For those of our patients wishing to receive a copy, please advise our staff and we will provide for you.
Kelvin W Gorrell MD PA
Village Square Plaza
5119 Commercial Way
Spring Hill, FL 34606
Main Tel: (352) 224-3139 Fax: (888) 972-3813
HIPAA Compliance Agreement
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.
If you have any questions about this notice, please contact Merrilee Severino, CPC, CMMP (352) 224-3139.
We are required by law to:
Maintain the privacy of protected health information
Give you this notice of our legal duties and privacy practices regarding health information about you
Follow the terms of our notice that is currently in effect
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:
The following describes the ways we may use and disclose health information that identifies you (“Health Information”). Except for the purposes described below, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to our practice Privacy Officer.
For Treatment. We may use and disclose Health Information for your treatment and to provide you with treatment-related health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.
For Payment. We may use and disclose Health Information so that we or others may bill and receive payment from you, an insurance company or a third party for the treatment and services you received. For example, we may give your health plan information about you so that they will pay for your treatment.
For Health Care Operations. We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example, we may use and disclose information to make sure the obstetrical or gynecological care you receive is of the highest quality. We also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operation activities.
Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services. We may use and disclose Health Information to contact you to remind you that you have an appointment with us. We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as
your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
Research. Under certain circumstances, we may use and disclose Health Information for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition. Before we use or disclose Health Information for research, the project will go through a special approval process. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any Health Information.
As Required by Law. We will disclose Health Information when required to do so by international, federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.
Business Associates. We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Organ and Tissue Donation. If you are an organ donor, we may use or release Health Information to organizations that handle organ procurement or other entities engaged in procurement, banking or transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
Workers’ Compensation. We may release Health Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Data Breach Notification Purposes. We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release Health Information if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.
National Security and Intelligence Activities. We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or to conduct special investigations.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official. This release would be if necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) the safety and security of the correctional institution.
USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care., 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.
Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do so.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES
The following uses and disclosures of your Protected Health Information will be made only with your written authorization:
1. Uses and disclosures of Protected Health Information for marketing purposes; and
2. Disclosures that constitute a sale of your Protected Health Information
Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose Protected Health Information under the authorization. But disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.
You have the following rights regarding Health Information we have about you:
Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Health Information, you must make your request, in writing, to Merrilee Severino, CPC, CMMP (352) 224-3139. We have up to 30 days to make your Protected Health Information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured Protected Health Information.
Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to Merrilee Severino, CPC, CMMP (352) 224-3139 .
Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to Merrilee Severino, CPC, CMMP (352) 224-3139 .
Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to Merrilee Severino, CPC, CMMP (352) 224-3139. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your Protected Health Information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. To request confidential communications, you must make your request, in writing, to Merrilee Severino, CPC, CMMP (352) 224-3139 . Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our web site, www.doctorgorrell.com. To obtain a paper copy of this notice, simply ask the receptionist.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future. We will post a copy of our current notice at our office. The notice will contain the effective date on the first page, in the top right-hand corner.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact Merrilee Severino, CPC, CMMP (352) 224-3139. All complaints must be made in writing. You will not be penalized for filing a complaint.
I have been offered a copy of the full Notice of Privacy Practices prior to signing this consent. Kelvin W Gorrell MD PA reserves the right to revise its Notice of Privacy Practices at any time and patients will be notified of any changes. As part of our Privacy Polices, Kelvin W Gorrell MD PA may call/mail/e-mail me at my home or office or any other designated location as required for TPO. The practice may leave a message on voicemail or in person in reference to any items that assist the practice in carrying out TPO, such as appointments, reminders, insurance items and any calls pertaining to my clinical care.
I have the right to request additional restrictions on how Kelvin W Gorrell MD PA discloses my Protected Health Information such as who can or can not receive it. List any restrictions below:
List Family members who may be informed about your health, treatment or payment.
List Family members who may only be informed in the event of an emergency:
Address and phone other than home you would like your communication to be received
(I am fully aware that a cell phone is not a secure line)
I have reviewed the Notice of Privacy Practices from Kelvin W Gorrell MD PA. By signing this form, I consent to allow Kelvin W Gorrell M D PA to use and disclose my Protected Healthcare Information as they deem necessary to carry out Healthcare Operations. I understand that I may revoke my consent at any time but it must be in writing and signed by both me and a representative of Kelvin W Gorrell M D PA. It is then only effective from that day forward.
Signature of Patient Date Signature of Witness
Kelvin W. Gorrell MD PA/ Forms/2013/HIPAA
We are always updating our Facebook page at https://www.facebook.com/thegorrellinstitute for tons of health tips and recipes for our TLS plan. We also have contests and giveaways for every 100th like. Please remember that messages sent thru any social media are not secure, so always call the office to communicate directly with us for confidentiality.
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Create a Gene SNP healthcare action plan today with this unique kit. Your DNA analysis will provide a personalized set of recommendations to support, improve your health and likely extend your life. After your DNA and online customer questionnaire of lifestyle choices is analyzed, you will receive a customized gene SNP action plan of steps you can take to improve your health. You can learn what lifestyle choices you are currently making are causing you to have obesity, high blood pressure, diabetes and heart disease. Conversely you can learn about things you can do differently to improve these conditions. Learn about how diet, lifestyle, exercise and choice nutraceuticals can turn on genes that promote health and cause diseases to go into remission. This unique offer is only available directly through the office and once the last four are sold the $100 discount will no longer apply! Call now: 352-224-3139 and you can either come in to pick up the kit or we can mail it to you overnight. A volume discount is available if you and your significant other would like to get the kit; we will offer 2 kits for $500.
This program is unique and is only for those who want to be proactive about their health and wellness. It is for those who accept the fact that their actions influence how long they live and that lifespan is modifiable. Just as a smoker does not live as long as a non-smoker, one who eats fatty meat and avoids fruits and vegetables also statistically dies prematurely. This is just the tip of the iceberg of a new field of medicine that the gene SNP DNA analysis calls upon and this is also the first nutrikinesio test that we are aware of that provides detailed actionable steps. These range all the way from foods you can eat differently, exercises that you can do differently and supplements that you can take to improve your health.
Accepting new chronic pain management patients. In network with Medicare, simply healthcare and others coming soon.
Call now: 352-224-3139 and we can begin the process of transferring your care to The Gorrell Institute. Doctor Gorrell is a compassionate, caring physician who is also a diplomat of the American Academy of Antiaging Medicine. He studies extensively in complementary, wellness medicine and is also a board-certified anesthesiologists with training in interventional pain management techniques. As the DEA continues to restrict the supply of narcotics to the state of FL, alternative pain management techniques become increasingly important. It is important to meet with a physician with training in Nutraceuticals, bio identical hormones and other alternative medicine modalities so you can get the optimal pain control that you deserve.
We do also accept self-pay patients. The initial visit costs $350 and follow-ups are $150. We offer Suboxone detox with the 1st month consisting of 3 to 4 visits with the physician and costing overall in the ballpark of $350. Follow-up months will only cost $150. Medication for the cash they price is about $200 for one month supply and the manufacturer offers a $50 discount card that is reusable for an entire year. This is much cheaper than an inpatient facility which may cause anywhere from $10,000-$20,000 per month.
We are still accepting new patients for a limited time only. Call 352-224-3139 to schedule your appointment now. Get healthier in 2013! Be honest with yourself and your doctor. Decide what is best for you and Doctor Gorrell is here to support you. If you’re coming from a “pill mill” where the doctor has lost his license, and you know that you have a drug problem, make this the year where you get the destructive opioid addiction out of your life. Take positive control by resetting your physiology with Suboxone. You do not have to suffer and go through a cold turkey withdrawal. This is rarely effective, and frequently people relapse. We offer a multidisciplinary approach including medication management, physiological repair, and psychotherapy. We refer to therapist in the community and work to create a customized program for our patients.
If your chronic pain patient in legitimate pain, Doctor Gorrell is a compassionate and caring physician who work hard to manage your pain. Again a multidisciplinary approach will be created which is customized to your problem. We offer interventional pain blocks, medication management, and referrals to orthopedic and spine surgery as indicated. All FDA approved medications may be prescribed in our quest to control your pain. We DO NOT OFFER A MONEY BACK GUARANTEE! This is a ridiculous proposal! We guarantee that you will see the doctor and he will listen to you. We guarantee that you will be provided a complete physical exam. We guarantee our best effort to treat patients to the standard of care and follow the best practices in medicine and in pain management. We guarantee that you will be treated with respect and dignity. Exams are performed with clothing on but if you are ever uncomfortable, you can ask for a chaperone to be present in the room at any time. Currently, we accept Medicare and soon will be on the panel with simply healthcare. Call now before the slots for new patients are filled.
Act now to get in and start the process of getting off opiates! To be a candidate, you must be tapered down to a moderate/low level of opiates equivalent to about 30 mg of methadone a day. The cost is only $350 for the 1st months worth of visits which usually takes 3 to 4 office visits on average and follow-up monthly maintenance visits are only $150. This is a less expensive option considering how much time, energy, money and effort is spent on finding these medications and purchasing them if you do not really need to be on them. The shortage on all opiates is only getting worse as the DEA continues to clamp down on the supply.
More and more pain clinics are going out of business. If you have been in pain management and have realized that you have been taking opiates for the wrong reasons, come see us so we can begin to plan an exit strategy for you! Doctor Gorrell will personally meet with you and customize the plan to minimize your discomfort, make things affordable, and rebuild your neurochemistry so you can be off narcotics without suffering withdrawal symptoms and having chronic cravings for them. Because of the shortage of oxycodone and opiates which is driven by DEA action, it is actually cheaper and easier to find Suboxone! Call 352-224-3139 now!
Merrilee Severino’s Certified Professional Coder exam prep Class Sat 9/22/12 9AM at Fortis College 6565 Ulmerton Rd Largo, FL
Learn from the master! Ms Severino, founder & CEO of Ms Physician’s Practice & Revenue Consulting will personally teach this class. She has over 25 years experience & will make the subject matter exciting & memorable. This will increase your chances of passing the test on the first try. Participation fee is only $50.00 for member of AAPC and $75 for non-members. Class is from 9AM to 3PM.
Topics that will be covered include:
- Sample questions with answers and reasoning
- Overview of CPT, ICD-9 and HCPCS books
- where and how to quickly find the information you need
- Book preparation – what is and what is not allowed
- Allowed reference materials
- Test taking tactics
- Time management
- Supplies – what is needed and what is allowed
- Examination – what to expect
- Overview of Medical Terminology and Anatomy
- Exam results – when to expect
Ms Severino is a speaker who is in demand nationally & just returned from speaking at the national
(POMAA) meeting in Nashville, TN where she was one of the keynote speakers on Thursday, 9/20/12. She also just got her Certified Medical Management Practitioner from the Center For Individual Excellence. This credential is in addition to her CPC, CPM, & NAAC certifications. RSVP with Merrilee at email@example.com or call (727) 408-0225.
Please bring current CPT, ICD-9 and HCPCS books! Pay at the door. Please make checks/money orders payable to: St Petersburg, FL LC Of AAPC. Credit card orders must be done by the group treasurer. Ask Merrilee how.
PS: Check out Merrilee’s new corp website: Yourbusinessmedic.com Tell her how you like it?
PPS: Are you currently using the Official CPC Certification Study Guide offered by AAPC? YES NO
The American Academy of professional coders is having a fantastic chapter seminar today which starts 7:15 AM. It is their local billing and coding symposium and you can get 7 CEU’s! If you are practice manager, Biller, coder, healthcare provider, or a physician who wants to better understand where the money comes from and how to get paid, you need to be there.
There will be a vendor booth section as well and people are coming from as far away as Miami! See speaker roster below and I urge you to become a certified professional coder and certified practice manager if you’re not on yet. It is only way to get paid with the insurance companies continuing to restrict reimbursements. Remember if you are a physician, all billing and coding errors are done under your license. If there is an error, it is considered health care fraud. If we charge you with Medicaid fraud, and successfully prosecute you. Under new Florida law, your license to practice. So it is actually very important for you are someone from your staff to come to these type of events. Also come to events like these to learn how to be audit proof when your RAC audit comes to her facility/physician’s office.
Subject: AAPC – Event Reminder – St Petersburg Fl
Dear Merrilee Severino, CPC (01041099),The St Petersburg Florida chapter officers have requested that this event reminder be sent to you. Please refer to the details below.
Local Chapter Seminar Start Date: Sep 08, 2012 Start Time: 7:15AM Location: St Pete Annual Billing and Coding Symposium
12600 Roosevelt Blvd N
St Pete, FL 33716
Directions: St. Petersburg Marriotthttps://www.marriott.com/hotels/maps/travel/tpasb-st-petersburg-marriott-clearwater/ Contact: Merrilee Severino Contact Phone: 727-408-0225 Contact Email: firstname.lastname@example.org CEUs: 7.00
Seminar Presentations Start Presenter Topic CEUs Sep 8 2012 8:00AM John Bishop, PA, CPC, CGSC, CPRC Auditing From A Clinicians Perspective 1.00 Sep 8 2012 9:00AM Arlene Morrow, CPC, CMM, CMSCS Linking Medical Necessity to the Complexity of Decision Making 1.00 Sep 8 2012 10:15AM Virginia Long Challenges in the Future 1.00 Sep 8 2012 11:15AM Demekisa Davis, DOM Alternative Medicine 1.00 Sep 8 2012 12:15PM Zoe Pine, CPC CODING GAMES 1.00 Sep 8 2012 1:15PM Kelvin Gorrell, MD Prolonged Services 1.00 Sep 8 2012 2:15PM Dr Jennifer Hayes Robotics in GYN surgery 1.00
Upholding a Higher Standard
If you are having troubles updating your preferences via the website, you may also contact AAPC directly by calling 1-800-626-CODE (2633).
Thought for the day:
definitely overrated!Moral to the story:
Come see Dr. Gorrell
Skip the RNC! Pampered Chef, 31 purses and NutraMetrix Open House at The Gorrell Institute Today! 8/29/12 @ 6:30PM!
RSVP now at 352-224-3139 and join us for a fun night of shopping, eating & socializing! There will be a Thirty One Purse demo by the legendary Kim Fanning and a Pampered Chef recipe demo of dark chocolate and fruit fondue & Asian chicken salad by the world famous Merrilee Severino! As a added bonus, there will be the opportunity for the first guests to arrive to sample NutraMetrix OPC 3, calcium, and ultimate aloe versus a competitor! A brief presentation about bio identical hormones and how wellness medicine combined with nutraceuticals cured Merrilee’s infertility problems after 39 years & resulted in our miracle baby Amy Beth Gorrell’s birth will be presented by Dr. Gorrell, Tampa Bay’s premier antiaging and pain management Doctor! Meet Amy Beth Gorrell 1.0! (she just had her 1st birthday on July 28!) You will learn how wellness medicine can reverse many chronic medical conditions, even curing them, and prolong your life. It can even making you look 10 years younger and live 10 years longer minimum on average. RSVP required as seating is limited. Call now! 352-224-3139.