Privacy Policy and Terms of Service
VICTERMA HEALTH CORP
Ph: +1(813) 755-4150 Fax: +1(813) 755-4205
victermahealth@gmail.com
Mailing Address:
12020 Midlake Dr. Tampa, FL 33612
Effective date: 04/08/2024
Victerma Health CORP, (“Victerma Health CORP,” “we,” “us,” “our”) provides its services (described below) through its website located at victermahealthcorp.godaddysites.com(the “https://victermahealthcorp.godaddysites.com”) and through In-home visits, Telehealth visits (“Virtual” visit), In-Office Visits.
(1) NOTICE OF PRIVACY PRACTICES (04/08/2024)
This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.
VICTERMA HEALTH CORP
Protected health information (PHI), about you, is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present or future physical or mental health condition and related healthcare services.
Our practice is required to follow specific rules on maintaining the confidentiality of your PHI, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your PHI. It also describes how we follow applicable rules and use and disclose your PHI to provide your treatment, obtain payment for services you receive, manage our healthcare operations and for other purposes that are permitted or required by law.
Your rights under the Privacy Rule
Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. Please feel free to discuss any questions with our staff.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices.
We are required to follow the terms of this notice. We reserve the right to change the terms of our notice, at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment. The Notice will also be posted in a conspicuous location within the practice, and if such is maintained by the practice, on it’s website.
You have the right to authorize other use and disclosure.
This means you have the right to authorize any use or disclosure of PHI that is not specified within this notice. For example, we would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization, at any time, in writing, except to the extent that your healthcare provider, or our practice has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to request an alternative means of confidential communication.
This means you have the right to ask us to contact you about medical matters using an alternative method (i.e., email, telephone), and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. We will follow all reasonable requests.
You have the right to inspect and copy your PHI.
This means you may inspect and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.
You have the right to request a restriction of your PHI.
This means you may ask us, in writing, not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You will have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction.
You may have the right to request an amendment to your protected health information.
This means you may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny
your request.
You have the right to request a disclosure accountability.
This means that you may request a listing of disclosures that we have made, of your PHI, to entities or persons outside of our office. You have the right to receive a privacy breach notice.
You have the right to receive written notification if the practice discovers a breach of your unsecured PHI and determines through a risk assessment that notification is required.
If you have questions regarding your privacy rights, please feel free to contact our Privacy Manager. Contact information is provided on the following page under Privacy Complaints.
How We May Use or Disclose Protected Health Information.
Following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose PHI to other Healthcare Providers who may be involved in your care and treatment.
Special Notices
We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health-related benefits and services offered by our office, for fund-raising activities, or with respect to a group health plan, to disclose information to the health plan sponsor. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.
Payment
Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as, making a determination of eligibility or coverage for insurance benefits.
Healthcare Operations
We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions and patient safety activities.
Health Information Organization
The practice may elect to use a health information organization, or other such organization to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.
To Others Involved in Your Healthcare
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person, that you identify, your PHI that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, of your general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.
Other Permitted and Required Uses and Disclosures
We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker’s compensation; when an inmate in a correctional facility; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.
Privacy Complaints
You have the right to complain to us, or directly to: US 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). Compliant forms are available at: http://www.hhs.gov/ocr/office/file/index.html.
You may file a complaint with us by notifying the Privacy Manager at: victermahealth@gmail.com. Mailing Address (12020 Midlake Dr. Tampa, FL 33612). Phone (813)-755-4150.
We will not retaliate against you for filing a complaint.
(2) FINANCIAL POLICY
Victerma Health CORP is committed to providing high-quality, comprehensive family health care and personal service to our patients. For every commitment, there is an obligation. It is the patients’ responsibility to meet their financial obligations. As we see patients from many different insurance plans, it is impossible for us to be certain of all the covered benefits, copays, and deductibles for each individual plan. While it is our intention to assist you, it is still your responsibility to ensure that all services rendered or referred by Victerma Health CORP on your behalf are paid in full. To clarify Victerma Health CORP Financial Policy, we have listed below our financial requirements:
You can contact victermahealth@gmail.com for assistance, we will respond in less than 24 business hours.
Insurance Billing
Charges incurred for services rendered are the patient’s responsibility regardless of insurance coverage. As a courtesy, Victerma Health CORP will submit claims to your primary and secondary insurance carrier for the medical services that we provide to you or your dependents. Please realize that having secondary insurance does not necessarily mean that your services will be 100% covered. Secondary insurances typically pay according to a coordination of benefits with the primary insurance. To properly bill your insurance company, we require that you disclose all insurance information including primary and secondary insurance, as well as any change of insurance information. Failure to provide complete insurance information may result in patient responsibility for the entire bill. Remember, it is your responsibility to provide us with accurate insurance information and to inform us of any changes in your coverage as they occur. We accept many insurance plans but cannot guarantee their coverage of services or payment.
Copays, Coinsurance and Deductibles
Copays, coinsurance, deductibles, and non-covered services are due at the time of service and will be collected upon check in by the registration staff. We accept cash, debit card, check (except starter checks), Visa, MasterCard, Discover and American Express. If we make an exception due to an emergent circumstance and allow you to be seen without paying your co-pay at the time of service, there will be a billing fee of $15.00 added to your account. We ask that you pay your co-payment and the billing fee within fifteen (15) days. This exception is only made for patients whose accounts are in good standing.
Uninsured or Self-Pay Patients
Payment is required at the time of service. Without knowing the exact care that will be provided prior to the actual visit, self-pay patients will be required to pay $90 towards the In-Office/In-Home visits and $60 for TeleHealth Visits, will be asked to make payment arrangements for the balance. New patients and patients that are scheduled for a physical or procedure must pay $120 towards the visit and will be asked to make payment arrangements for the balance. Extended payment arrangements are available if needed. It is never our intention to cause hardship to our patients, only to provide them with the best care possible and the least amount of stress.
Balance Owed or Past Due Accounts
Unless an acceptable payment plan has been made, the account balances are to be paid in full by your statement due date. If you fail to keep the terms of your payment plan without contacting us further, we will be forced to turn your account balance over to an outside collection agency. If your account is turned over to a collection agency, you will be responsible for all collection costs including reasonable attorney’s fees. Please be advised that there is a finance charge of 1.75% per month on all past due balances.
Patient Payment Responsibilities
It is the patient’s responsibility to understand his/her benefits and to keep us informed of any changes. Ask your insurer about any policy exclusions, including pre-existing conditions and verify deductible amounts. You should also verify your plan coverage for physicals, immunizations, and preventative services. This helps us better accommodate the patient at time of service and helps the patient to better anticipate any out-of-pocket expenses. Please note, even if they cover an annual physical, your insurance company may not pay for additional problems that are addressed during the well exam. For physical exams or annual wellness visits that require additional services beyond the scheduled physical, an additional charge will be incurred, and you will be responsible for payment of the resulting copay, coinsurance, or deductible amount. The patient or his/her legal representative is ultimately responsible for all charges for services rendered. Please call your insurance company directly if you are unsure whether a service is covered by your plan.
Non-sufficient Funds / Returned Checks
There is a $30 fee for any check returned by the bank. If a check is returned on your account, we will no longer be able to accept checks and your account will be made cash/credit only.
Missed Appointments, Cancellations and Late Arrivals
There will be a missed appointment charge of $25 if you fail to cancel your appointment within 24 business hours prior to the scheduled appointment. After the third occurrence, any patient who fails to cancel an appointment may be discharged from the practice. Patients who arrive more than 15 minutes after their scheduled appointment time will be asked to reschedule. New patients are asked to arrive 30 minutes prior to their scheduled appointment time and will be rescheduled if they fail to arrive on time.
Refund
In the event an overpayment was made, the refund will be issued to the appropriate party. Patient refunds will not be processed until all active or past due balances are paid in full. Refunds are processed at the end of each month.
(3) IN-OFFICE / IN-HOME VISIT DURING COVID
During the COVID-19 pandemic, there is some increased risk for patients who visit a healthcare provider. Health problems can happen from being exposed to:
Other patients, Healthcare staff, or Healthcare facilities.
Some patients have a higher risk of complications from COVID-19, including those with:
Asthma, Chronic Lung Disease, Serious heart disease or problems, Chronic kidney disease, Extreme obesity, A compromised or suppressed immune system, Liver disease, Pregnant, Age 65 or older, or Nursing home or long-term care facility resident.
If these high risk-patients get COVID-19, they may have a greater chance for having more health problems. These may be serious. Patient may need to be in the hospital. They could even die.
There may be other ways to meet with your provider and be treated. You could have: A phone evaluation or A Telehealth evaluation.
These other options may or may not be right for you. This depends on your health problems and overall health. If remote assessment and treatment are not appropriate, your provider will explain why you need an in-person visit.
Medical and office staff may help your provider when you arrive and while you are evaluated and treated. They will follow state laws and recommendations from local, state, and national health officials related to caring for patients during the COVID-19 pandemic. However, they cannot eliminate risks, especially for high-risk patients.
(4) PATIENTS UNDER THE AGE OF EIGHTEEN (18)
It is the policy of Victerma Health CORP that patients under the age of eighteen (18) must be accompanied by a parent or legal guardian. We do realize that sometimes, it may be necessary for someone else to bring your child to our office. We will ask that you provide written permission for that to occur. This permission may be withdrawn at any time with a written request by parent / legal guardian.
(5) CONDITIONS TO REGISTRATION AND ACCEPTANCE AS A PATIENT OF MARIO’S HEALTH CARE LLC.
Consent to Medical Care
The undersigned requests and authorized the physicians and other health care providers of Victerma Health CORP and their professional staff to perform any medical diagnostic procedures and medical surgical care which in their professional judgement is deemed necessary to diagnosis and/or treat the condition(s) that have brought about my seeking medical services at Victerma Health CORP. I understand that the practice of medicine is not an exact science, that there are risks and benefits associated with receiving medical treatment and I acknowledge that no guarantees are made to me concerning the results of the medical examinations and treatments I receive by the providers and professional staff.
Release of Medical Records and PHI
The undersigned hereby authorizes Victerma Health CORP to disclose all or any part of the contents of the medical record of the patient to third party organizations necessary for diagnosis and/or treatment and/or comprehensive management (examples: laboratory work-up, radiological tests/procedures, Referrals to specialized services, etc.) as well to health insurance companies, organizations or agencies that may be concerned with the payment of medical services provided to the patient. This authorization is given with the full knowledge that such disclosure may contain information which may result in a denial of insurance benefits or otherwise may not serve the interest of the registered patient.
Assignment of Benefits
I hereby request and authorize that all insurance benefits due for the medical services rendered to the registered patient be paid directly to Victerma Health CORP The undersigned, whether signing as the patient or as representative for the patient, accepts responsibility for and agrees to pay for any health insurance co-payments, deductibles and co-insurance required under the terms of the insurance policies.
Consent to Obtain External Prescription History
I authorize Victerma Health CORP and its providers to view my external prescription history via any prescription service in use at that moment. I understand that prescription history from multiple other unaffiliated medical providers, insurance companies and pharmacy benefit managers may be viewable by my providers and staff here at it may include prescriptions history for several years. I understand this will allow my providers to better coordinate my care and medication history to maximize the effectiveness and safety of my treatment plan.
Consent to Contact Via Email
To the extent that our medical records software allows it, we may be able to contact you via email to remind you of appointments or to share other pertinent information about your healthcare. I authorize Victerma Health CORP to use the email address I provided to contact me regarding my healthcare. I consent that protected health information may be transmitted to me via this email address.
TeleHealth Consent
Telehealth involves the use of electronic communications to enable providers at different locations to share individual client information for the purpose of improving client care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:
Client health records
Live two-way audio and video
Output data from health devices and sound and video files
Electronic systems used will incorporate network and software security protocols to protect the confidentiality of client identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
Expected Benefits:
Improved access to care by enabling a client to remain in his/her provider's office (or at a remote site) while the providers obtains test results and consults from practitioners at distant/other sites.
More efficient client evaluation and management.
Obtaining expertise of a distant specialist.
Possible Risks:
There are potential risks associated with the use of Telehealth. These risks include, but may not be limited to:
In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate decision making by the providers and consultant(s);
Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment;
In very rare instances, security protocols could fail, causing a breach of privacy of personal health information;
In rare cases, a lack of access to complete health records may result in interactions or allergic reactions or other judgment errors;
I understand the following:
Electronic Signature Disclosure and Consent
I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on any electronic document I receive from Victerma Health CORP. By selecting “I agree” and/or “I Accept”, using any device, means, or action, I consent to the legally binding terms and conditions of the corresponding document. I further agree that my electronic signature on Victerma Health CORP documents is as valid as if I signed the documents in writing. If I am signing Victerma Health CORP documents on behalf of a minor, I represent and warrant that I am the minor’s parent or legal guardian. I may decline to electronically sign Victerma Health CORP documents and withdraw my consent to sign them electronically by contacting the signature requestor directly, which may delay Victerma Health CORP operations. I may contact the signature requestor separately to request to sign Victerma Health CORP documents on paper and/or to receive a paper copy of the signed document. Any fees for such paper copy will be charged then by the signature requestor. When I sign Victerma Health CORP documents, I will receive a copy via email.
Third Parties Disclaimer
Currently our website victermahealth.goddaddysites.com and payment processing are powered through godaddy and Square platform, by using victermahealth.goddaddysites.com website and Victerma Health CORP services you also agree to goddaddysites Privacy Policy and Terms of Service. Currently the EHR in use is eclicalwork.com by using victermahealth.goddaddysites.com website and Victerma Health CORP services you also agree to eclinicalwork Privacy Policy and Terms of Service. Currently the Telehealth Visits are performed using Zoom Platform, by using victermahealth.goddaddysites.com website and Victerma Health CORP services you also agree to Zoom Platform Privacy Policy and Terms of Service. Victerma Health CORP operations are partially supported by Microsoft 365, by using victermahealth.goddaddysites.com website and Victerma Health CORP services you also agree to Microsoft 365 Privacy Policy and Terms of Service. Victerma Health CORP operations are partially supported by Google platform, by using victermahealth.goddaddysites.com website and Victerma Health CORP you also agree to Google platform Privacy Policy and Terms of Service.
I UNDERSTAND THAT THE CURRENT SERVICES OFFERED BY VICTERMA HEALTH CORP ARE NOT APPROPRIATE FOR EMERGENCIES. IF YOU THINK YOU HAVE A MEDICAL OR MENTAL HEALTH EMERGENCY, OR IF AT ANY TIME YOU ARE CONCERNED ABOUT YOUR CARE OR TREATMENT, CALL 911 OR GO TO THE NEAREST OPEN CLINIC OR EMERGENCY ROOM.
Victerma Health CORP reserves the right, at our sole discretion, to change or modify portions of these Privacy Policy and Terms of Service at any time.
Copyright © 2024 VICTERMA HEALTH CORP - All Rights Reserved.
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