THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are ethically and legally required to maintain the privacy of protected health information. We must provide individuals with notice of our legal duties and privacy policies with
respect to protected health information. We must abide by the terms of our Notice of Privacy Practices currently in effect. We reserve the right to change the privacy practices described in this notice without prior notification. We will post any revised notice in the waiting area and you may obtain a revised notice by forwarding a written request to our Privacy Officer at 5664 SW 60th Ave, Ocala, Florida 34474 or by asking a staff member.
With or without your consent, we may use protected health information about you to carry out treatment, payment, or healthcare operations. Treatment means the provision of healthcare and related services by one or more healthcare providers. For example, nurses providing healthcare under our direction may use protected health information. Payment means activities we take to obtain reimbursement for the provision of healthcare. For example, your health insurer may require us to provide information about the services we furnished to you before the insurer pays for the services. Healthcare operations include many oversight functions, such as quality assessment, credentialing, and business management. For example, we may disclose protected health information to licensing officials in obtaining or renewing our professional licenses.
The release of protected health information to persons outside the Center will require prior, written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing except to the extent that action has been taken in reliance on the use or disclosure indicated in the authorization. Only in extreme circumstances, such as life-threatening emergencies or a court order by a judge, would information be released without an authorization. Even in these cases, the release of information would be limited to the minimum amount of information necessary to fulfill the requirement. In addition, State of Florida regulations currently require (1) information regarding abuse of a child, disabled adult, or aged person to be reported to the State Abuse Registry; (2) physicians to report the diagnosis of certain communicable diseases to the County Health Department; and (3) that certain identifying, demographic, and clinical information pertaining to person receiving State-supported services be reported to the Department of Children and Families.
We may use or disclose protected health information without your written consent or authorization for certain purposes such as:
- For payment, treatment, and healthcare operations
- To report suspected child abuse and neglect
- Crimes on program premises or against program personnel
- Medical emergencies
- Research activities conducted by qualified researchers
- Audit and evaluation activities, including third party payers, Medicaid, Medicare and peer review organizations
- Qualified service organizations
- Court order
- Duty to warn
- Release to the Medical Examiner Office
We may use or disclose protected health information without your written consent or authorization for certain purposes unless you object. The following is a brief description of these purposes for which you have an opportunity to object:
The Centers’ will not use or disclose your protected health information for the following activities without your prior authorization:
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services. Except as otherwise stated in our Notice of Privacy Practices, we will use and disclose your protected health information only with your written authorization and you may revoke such authorization at any time.
You have the following rights with respect to your protected health information:
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a paper or electronic copy of. Your medical record and other health information we maintain. We will provide a copy or a summary of your health information, usually within 30-days of your request. Under federal law, however, you may not inspect or receive copies of the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in. a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. In certain circumstances, your request may be denied; if that occurs you can request a review of the decision by another licensed provider identified by the Centers’. The Centers’ will comply with the decision of the licensed provider conducting the review.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. If you pay for treatment services out-of-pocket in full, you can request your protected health information not be used for payment or health care operations; in which case we will abide by your request unless state or federal law requires the disclosure of that information. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
We are not required to agree to a restriction that you may request. If your treatment team believes it is in your best interest to permit use and disclose your protected health information, your protected health information will not be restricted. If your treatment team does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your treatment team. You may request a restriction by sending a written request to the Privacy Officer of the Centers at 5664 SW 60th Ave, Ocala, Florida 34474. This request must contain a specific description of the restriction you are requesting as well as the reason for the restriction.
You have the right to request to receive confidential communications from us by alternative means or at an alternate location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternate address or other method of contact. We will not request an explanation from you as to the basis for the request. You do not have to explain why you are requesting confidential communications. Please make this request in writing to our Privacy Officer at 5664 SW 60th Ave, Ocala, Florida 34474.
You have the right to have to request your protected health information be amended. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. We may deny your request for an amendment; if we deny your request for amendment, you have the right to file a state of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your medical record. You have the right to receive an accounting of disclosures of your protected health information. The accounting of disclosures is a list of disclosures of your protected health information made by the Centers’ in the 6-years prior to the date of your request and will include who the disclosure was made to, what information was disclosed, and who the information was disclosed. The listing of disclosures will not include: disclosures made for treatment, payment, and healthcare operations; and certain other disclosures (such as those made based your request to release information; or those otherwise permitted or required by state or federal laws); or disclosures that occurred prior to April 14, 2003.
You have a right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically. You have the right to be notified of a data security breach. If the Centers’ identifies a breach of security has occurred; and your protected health information is accessed or is reasonably believed to have been accessed you will receive a letter notifying you of the breach within 60-days from the data the breach was discovered. You have the right to opt out of fundraising communications from the Centers. We may contact you for fundraising activities; however you can opt out of fund raising communications by notifying us you do not wish to be contacted.
You have the right to file a complaint if you feel your rights have been violated.
You may complain to us or the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated. To file a complaint with the Department of Health and Human Services, Office of Civil Rights at:
Office for Civil Rights
U.S. Department of Health and Human Services
Sam Nunn Atlanta Federal Center, Suite 16T70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
Voice Phone (800) 368-1019
FAX (404) 562-7881
TDD (800) 537-7697
To file a complaint with us, you must forward a written statement describing the acts or omissions believed to be in violation of your rights to:
The Centers, Inc.
Attn: Privacy Officer
5664 SW 60th Ave
Ocala, Florida 34474
We will not retaliate against you for filing a complaint. For further information, please contact our Privacy Officer, Penny Napier at 5664 SW 60th Ave, Ocala, Florida 34474 or view the information provided by the Office of Civil Rights at http://www.hhs.gov/ocr/hipaa/