Privacy Policy

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED

AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.

The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.

Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Operations

For treatment:

• Information obtained by a nurse, or another member of our health care team will be recorded in your health record
  and used to help decide what care may be right for you.
• We may also provide information to others providing you care. This will help them stay informed about your care.

For payment:

• We request payment from your health insurance plan. Health plans need information from us about your health care.
Information provided to health plans may include your diagnoses; procedures performed, or recommended care.

For health care operations:

1. We use your health records to assess quality and improve services.
2. We may use and disclose health records to review the qualifications and performance of our health care providers
and to train our staff.
3. We may contact you to remind you about appointments and give you information about treatment alternatives or
other health-related benefits and services.
4. We may use and disclose your information to conduct or arrange for services, including:

• health quality review by your health plan;
• accounting, legal, risk management, and insurance services;
• audit functions, including fraud and abuse detection and compliance programs.

Your Health Information Rights

The health and billing records we create and store are the property of the practice/health care facility. The protected health information in it, however, generally belongs to you. You have a right to:

1. Receive, read, and ask questions about this Notice;
2. Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to
grant the request, but we will comply with any reasonable request, as allowable by Florida State Statute.
3. Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health
Information (“Notice”);
4. Request that you be allowed to see and get a copy of your protected health information. You may make this request
in writing. We have a form available for this type of request. The request will be considered as allowed by Florida
State law.
5. Have us review a denial of access to your health information—except in certain circumstances;
6. Ask us to change your health information. You may give us this request in writing. You may write a statement of
disagreement if your request is denied. It will be stored in your health record, and included with any release of your
records.

Request a list of disclosures of your health information. The list will not include disclosures to third party payors or other agencies directly involved in your care that this agency has a Business Associate Agreement with (such as DCF, CBC, etc.). You may

1. Receive this information without charge once every 12 months. We will notify you of the cost involved if you request
this information more than once in 12 months.
2. Ask that your health information be given to you by another means or at another location. Please sign, date, and give
us your request in writing.
3. Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation
does not affect information that has already been released. It also does not affect any action taken before we have it.
Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.

For help with these rights during normal business hours, please contact: Maryann Barry at 386-238-3830.

Our Responsibilities: We are required to:

1. Keep your protected health information private;
2. Give you this Notice;
3. Follow the terms of this Notice.

We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and asking for it or by visiting our main office which is located at 344 South Beach Street, Daytona Beach, Florida.

To Ask for Help or Complain: If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact: Maryann Barry at 386-238-3830

If you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also deliver a written complaint to Maryann Barry at 386-238-3830 at our main office. You may also file a complaint with the U.S. Secretary of Health and Human Services.

We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services. If you complain, we will not retaliate against you.

Other Disclosures and Uses of Protected Health Information

Notification of Family and Others

1. Unless you object, we may release health information about you to a friend or family member who is involved in your
health care. We may also give information to someone who helps pay for your care. We may tell your family or
friends your condition. In addition, we may disclose health information about you to assist in disaster relief efforts.
2. You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it.

We may use and disclose your protected health information without your authorization as follows:

1. With health researchers—if the research has been approved and has policies to protect the privacy of your health
information. We may also share information with health researchers preparing to conduct a research project.
2. To Funeral Directors/Coroners consistent with applicable law to allow them to carry out their duties.
3. To Organ Procurement Organizations (tissue donation and transplant) or persons who obtain, store, or transplant
organs.
4. To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products.
5. To comply with workers’ compensation laws--if you make a workers’ compensation claim.
6. For Public Health and Safety purposes as allowed or required by law: to prevent or reduce a serious, immediate
threat to the health or safety of a person or the public.

• to public health or legal authorities;
• to protect public health and safety;
• to prevent or control disease, injury, or disability;
• to report vital statistics such as births or deaths.
• to report suspected Abuse or Neglect to public authorities.

1. To Correctional Institutions if you are in jail or prison, as necessary for your health and the health and safety of
others.

2. For Law Enforcement purposes such as when we receive a subpoena, court order, or other legal process, or you are
the victim of a crime.

3. For Health and Safety oversight activities. For example, we may share health information with the Department of
Health.

4. For Disaster Relief Purposes. For example, we may share health information with disaster relief agencies to assist in
notification of your condition to family or others.

5. For Work-Related Conditions That Could Affect Employee Health. For example, an employer may ask us to assess
health risks on a job site.

6. To the Military Authorities of U.S. and Foreign Military Personnel. For example, the law may require us to provide
information necessary to a military mission.

7. In the Course of Judicial/Administrative Proceedings at your request, or as directed by a subpoena or court order.

8. For Specialized Government Functions. For example, we may share information for national security purposes.

Other Uses and Disclosures of Protected Health Information

Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.

Web Site

We have a Web site that provides information about us. For your benefit, this Notice is on the Web site at this address: www.childrensadvocacy.org

Effective Date: April 14, 2003

Notice of Privacy Practices -- Acknowledgement

We keep a record of the health care services we provide you. You may ask to see and copy that record. You may also ask to correct that record as allowed by state and federal law. We will not disclose your record to others unless you direct us to do so or unless the law authorizes or compels us to do so. To get more information, contacting the agency Privacy Officer, Maryann Barry at 386-238-3830.

When you register as an donor or subscriber to The Children’s Advocacy Center newsletter, we will ask you to provide limited personal information. We use the information we collect to provide the services you request. We use your information to inform you of related news and events through mailings from The Children’s Advocacy Center. To unsubscribe from the newsletter or our mailing list at any time, please send an e-mail to dbarker@childrensadvocacycenter.org. We do not sell, rent or lease our lists or the information we collect to third parties.

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