Health Insurance Portability & Accountability Act (HIPAA) Notice of Privacy and Security Practices and Notice of Client Rights Statement
For more than 30 years David Lawrence Center has maintained an unwavering commitment to assure you, our client, that the privacy and security of your information is high priority throughout our organization.
We have developed standards, policies and procedures to ensure that we treat your personal information properly at all times. This notice describes how your medical, mental health, and substance abuse information may be used and disclosed and how you may have access to this information. PLEASE REVIEW THIS INFORMATION CAREFULLY.
The following are our standards on assuring that your information is protected.
COLLECTION OF INFORMATION:
The Center collects the information needed to assess and provide treatment for your mental health and/or substance abuse conditions. This information is necessary to complete the Assessment and Treatment Planning, to provide Medication and Management of your Pharmaceutical needs and to provide any other treatment modalities required to assure that you receive quality and individualized treatment. The Center collects information that is required when the treatment requests come from the Department of Children and Families, Law Enforcement, Baker Act, Marchman Act, Judicial Court Systems and Department of Corrections. We also collect information and document information in a format that will meet the requirements of our monitoring agents and funding sources.
DISCLOSURE OF INFORMATION:
The Center may disclose your information described above if there is a proper consent, court order or as allowed by Federal and Florida Law 42 C.F.. Part 2 and 2.22 and HIPAA (Health Insurance Portability and Accountability Act) to conduct our business and to assure that you receive appropriate treatment and medications. You must authorize with a specific written consent, before being filmed, taped etc., or before becoming part of a research project.
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law.
The information that is released will contain only the minimal necessary to meet the request or requirement.
USES AND DISCLOSURES OF INFORMATION WITHOUT YOUR PERMISSION:
There are some circumstances when confidential information may be released to others without your permission.
- If we have reason to believe that you are abusing or neglecting children, or if you tell us your spouse or someone else is abusing your children or any other children. We are obligated by law to report this to the appropriate state agency. The law is designed to protect children from harm and the obligation to report suspected abuse or neglect is clear in this regard.
- If we have reason to believe that you are abusing or neglecting, or exploiting an elderly or disabled adult, or if you tell us that someone is abusing, neglecting, or exploiting an elderly or disabled adult. We are obligated by law to report this to the appropriate state agency.
- If you threaten to harm either yourself or someone else and we believe your threat to be serious, we are obligated by law to take whatever actions deemed necessary to protect you and/or other individuals from harm.
- If we determine that you have a reportable communicable disease such as hepatitis, AIDS, or a sexually transmitted disease, we are required by law to report this to the Health Department within (24) twenty-four hours.
- If you have a life-threatening or potentially disabling medical emergency, we are required to release to medical personnel the minimum necessary information to quickly assist medical personnel with your treatment. Example: Diagnosis, Medication
- A court of law can obtain information without your permission. David Lawrence Center does not automatically release information about you to the court when we receive a court order. The judge may set aside your rights to privileged communication. If you have been court ordered to treatment, you should discuss with us exactly what information may be included in a report to the court. You must be aware that failure to release information to a court or a referral agency may have adverse consequences for you.
- The State of Florida may require that some of our programs release your social security number to qualified state personnel for the purpose of auditing and program evaluations. The State of Florida is governed by federal and state regulations and laws and is required to protect your right to confidentiality.
You have the right to file a complaint if you think we may have violated your privacy rights. You may contact our Privacy Officer by phone at (239) 455-8500 or via email at email@example.com.
You also have the right to notify the U.S. Department of Health and Human Services (DHHS) or their designee at:
United States Department of Health and Human Services (DHHS)
Attention: Office for Civil Rights
Sam Nunn Atlanta Federal Center, Suite 3B70
61 Forsyth Street SW
Atlanta, Georgia 32303-8909
If you feel that David Lawrence Center has not been compliant with the Privacy and Security of your health information. We will provide you with the address to file your complaint with U.S. Department of Health and Human Services (DHHS) or their designee. The U.S. Department of Health and Human Services (DHHS) or their designee, has the right to access your records at any time in order to follow-up on complaints.
There will be no retaliation for filing a complaint.
SAFEGUARDS TO PROTECT YOUR INFORMATION:
The Center makes every reasonable effort to provide protection against unauthorized access to your information that the Center collects, including paper but not limited to that held in any electronic format or our computer systems. The Center maintains physical, electronic and procedural safeguards to protect your information.
Your active non – electronic information is stored on site in a protected and secure area, at the program where you are currently receiving treatment or in our computer system, which is password protected. Your closed non – electronic record is stored at the clinical records department in a protected and secure area. Your non -electronic information that is over (2) years old with no current activity is stored off site in a protected and secure environment.
INTERNAL ACCESS AND USE OF YOUR INFORMATION:
Employee access to your information is limited to those who need to know in order to provide you with services and review your information for quality assurance, peer reviews, completeness and utilization reviews, billing and collections, internal audits and transcription services.
Your information will be used to perform clinically and medically necessary treatment and to have information to improve the quality and effectiveness of the care and service we provide. We may also use your information to contact you or remind you of your appointment. Our employees are required to protect your information from inappropriate access, disclosure and modification.
There are some services provided in our organization through contracts with business associates. Examples include Pharmacy, Laboratory, Billing, Collection, Attorney, Transcription and Copy Services. We may disclose your information so that they can perform the job we have asked them to do. To protect your information, however, we require business associate to sign an agreement to assure that they will appropriately safeguard your information.
CLIENT’S RIGHTS TO DISCLOSE, REVOKE, ACCESS AND REQUEST CORRECTION OF INFORMATION:
You have the right to make a written request to disclose your protected information and you have the right to revoke your consent for disclosure of your protected information at any time except to the extent that action has been taken in reliance on it. You also have the right to review the information in your record and to request copies at a nominal charge. We will also inform you as to whom we have disclosed information (for any information disclosed since the inception of HIPAA privacy rules and security regulations April 2003). If there is not a record of information disclosed, we will provide you with a list of entities that we normally disclose to. There is some information we cannot disclose to you. The information that we cannot disclose to you is information provided to us from another provider or entity.
CORRECTION OF INFORMATION:
If, after reviewing the information in your record, you perceive that it is incorrect and want to request a correction, please notify the Center in writing to the attention of the Clinical Records Director. Upon receipt of your request, the Center will investigate the information questioned. If the Center agrees, we will make the necessary corrections and if appropriate, notify the parties that the Center previously disclosed inaccurate information to. If the Center disagrees with you, the Center will explain why by providing a reason for not correcting the information. If you are not satisfied with our evaluation and response, you will have the right to place a statement in your record explaining why you believe the information is incorrect. The Center will, if requested or appropriate and with your written consent, send a copy to the parties to whom we have previously disclosed this information and include it with future disclosures.
OUR COMMITMENT TO PRIVACY AND SECURITY:
In the mental health and substance abuse industry, client and service provider relationships are built upon mutual respect and trust. With this in mind, the Center will continually review and assess our privacy and security policies to ensure that we are able to properly serve you and continue our relationship built on respect and trust.
You have the right to receive a paper copy of this notice. Please ask our staff for a copy if you have not received one and please sign the Acknowledgement Form.
The Center may change the terms of our notice and will provide you, upon request, with a copy of our updated notice.
If you need further information on this notice please contact our Privacy Officer by phone at: (239) 455-8500 or by email at firstname.lastname@example.org.