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.
FEDERAL LAW REQUIRES THE PROVISION OF THIS NOTICE
Alvin Butler, LMHC Harry Spears, LMHC
225 SW 7th Terrace
GAINESVILLE, FLORIDA 32601
Notice of Privacy Practices
We are required by law to maintain the privacy of protected health information and must inform you of our privacy practices and legal duties. You have the right to obtain a paper copy of this Notice upon request. We are required to abide by the terms of the Notice of Privacy Practices that is most current. We reserve the right to change the terms of the Notice at any time. Any changes will be effective for all protected health information that we maintain. The revised Notice will be posted in the waiting room. You may request a copy of the revised Notice at any time.
We have designated a Privacy Officer to answer your questions about our privacy practices and to ensure that we comply with applicable laws and regulations. The Privacy Officer also will take your complaints and can give you information about how to file a complaint. Our Privacy Officer is Alvin Butler, LMHC. You can contact the Privacy Officer by calling (352) 379-2829.
Use and disclosure of
your protected health information that we may make to carry out treatment, payment, and health
We may use information in your record to provide treatment to you. We may disclose information in your record to help you get health care services from another provider, a hospital, etc. For example, if we want an opinion about your condition from a specialist to obtain a consultation.
We may use or disclose information from you record to obtain payment for the services you receive. For example, we may submit your diagnosis with a health insurance claim in order to demonstrate to the insurer that the service should be covered.
We may disclose information from you record to allow “health care operations”. These operations include activities like reviewing records to see how care can be improved, contacting you with information about the treatment alternatives, and coordinating care with other providers. For example, we may use information in your records to train our staff about your condition and its treatment.
You may ask us to restrict the use and disclosure of certain information in your record that otherwise would be allowed for treatment, payment, or health care operations. However, we do not have to agree to these restrictions.
You have a right to receive confidential communications from us. For example, if you want to receive bills and other information at an alternative address, please notify us.
You have a right to inspect the information in your record, and may obtain a copy of it. This may be subject to certain limitations and fees. Your request must be in writing.
If you believe the information in your record is inaccurate or incomplete, you may request for amendment of the information. You must submit sufficient information to support your request for amendment. Your request may be in writing.
You have the right to request an accounting of certain disclosures made by us.
You have the right to complain to us about our privacy practices (including the actions of our staff with respect to the privacy of your health information. You have the right to complain to the Secretary of the Department of Health and Human Services about our privacy practices. You will not face retaliation from us for making complaints.
Except as described in this Notice, we may not make any use or disclosure of information from your record unless you give your written authorization. You may revoke an authorization in writing at any time, but this will not affect any use or disclosure made by us before the revocation. In addition, if the authorization was obtained as a condition of obtaining insurance coverage, the insurer may have the right to contest the policy or claim under the policy even if you revoke the authorization.
Use or disclosure of
your protected health information that we are required to make without your permission:
In certain circumstances, we are required by law to make a disclosure of your health information. For example, state law requires us to report suspected child abuse or neglect. Also, we must disclose information to the Department of Health and Human Services, if requested, to prove that we are complying with regulations that safeguard your health information.
We may use or disclose information from your record if we believe it is necessary to prevent or lessen a serious and imminent threat to the safety of a person or the public. We may report suspected cases of abuse, neglect, or domestic violence involving adult or disabled victims.
Use or disclosure of your protected health information that we are allowed to make without your permission:
There are certain situations where we are allowed to disclose information from your record without your permission. In these situations, we must use our professional judgment before disclosing information about you. Usually, we must determine that the disclosure is in your best interest, and may have to meet certain guidelines and limitations. If you receive mental health care, including treatment for substance abuse, information related to that care may be more protected than other forms of health information. Communications between a psychotherapist and patient in treatment are privileged and may not be disclosed without your permission, except as required by law. For example, psychotherapists still must report suspected child abuse and may have to breach confidentiality if you appear to pose an imminent danger to yourself or others, in order to reduce the likelihood of harm to you or others. We may report births and deaths to public health authorities, as well as certain types of diseases, injuries, adverse drug reactions, and product defects. We may assist health oversight activities, such as investigations of possible health care fraud. We may disclose information from your record as authorized by workers’ compensation laws.
We may disclose information from your record if ordered to do so by a court, grand jury, or administrative tribunal. Under certain conditions, we may disclose information in response to a subpoena or other legal process, even if this is not ordered by a court. We may disclose information from your record to a law enforcement official if certain criteria are met. For example, if such information would help locate or identify a missing person, we are allowed to disclose it. If you tell us that you have committed a violent crime that caused serious physical harm to the victim, we may disclose that information to law enforcement officials. However, if you reveal that information in a counseling or psychotherapy session, or in the course of treatment for this sort of behavior, we may not disclose the information to law enforcement officials.
We may use or disclose information from your record for research under certain conditions. Under certain conditions, we may disclose information for specialized government purposes, such as military, national security and intelligence, or protection of the President.
The confidentiality of protected health information related to alcohol or drug abuse is protected by federal law regulations. Violation of the applicable federal law and regulations is a crime, and may be reported to appropriate authorities. We may not disclose any information about you unless you authorize the disclosure in writing, except as specified: We may disclose information about you if a court orders the disclosure. We may disclose information about you in a medical emergency, to permit you to receive needed treatment. We may disclose information about you for purposes of program evaluations, audits, or research. We may disclose information about you if you commit a crime on our premises or against any person who works for us, or if you threaten to commit such a crime. We are required to disclose information about you if we suspect child abuse or neglect. Except as stated in this notice, you have the same rights and protections with respect to your health information as described in our general Notice of Privacy Practices.
We may contact you to provide appointment reminders as a courtesy. We may contact you with information about treatment alternatives or other health-related benefits or services that may be of interest to you.