THIS NOTICE DESCRIBES HOW PERSONALLY IDENTIFIABLE HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

THE CONFIDENTIALITY OF ANY INFORMATION YOU PROVIDE FLORIDA DETOX CONCERNING DRUG OR ALCOHOL USE IS PROTECTED, BEGINNING WITH YOUR FIRST TELEPHONE OR EMAIL CONTACT WITH FLORIDA DETOX.

Confidentiality of Alcohol and Drig Abuse Patient Records

The confidentiality of alcohol and drug abuse patient records maintained by Florida Detox is protected by Federal law and regulations. GENERALLY, FLORIDA DETOX MAY NOT SAY TO A PERSON OUTSIDE THE PROGRAM THAT A PATIENT ATTENDS THE PROGRAM, OR DISCLOSE ANY INFORMATION IDENTIFYING A PATIENT AS AN ALCOHOL OR DRUG ABUSER

Unless:

(1) The patient consents in writing:

(2) The disclosure is allowed by a court order; or

(3) The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.

Violation of the Federal law and regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.

Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime.

Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.

(See 42 U.S.C. 290dd–3 and 42 U.S.C. 290ee–3 for Federal laws and 42 CFR part 2 for Federal regulations.)

Florida Detox will make other disclosures, only with your written consent, which can be revoked.

Florida Detox may contact you regarding scheduling appointments, reminding you of appointments or informing you of test results.

Florida Detox is required by law to maintain the privacy of your personally identifiable health information, and notify you of our legal duties and privacy practices, including changes in our privacy policies.

Florida Detox must abide by the terms of the notice currently in effect; Florida Detox reserves the right to change the terms of its notice and to make the new notice provisions effective for all information it maintains; Florida Detox will provide patients with a revised notice of its practices; by providing it, in person, during a scheduled appointment; mailing it to your last known address, first class postage prepaid; or sending it to an email address, if you make a written request to have notices sent to a designated email address.

• If you require further information regarding our privacy policies, your may contact our Privacy Officer, Steven Sponaugle, by telephone, at 727 945-9198; email at Steves@floridadetox.com; or US Postal Service, at Florida Detox, 1501 South Pinellas Ave., Suite P, Tarpon Springs, FL 34689.

You have legal rights regarding your personally identifiable health information including:

• The right to request restrictions on certain uses and disclosures of PERSONALLY IDENTIFIABLE HEALTH INFORMATION; Florida Detox is not required to agree with requested restrictions;
• The right to receive confidential communications of PERSONALLY IDENTIFIABLE HEALTH INFORMATION (such as having mail and telephone calls be limited to home or office location); Forida Detox will not display the words, “Florida Detox,” on the outside of any packages or envelopes mailed to you.
• The right to access and amend PERSONALLY IDENTIFIABLE HEALTH INFORMATION;
• The right to receive an accounting of Florida Detox's disclosures of PERSONALLY IDENTIFIABLE HEALTH INFORMATION;
• The right to complain-free from retaliation-to Florida Detox and to the Secretary of Health and Human Services (HHS) about violations of privacy rights, and information on how to file a complaint with Florida Detox; and
• The right to obtain a paper copy of this notice upon request.

• This notice is effective 10/29/05.

Florida Detox must make a good faith effort to obtain patients' written acknowledgment of receipt of this notice, except in an emergency treatment situation, on the date of the first service delivery. If written acknowledgment is not obtained, Florida Detox must document its efforts and the reason it was not able to obtain the acknowledgement.

Patient rights

The Privacy Rule provides patients with new Federal privacy rights, including the right to request restrictions of uses and disclosures of PERSONALLY IDENTIFIABLE HEALTH INFORMATION, and the right to access, amend, and receive an accounting of disclosures of PERSONALLY IDENTIFIABLE HEALTH INFORMATION.

Right to request a restriction of uses and disclosures

The Privacy Rule requires that programs allow patients to request that Florida Detox restrict uses or disclosures of PERSONALLY IDENTIFIABLE HEALTH INFORMATION for the purpose of treatment, payment or health care operations and for involvement in the patient's care and notification under 45 CFR §164.510(b). Florida Detox is not required to agree to a requested restriction. If, however, Florida Detox agrees to a restriction, Florida Detox may not then violate the agreed-upon restriction, except for emergency treatment purposes, so long as Florida Detox requests that the emergency treatment provider not further use or disclose the PERSONALLY IDENTIFIABLE HEALTH INFORMATION. A covered entity may terminate the agreement to a restriction, effective after the patient has been informed of the termination.

The Privacy Rule gives the individual the right to request that communication of PERSONALLY IDENTIFIABLE HEALTH INFORMATION be done by alternative means or to alternative locations (confidential communications). This might include the right to request that mail and telephone calls be limited to home or office location. The Privacy Rule requires programs to accommodate reasonable requests.

Right to access PERSONALLY IDENTIFIABLE HEALTH INFORMATION

You have the right to request a copy of your patient records. The Privacy Rule requires Florida Detox to respond to a patient's request for access within 30 days after receipt of the request (within 60 days if the information is not maintained or accessible on-site). Florida Detox may extend the deadline once by not more than 30 days, if within 30 days of the receipt of the request (or 60 days of receipt if the information is not on-site), the patient is provided with a written statement containing the reasons for the delay and the date by which it will permit access. If the program does not maintain the requested information, but knows where the requested information is maintained, it must inform the patient where to direct his or her request.

If Florida Detox grants the patient's request for access to his or her records, it can charge the patient a reasonable, cost-based fee, consistent with the restrictions on fees as provided in the Privacy Rule. See 45 CFR §164.524(c)(4).

The Privacy Rule permits Florida Detox to require that such requests be in writing. See 45 CFR §164.524(b)(1). The Privacy Rule provides patients with a right of access to inspect and obtain a copy of their PERSONALLY IDENTIFIABLE HEALTH INFORMATION. Certain information, however, is exempt from this right of access:

• Psychotherapy notes;
• Information compiled in reasonable anticipation of or for use in a civil, criminal, or administrative action or proceeding; and
• Information that may be subject to or exempt from certain Clinical Laboratory Improvement Amendment (CLIA) provisions.

Denial of Access

The Privacy Rule allows Florida Detox to deny a patient access without providing an opportunity for review of the denial, on the following grounds:

• The information is specifically exempted from the right of access by the Privacy Rule. See 45 CFR §164.524(a)(1);
• The requested information was created or obtained by a program in the course of research that includes treatment. The individual's access to such information may be temporarily suspended for as long as the research is in progress, provided that the individual has agreed to the denial of access when consenting to participate in the research and Florida Detox has informed him or her that the right of access will be reinstated upon completion of the research. See 45 CFR §164.524(a)(2)(iii);
• The requested information is subject to the Privacy Act and would be denied under the access provisions of the Privacy Act, 5 USC §522a. See 45 CFR §164.524(a)(2)(iv); or The requested information was obtained under a promise of confidentiality from someone other than a health care provider and such access would be likely to reveal the source of the information. See 45 CFR §164.524(a)(2)(v).

The Privacy Rule permits a program to deny patient access, provided that the patient is given the right to have such a denial reviewed, on the following grounds:

• A licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to endanger the life or physical safety of the patient or another person;
• The information makes reference to another person (other than a health care provider) and a licensed health care professional has determined, in the exercise of professional judgment, that the access is reasonably likely to cause substantial harm to such other person; or
• The request for access is made by the patient's personal representative and a licensed health care professional has determined, in the exercise of professional judgment, that the provision of access to such personal representative is reasonably likely to cause substantial harm to the patient or another person.

See 45 CFR §164.524(a)(3).

If Florida Detox's denial is based on one of the last three reasons, the patient has the right to have that denial reviewed by a licensed health care professional who is designated by Florida Detox to act as a reviewing official and who did not participate in the original decision to deny access.

If Florida Detox denies a patient access to all or parts of his or her PERSONALLY IDENTIFIABLE HEALTH INFORMATION, it must give the patient a timely denial written in plain language containing:

• The basis for the denial;
• If applicable, a statement of the patient's review rights, including a description of how the patient may exercise those rights; and
• A description of how the patient may complain to Florida Detox or to the Secretary of HHS. The description must include information regarding how the patient may complain to Florida Detox pursuant to Florida Detox's complaint procedures or to the Secretary, and must include the name or title, and telephone number of the contact person or office designated by Florida Detox to receive complaints.

A program that denies a patient access in part must give the patient access to any other PERSONALLY IDENTIFIABLE HEALTH INFORMATION requested after excluding the information to which Florida Detox had reason to deny access. See 45 CFR §164.524(d)(1).

The right to amend PERSONALLY IDENTIFIABLE HEALTH INFORMATION

The Privacy Rule gives patients the right to have Florida Detox amend their PERSONALLY IDENTIFIABLE HEALTH INFORMATION or a record about the patient in a designated record set. Florida Detox must act on a patient's request for amendment within 60 days after it receives the request. Florida Detox may extend the deadline once by not more than 30 days if, within the 60 days, the patient is provided with a written statement of the reasons for the delay and the date by which it will respond. See 45 CFR §164.526(b)(2).

A program that accepts a patient's request to amend PERSONALLY IDENTIFIABLE HEALTH INFORMATION must:

• Timely inform the patient of its decision to accept the amendment;
• Make the appropriate amendment by identifying the records in the designated record set that are affected by the amendment and appending or otherwise providing a link to the location of the amendment; and
• If the patient agrees, make reasonable efforts to notify and provide the amendment within a reasonable period of time to:

• Persons identified by the patient as having received the patient's PERSONALLY IDENTIFIABLE HEALTH INFORMATION and needing the amendment; and
• Persons, including business associates, that Florida Detox knows to have received the PERSONALLY IDENTIFIABLE HEALTH INFORMATION that is the subject of the amendment and that may have relied, or could foreseeably rely on such information to the detriment of the patient.

A program must obtain patient consent on forms that comply with 42 CFR §2.31 before it provides any copies of the amendment to other persons or organizations.

Denial of Amendment

A program may deny a patient's request for amendment if it determines that:

• It did not create the information, unless the patient provides a reasonable basis to believe that the originator of the PERSONALLY IDENTIFIABLE HEALTH INFORMATION is no longer available to act on the requested amendment;
• The information or record is accurate and complete; or
• The information that is the subject of the request is not part of a designated record set or would not otherwise be available for inspection under the Privacy Rule's request for access provisions.

If Florida Detox denies a patient's request to amend records, it must give him or her a timely denial, written in plain language, and contain:

• The basis for the denial;
• Notice of the patient's right to file a written statement of disagreement with the denial and how the patient may file such a statement;
• Notice that, if the patient does not submit a statement of disagreement, the patient may request that Florida Detox include his or her request for amendment and its denial with any future disclosures of the PERSONALLY IDENTIFIABLE HEALTH INFORMATION that is subject to the amendment; and
• A description of how the patient may complain about Florida Detox's actions to Florida Detox or to the Secretary of HHS. The description must include information regarding how the individual may complain to Florida Detox pursuant to its complaint procedures or to the Secretary, and must include the name or title, and telephone number of the contact person or office designated by Florida Detox to receive complaints.

Florida Detox may prepare a written rebuttal to the patient's statement of disagreement. If it prepares such a rebuttal, it must provide a copy to the patient who submitted the statement of disagreement. This information (e.g. the statement of disagreement and rebuttal), or in some cases, a summary, must all be included in any subsequent disclosures of the information to which the disagreement relates as provided in 45 CFR §164.526(d)(3), (4), and (5).

Florida Detox must document the titles of the persons or offices responsible for receiving and processing requests for amendment. It must retain the documentation for six (6) years from the date it was created or last effective, whichever is later.

Right to an accounting of disclosures of PERSONALLY IDENTIFIABLE HEALTH INFORMATION

The Privacy Rule provides individuals with the right to obtain an accounting of certain disclosures of PERSONALLY IDENTIFIABLE HEALTH INFORMATION made by a program during the six (6) years prior to the request.

Florida Detox does not have to provide an accounting for any disclosures that were made:

• For treatment, payment, and health care operations as provided in 45 CFR §164.506;
• To the patient as provided in 45 CFR §164.502;
• Incident to a use or disclosure that is otherwise permitted as provided in 45 CFR §164.502;
• Pursuant to the patient's written consent (an "authorization" meeting the Privacy Rule's requirements at 45 CFR §164.508);
• To persons involved in the patient's care or other notification purposes as set forth by the rule at 45 CFR §164.510;
• For national security or intelligence purposes as provided by the rule at 45 CFR §164.512(k)(2);
• To correctional institutions or law enforcement officials having custody of an inmate or individual and as specified under 45 CFR §164.512(k)(5);
• As part of a limited data set in accordance with the rule at 45 CFR §164.514(e); and
• Before April 14, 2003.

See 45 CFR §164.528(a)(1). In addition, a program must temporarily suspend a patient's right to receive an accounting of disclosures to a health oversight agency or law enforcement official if Florida Detox receives notification that it would be reasonably likely to impede the activities of the agency or official. See 45 CFR §164.528(a)(2).

The accounting must be in writing and include:

• The date of each disclosure;
• The name and address (if known) of the entity or person who received the PERSONALLY IDENTIFIABLE HEALTH INFORMATION;
• A brief description of the PERSONALLY IDENTIFIABLE HEALTH INFORMATION disclosed; and
• A brief statement of the purpose of the disclosure that reasonably informs the individual of the basis for the disclosure, or a copy of a written request for disclosure, if any.

See 45 CFR §164.528(b)(2).

For substance abuse treatment programs, the following disclosures are typically made without patient consent and must therefore be included in an accounting of disclosures:

• Disclosures to health oversight agencies;
• Disclosures to researchers that include patient-identifying information;
• Disclosures to public health authorities;
• Court-ordered disclosures;
• Reports of patient crimes on program premises or against program personnel; and
• Child abuse and neglect reports.

The accounting must be made within 60 days of Florida Detox's receipt of the request. Florida Detox may extend the deadline once by not more than 30 days if, within the 60 days, the patient is provided with a written statement of the reasons for the delay and the date by which it will provide the accounting. A program must respond to a patient's request for one accounting within any 12-month period without charge. For any subsequent request within a 12-month period, it may charge a patient a reasonable, cost-based fee. If Florida Detox imposes a fee, it must inform the patient of the fee in advance and give the patient an opportunity to withdraw or modify the request. See 45 CFR §164.528(c).

Florida Detox must also document the following:

• The information it was required to provide the patient;
• The written accounting it provided the patient; and
• The titles of the persons or offices responsible for receiving and processing requests for an accounting.

This documentation must be retained for six (6) years from the date created or last effective, which ever is later. See 45 CFR §164.528(d).

Complaints about Florida Detox's privacy practices

Part 2 allows violations of those regulations to be reported to the United States Attorney for the judicial district in which the violation occurs. See 42 CFR §2.5.

The Privacy Rule establishes a process for individuals to file a complaint with the Secretary of HHS if they believe a program violated the Privacy Rule. The complaint must be written, either on paper or electronically, and filed with HHS' Office for Civil Rights within 180 days of when the complainant knew, or should have known, that the act or omission complained of occurred, unless a waiver is granted. The complaint must name Florida Detox and describe the violation of the Privacy Rule. See 45 CFR §160.306