Children’s Advocacy Center of SW Florida, Inc.
Notice of Privacy Practices
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.
I. Our Duties As They Relate to Your Protected Health Information (PHI).
Our records about you contain health information that is very personal. The confidentiality of this personal information is protected by federal and state law. We have a duty to safeguard your Protected Health Information (PHI) which includes individually identifiable information about:
Except in very specific circumstances, we must use or disclose only the minimum PHI that is necessary to accomplish the reason for the use or disclosure.
We must follow the privacy practices described in this Notice; however, we reserve the right to change the terms of this Notice at any time and to make the new Notice provisions effective for all protected health information that we receive, disclose or maintain. Should our Notice change, we will post a new Notice in our lobby. You may request a copy of the new notice from the front desk.
Why We May Need to Use or Disclose Your PHI:
We use or disclose PHI for a variety of reasons. For some of these uses or disclosures, we must have your written authorization. For some, the law permits us to make some uses or disclosures without your authorization.
Generally these uses or disclosures are related to treatment, payment, or health care operations. Some examples of these uses or disclosures are:
Uses and Disclosures For Which We Require Your Authorization (consent):
Uses and Disclosures For Which We Do Not Require Your Authorization:
Uses or Disclosures For Which You Must Be Given An Opportunity To Object:
Sometimes we may disclose your PHI if we have told you that we are going to use or disclose your information and you did not object.
If there is an emergency situation and we do not have time to allow you to object to the disclosure, we may still disclose your PHI if you have previously given your permission and disclosure is determined to be in your best interests. If we do this, you must be informed and given an opportunity to object to further disclosure as soon as you are able to do so.
II. Your Rights As They Relate to Your Protected Health Information (PHI).
A denial will state the reasons for denial. It will also explain your rights to have your request, our denial, and any statement in response that you provide, added to your PHI. If we approve the request for amendment, we will change the PHI and inform you, as well as tell others who need to know about the change in the PHI.
III. How to Complain about our Privacy Practices.
If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed in Section IV below. You also may file a written complaint with the Secretary of the U.S. Department of Health and Human Services at the following address: United States Department of Health and Human Services (HHS), Attention: Office for Civil Rights, Sam Nunn Atlanta Federal Center, Suite 3B70, 61 Forsyth Street SW, Atlanta, Georgia 32303-8909.
We will take no retaliatory action against you if you make such complaints.
IV. Contact Person for Additional Information, or to Submit a Complaint.
If you have questions about this Notice, need additional information, or have any complaints about our privacy practices, please contact:
Phyllis Jacoby, Privacy Officer,
Children’s Advocacy Center of SW Florida, Inc. 3830
Evans Avenue, Fort Myers, FL 33901