~~~PLEASE REVIEW THIS NOTICE CAREFULLY~~~
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment. Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your mental health care treatment and related service.
For Payment. We may use and disclose PHI so that we can receive payment for the treatment services provided to you. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.
For Health Care Operations.We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. (I.e. clerical services)
Required by Law.Under the law, we must make disclosures of your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.
Without Authorization. Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of other situations. The types of uses and disclosures that may be made without your authorization are those that are:
Required by Law, such as the mandatory reporting of child abuse or neglect or mandatory government agency audits or investigations (such as the social work licensing board or the health department) or Required by a Court Order.
Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat, it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
With Authorization. Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization.
Right of Access to Inspect and Copy. You have the right to inspect and copy PHI that may be used to make decisions about your care, which may be restricted only in those situations where there is compelling evidence that access would cause serious harm to you. We may charge a reasonable, cost-based fee for copies.
Right to Amend.If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information, although we are not required to agree to the amendment.
Right to an Accounting of Disclosures.You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.
Right to Request Restrictions.You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request.
Right to Request Confidential Communication.You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
Right to a Copy of this Notice.You have the right to a copy of this notice.
YOUR RIGHTS REGARDING YOUR PHI. You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to:
Youth Crisis Center, Inc
3015 Parental Home Road
Jacksonville, FL 32216.
In accordance with the Americans with Disabilities Act, appropriate auxiliary aids and services are provided at no cost to deaf and hard-of-hearing clients and companions. Persons needing special accommodations to participate in any meeting/hearing should contact SPOC: Cecelia Stalnaker-Cauwenberghs, CCO 904-720-0387 for assistance.