Notice of Privacy Practices

Our Responsibilities

We understand the importance of privacy and are committed to maintaining the confidentiality of your medical and personal information. We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our office listed above.

This Behavioral Health Agency collects health information about you and stores it in a chart and in an electronic health record. This is your medical record. The medical record is the property of this behavioral health agency, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:

Payment, Treatment, and Health Care Operations Business Associates

Appointment Reminders

Health-related Benefits or Services

As required by law to State/Federal Agencies Entities assisting in Disaster Relief

Your Health Information Rights

Although your person served files are the physical property of Advance Health and Community Services, you have the right to:

Request Information Request Amendments

An Accounting of Disclosures Request Privacy Restrictions Request Alternate Communication File Complaints

Obtain a Detailed Copy of this Notice.

Please refer all requests to our Executive Director.

Access:

You have the right to inspect and copy information that may be used to make decisions about your care. Usually, this includes the information in your Designates Record Set (Person served File), but there are limited circumstances in which we can deny your request. These denials must be provided to you in writing, and you may request a second review in writing.

Amend:

If you feel that the information, we have about you is incorrect or incomplete, you may ask us to amend, or add to the information. You have the right to request and amendment for as long as the information is kept by or for the physician.

A Paper Copy of This Notice

You have the right to a detailed 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.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by contacting the Privacy Officer with the Secretary of the Department of Health and Human Services. All Complaints must be submitted in writing.

You will not be penalized for filing a complaint.

Other Uses of Medical Information

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or release medical information about you, you may withdraw that permission, in writing, at any time.

Changes to This Notice

We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you, as well as any information we receive in the future. The current notice will be posted in the practice and include the effective date. We can provide additional copies of the notice when you check in for future appointments, at your request.

If you have any questions about this notice, would like to request a form or have any complaints, please contact: Human Resource Manager 954-367-2840 Ext 102

We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial in writing.

An Accounting of Disclosures

You have the right to request an accounting of disclosures of medical information about you. This does not include disclosures for treatment, payment, operations, or to you or your authorized representative.

Request Restrictions:

You have the right to request a restriction or limitation on the medical information we use or release about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we release about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request but will do so if the request is reasonable.

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. We will agree to the request to the extent that it is reasonable for us to do so. We reserve the right to contact you by other means and at other locations if you fail to respond to communications from us.