We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations. (example)
“On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Tri County Physicians LLC (Villa Health Center)”
“It is our policy to provide a substitute health care provider, authorized by Tri County Physicians LLC (Villa Health Center) to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation.”
We may disclose your health information to your insurance provider for the purpose of payment or health care operations. (example)
““As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to Tri County Physicians LLC (Villa Health Center) for health care services rendered. If you pay for your health care services personally, we will, as a courtesy, provide an itemized billing to your insurance carrier for the purpose of reimbursement to you. The billing statement contains medical information, including diagnosis, date of injury or condition, and codes which describe the health care services received.”
We may disclose your health information as necessary to comply with State Workers’ Compensation Laws.
We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.
As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.
We may disclose your health information in the course of any administrative or judicial proceeding.
We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.
We may disclose your health information to coroners or medical examiners.
We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.
We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.
It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.
We may disclose your health information for military, national security, prisoner and government benefits purposes.
We may contact you for marketing purposes or fundraising purposes, as described below: (example)
“As a courtesy to our patients, it is our policy to call your home on the evening prior to your scheduled appointment to remind you of your appointment time. If you are not at home, we leave a reminder message on your answering machine or with the person answering the phone. No personal health information will be disclosed during this recording or message other than the date and time of your scheduled appointment along with a request to call our office if you need to cancel or reschedule your appointment.”
“It is our practice to participate in charitable events to raise awareness, food donations, gifts, money, etc. During these times, we may send you a letter, post card, invitation or call your home to invite you to participate in the charitable activity. We will provide you with information about the type of activity, the dates and times, and request your participation in such an event. It is not our policy to disclose any personal health information about your condition for the purpose of Tri County Physicians LLC (Villa Health Center) sponsored fund-raising events.”
In the event that Villa Health Center Medicine is sold or merged with another organization, your health information/record will become the property of the new owner.
Your Health Information Rights
- You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Tri County Physicians LLC (Villa Health Center) is not required to agree to the restriction that you requested.
- You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.
- You have the right to inspect and copy your health information.
- You have a right to request that Tri County Physicians LLC (Villa Health Center) amend your protected health information. Please be advised, however, that Tri County Physicians LLC (Villa Health Center) is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.
- You have a right to receive an accounting of disclosures of your protected health information made by Tri County Physicians LLC (Villa Health Center) .
- You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Web site.
Complaints about your Privacy rights or how Tri County Physicians LLC (Villa Health Center) has handled your health information should be directed to the Privacy Officer by calling this office at (352) 561-6299. If the Privacy Officer is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.
200 Independence Avenue, S.W., Room 509F HHH Building, Washington, DC 20201
1. You have the right to obtain the name and specialty of the doctor or other person responsible for your care.
2. You have a right to confidentiality of all records and communications concerning your medical history and treatment to the extent provided by law.
3. You have a right to a prompt response to all reasonable requests.
4. You have a right to request and receive information about financial assistance and free health care.
5. You have a right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap, or source of payment.
6. You have a right to obtain a copy of any rules or regulations of this facility which may apply to your conduct as a patient.
7. You have a right upon request to inspect your medical records, request an amendment to, or receive an accounting of disclosures regarding personal health information, and for a reasonable fee, receive a copy of your record.
8. You have a right to receive a copy of your medical record free if you show that your request is to support a claim or appeal under any provisions of the Social Security Act in any federal or state financial needs-based benefit program.
9. You have a right to refuse any treatment, except as otherwise provided by law.
10. You have a right to personal dignity and, to the extent reasonably possible, to privacy during medical treatment and other care.
11. You have the right to have your cultural, psychosocial, spiritual, and personal values, beliefs, and preferences respected.
12. You have the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
13. You have a right to access any mode of treatment that is, in your own judgment and the judgment of your health care practitioner, in your best interest, including complimentary or alternative health care treatments, designed to provide you with an effective option to prevailing or conventional treatments.
14. You have the right to know if medical treatment is for purposes of experimental research and to give your consent or refusal to participate in such experimental research.
15. You have the right to know what patient support services are available, including whether an interpreter is available if you do not speak English.
16. You have a right to informed consent to the extent provided by law.
17. You have a right to request and receive an itemized explanation of your medical bill.
18. You have the right to be given, upon request and in advance of treatment, whether our health care providers or facility accepts the Medicare assignment rate if you are eligible for Medicare.
19. You have the right, upon request, prior to treatment, a reasonable estimate of charges for medical care.
20. You have the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
21. You have the right to file a grievance, as stated in Florida law, by calling our Compliance Office at (352) 561-6299 if you have concerns regarding your care and treatment. In addition, you have the right to file a grievance with either the Florida Department of Public Health, Consumer Services Unit, (850-245-4339), Florida Board of Medicine, (850-245-4224); or The Joint Commission, Office of Quality Monitoring, One Renaissance Boulevard, Oakbrook Terrace, IL 60181 (800 – 994 – 6610).
22. You have the right to be informed of your health status, be involved in care planning and treatment and be able to request or refuse treatment. This right must not be construed as a mechanism to demand the provision of treatment or services deemed medically necessary or inappropriate.
23. You have the right to formulate advance directives. However, Tri County Physicians LLC (Villa Health Center) does not honor any advance directive that does not allow resuscitation. Should you suffer from any life threatening condition while receiving treatment or undergoing a procedure or diagnostic test in our facility, you will be transferred to a hospital where they can determine when to implement the advance directive.
24. You have the right to access advocacy or protective services and to be free from all forms of abuse and harassment.
25. You have the right to have your consent obtained prior to any recording or filming of care treatment and services provided to you which is made for purposes other than the identification, diagnosis or treatment.
26. You have the right to be informed about outcomes or care, treatment, and services that have been provided including unanticipated outcomes.
27. You have the right to pain management.
As a patient, we ask that you accept the following responsibilities. This will help us provide the best possible care and will foster an environment of respect and consideration.
- Please give your doctors and clinical assistants the most accurate information about your medical history, present condition, medications, and other relevant aspects of your health
- If your condition changes or if you feel something is “different” about the way you feel, please tell your doctor or clinical assistant right away
- If you experience pain, please tell your doctor or clinical assistant and work with them to develop a pain management plan
Please follow your doctors’ and clinical assistants’ instructions. Any requests they make are in the best interest of your health and safety
- If you do not understand or have forgotten the instructions, ask for clarification
- If you cannot comply with your doctors’ instructions, please let them know right away
- Please follow all facility regulations.
- Please be considerate of the rights of other patients and all members of the Villa Health Center staff
- Please be respectful of others’ personal possessions
- Please be respectful of facility property
- Please provide accurate health insurance, managed care, or other financial information so we can work effectively with the necessary organizations to process your bill
1. Compliance Office, Villa Health Center , 1507 Buenos Aires Blvd., The Villages Fl 32159; telephone (352) 561-6299.
2. Florida Department of Public Health, Consumer Services Unit. Call 850-245-4339 to obtain instructions on how to file a complaint.
3. The Joint Commission, Office of Quality Monitoring, One Renaissance Boulevard, Oakbrook Terrace, IL 60181 (800 – 994 – 6610).
In an ambulatory care setting, we expect to provide medical care to patients who are not acutely ill. Admission to the Center indicates that the patient will tolerate the procedures, treatments, or diagnostic tests in the ambulatory setting without difficulty. If a patient should suffer from any life threatening condition, the patient will be transferred to a more acute level of care, that is, the hospital emergency room.
Tri County Physicians LLC (Villa Health Center) does not honor any advance directive that does not allow resuscitation. It is the policy of the practice to transfer any patient requiring resuscitation to the hospital. The hospital can determine when to implement the advance directive. If a patient brings in an advance directive or has one already in his/her medical record, the practice will send the original or copy of the advance directive with the patient upon transfer to a more acute level of care.
If you do not agree with this policy, your procedure, treatment, or diagnostics test may be rescheduled at another facility.
There are no refunds for PRP, Hormone Therapy, & Stem Cell services purchased.