 2 records only as permitted by applicable law and will obtain patient consent when Part 2 requires it. We are required to protect the privacy and security of applicable Part 2 records, provide notice of applicable privacy rights, and provide breach notification when required. Part 2 records may not be used or disclosed in civil, criminal, administrative or legislative proceedings against a patient except as permitted by Part 2. If Nova Medica becomes a Part 2 program or regularly maintains Part 2 records, this Notice will be reviewed and updated as necessary to ensure that all required Part 2 notice provisions are included.

Your Rights Regarding Your Health Information

You have the following rights with respect to your PHI. To exercise any of these rights, please submit your request in writing to our Privacy Officer at the address at the end of this Notice.

Right to Request Restrictions. You may ask us to limit how we use or disclose your PHI for treatment, payment or health care operations, or to limit what we disclose to family members or others involved in your care. We are not required to agree to your request, except that we must agree to a request not to disclose PHI to your health plan for a service that you, or someone on your behalf other than the health plan, has paid for in full out of pocket. If we do agree to a restriction, we will honor it unless the information is needed to provide you with emergency treatment.

Right to Confidential Communications. You may ask us to communicate with you about your health in a particular way or at a particular location, for example by contacting you only at work or only by mail. We will accommodate all reasonable requests. You do not need to tell us the reason for your request.

Right to Inspect and Copy. You have the right to inspect and obtain a copy of the PHI we maintain about you in a designated record set, including your medical and billing records, for as long as we keep the information. If we maintain the information electronically, you may request an electronic copy. We may charge a reasonable, cost-based fee for copies as permitted by federal and Florida law. In limited circumstances we may deny your request, and if we do, you may ask that the denial be reviewed by a licensed health care professional chosen by us who was not involved in the original decision.

Right to Amend. If you believe that information in your record is incorrect or incomplete, you may ask us to amend it. We may deny your request if the information was not created by us, is not part of the records we maintain, is not information you would be permitted to inspect, or is accurate and complete. If we deny your request, you may submit a written statement of disagreement, which we will add to your record.

Right to an Accounting of Disclosures. You have the right to receive a list of certain disclosures we have made of your PHI during the six years before your request. This list will not include disclosures made for treatment, payment or health care operations, disclosures made to you or with your authorization, or certain other disclosures. The first accounting in any twelve-month period is free of charge; we may charge a reasonable fee for additional requests within the same period.

Right to Be Notified of a Breach. You have the right to be notified in writing if there is a breach of your unsecured PHI.

Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically. You may obtain a copy at our front desk or by contacting our Privacy Officer. This Notice is also available on our website at www.NovaMedicaHealth.com/notice-of-privacy-practices

Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information. We will verify the person's authority before acting on their request.

Questions or Complaints

If you have questions about this Notice or about our privacy practices, or if you believe your privacy rights have been violated, you may contact our Privacy Officer using the information below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights, by mail at 200 Independence Avenue, S.W., Washington, D.C. 20201, by telephone at 1-800-368-1019, or online at www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you in any way for filing a complaint.

Privacy Officer

Nova Medica Acute & Comprehensive Care

10460 Philips Highway

Jacksonville, Florida 32256

Telephone: 904-426-1000

Fax: 1-833-466-5252

Email: admin@novamedicahealth.com

Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for all PHI we already maintain as well as information we receive in the future, as permitted by law. We will post the current Notice in a clear and prominent location at our facility and on our website, and copies will be available upon request and at our front desk. The effective date of the current Notice is shown at the top of this Notice. When we materially revise this Notice, we will make the revised Notice available as required by applicable law.

Acknowledgment

At or before your first service encounter, except in an emergency treatment situation, we will make a good-faith effort to obtain your written acknowledgment that you received this Notice. Your signature acknowledges receipt only; it does not authorize any additional use or disclosure of your health information. Your signature is not required in order to receive care, and your care will not be affected if you decline to sign. If we are unable to obtain an acknowledgment, we may document our efforts and the reason it was not obtained, as required by law.

Effective Date

This Notice of Privacy Practices is effective as of the date shown at the top of this Notice.