SOUTHWEST FLORIDA ADDICTION SERVICES, INC.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL AND DRUG AND ALCOHOL RELATED INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
General Information
Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), 42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under these laws, Southwest Florida Addiction Services, Inc. (SWFAS) may not say to a person outside SWFAS that you attend the program, nor may SWFAS disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
SWFAS must obtain your written consent before it can disclose information about you for payment purposes. For example, SWFAS must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before SWFAS can share information for treatment purposes or for health care operations. However, federal law permits SWFAS to disclose information without your written permission:
1. Pursuant to an agreement with a business
associate;
2. For research, audit or evaluations;
3. To report a crime committed on SWFAS' premises or against SWFAS
personnel;
4. To medical personnel in a medical emergency;
5. To appropriate authorities to report suspected child abuse or neglect
6. As allowed by a court order
For example, SWFAS can disclose information without your consent to obtain
legal or financial services, or to another medical facility to provide health
care to you, as long as there is a business associate agreement in place.
Before SWFAS can use or disclose any information
about your health in a manner which is not described above, it must first
obtain your specific written consent allowing it to make the disclosure. Any
such written consent may be revoked by you in writing.
Your Rights
Under HIPAA you have the right to request restrictions on certain uses and
disclosures of your health information. SWFAS is not required to agree to any
restrictions you request, but if it does agree then it is bound by that
agreement and may not use or disclose any information which you have
restricted except as necessary in a medical emergency. You have the right to
request that we communicate with you by alternative means or at an alternative
location. SWFAS will accommodate such requests that are reasonable and will
not request an explanation from you. Under HIPAA you also have the right to
inspect and copy your own health information maintained by SWFAS, except to
the extent that the information contains psychotherapy notes or information
compiled for use in a civil, criminal or administrative proceeding or in other
limited circumstances. Under HIPAA you also have the right, with some
exceptions, to amend health care information maintained in SWFAS's records,
and to request and receive an accounting of disclosures of your health related
information made by SWFAS during the six years prior to your request. You also
have the right to receive a paper copy of this notice.
SWFAS' Duties
SWFAS is required by law to maintain the privacy of your health information
and to provide you with notice of its legal duties and privacy practices with
respect to your health information. SWFAS is required by law to abide by the
terms of this notice. SWFAS reserves the right to change the terms of this
notice and to make new notice provisions effective for all protected health
information it maintains. SWFAS will provide all patients a copy of the new
notice upon their first visit after the notice takes effect.
Complaints and Reporting Violations
You may complain to SWFAS and the Secretary of the United States Department of
Health and Human Services if you believe that your privacy rights have been
violated under HIPAA. If you have a complaint you may call SWFAS' Continuous
Quality Improvement Manager (contact information listed below). You will not
be retaliated against for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected
violations of the Confidentiality Law may be reported to the United States
Attorney in the district where the violation occurs.
Contact
For further information, contact:
Continuous Quality Improvement Manager
2101 McGregor Blvd.
Ft. Myers, FL 33901
(239) 332-6937
Effective Date
April 14, 2003