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.
If you have any questions or wish to receive additional information about the matters covered by this Notice of Privacy Practices (“Notice”), please contact the Privacy Officer for Horizons (“Arc”), Julia McNabb, or call: (850)863-1530 ext. 224.
This Notice is provided to you in compliance with the requirements of the Health Insurance Portability and Accountability Act of 1996, the Health Information Technology for Economic and Clinical Health Act, Title XIII of the American Recovery and Reinvestment Act of 2009 (the “HITECH Act”) and associated regulations, as may be amended (collectively referred to as “HIPAA”) describing ARC’s legal duties and privacy practices with respect to your Protected Health Information (“PHI”). ARC is required to abide by the terms of this Notice currently in effect, and may need to revise the Notice from time to time. Any required revisions of this Notice will be effective for all PHI that ARC maintains. A current copy of the Notice will be posted in each office and you may request a paper, or electronic, copy of it.
PHI consists of all individually identifiable information which is created or received by ARC and which relates to your past, present or future physical or mental health condition, the provision of health care to you, or the past, present or future payment for health care provided to you.
USE AND DISCLOSURE OF PHI FOR WHICH YOUR CONSENT OR AUTHORIZATION IS NOT REQUIRED
HIPAA permits ARC to use or disclose your PHI in certain circumstances, which are described below, without your authorization. However, Florida law may not permit the same disclosures. ARC will comply with whichever law is stricter.
USES AND DISCLOSURES TO WHICH YOU MAY OBJECT
15. If you do not object to the following uses or disclosures of your PHI, ARC may: 1) disclose to a family member, other relative, a close personal friend, or other person identified by you the information relevant to their involvement in your care or payment related to your care; 2) notify others, or assist in the notification, of your location, general condition, or death; or 3) disclose your PHI to assist in disaster relief efforts.
OTHER USES AND DISCLOSURES OF PHI
16. Any use or disclosure of your PHI that is not listed herein will be made only with your written authorization. You have the right to revoke such authorization at any time, provided that the revocation is in writing, except to the extent that: 1) ARC has taken action in reliance on the prior authorization; or 2) If the authorization was obtained as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy or the policy itself.
YOUR RIGHTS REGARDING YOUR PHI
17. Restriction of Use and Disclosure: You have the right to request that ARC restrict the PHI it uses and discloses in carrying out treatment, payment and health care operations. You also have the right to request that ARC restrict the PHI it discloses to a family member, other relative or any other person identified by you, which is relevant to such person’s involvement in your treatment or payment for your treatment. By law, ARC is not obligated to agree to any restriction that you request. If ARC agrees to a restriction, however, it may only disclose your PHI in accordance with that restriction, unless the information is needed to provide emergency health care to you. If you wish to request a restriction on the use and disclosure of your PHI, please send a written request to the Privacy Officer which specifically sets forth: 1) that you are requesting a restriction on the use or the disclosure of your PHI; 2) what PHI you wish to restrict; and 3) to whom you wish the restrictions to apply (e.g., your spouse). ARC will not ask why you are requesting the restriction. The Privacy Officer will review your request and notify you whether or not ARC will agree to your requested restriction. You also have the right to request to restrict disclosure of your PHI to a health plan, if the disclosure is for payment or health care operations and the disclosure pertains to a health care item or service for which you have paid out of pocket in full.
18. Authorization Required: Most uses and disclosures of PHI for marketing and the sale of PHI require your authorization. In addition, disclosure of psychotherapy notes is prohibited without your authorization, except as allowed by law.
19. Fundraising: ARC may contact you for purposes of fundraising to support its programs. You have the option to opt-out of this type of communication.
20. Confidential Communications: You have the right to receive confidential communications of your PHI. You may request that you receive communications of your PHI from ARC in alternative means or at alternative locations. ARC will accommodate all reasonable requests, but certain conditions may be imposed.
To request that ARC make communications of your PHI by alternative means or at alternative locations, please send a written request to the Privacy Officer setting forth the alternative means by which you wish to receive communications or the alternative location at which you with to receive such communications. ARC will not ask why you are making such a request.
21. Access to PHI: You have the right to inspect and obtain a copy of your PHI maintained by ARC. Under HIPAA, you do not have the right to inspect or copy information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding, or information that ARC is otherwise prohibited by law from disclosing.
If you wish to inspect or obtain a copy of your PHI, please send a written request to the Privacy Officer. If you request a copy of your PHI, ARC may charge a fee for the cost of copying and mailing the information. You may also request that a copy of your PHI be transmitted to you electronically.
HIPAA permits ARC to deny your request to inspect or obtain a copy of your PHI for certain limited reasons. If access is denied, you may be entitled to a review of that denial. If you receive an access denial and want a review, please contact the Privacy Officer. The Privacy Officer will designate a licensed health care professional to review your request. This reviewing health care professional will not have participated in the original decision to deny your request. ARC will comply with the decision of the reviewing health care professional.
22. Amending PHI: You have the right to request that ARC amend your PHI. To request that an amendment be made to your PHI, please send a written request to the Privacy Officer. Your written request must provide a reason that supports the request amendment. ARC may deny your request if it does not contain a reason that supports the requested amendment. Additionally, ARC may deny your request to have your PHI amended if it determines that: 1) the information was not created by ARC and amendment may be made elsewhere; 2) the information is not part of a medical or billing record; 3) the information is not available for your inspection; or 4) the information is accurate and complete.
23. Notification of Breach: ARC will notify you following a breach of your PHI as required by law.
24. Accounting of Disclosure of Your PHI: You have the right to request a listing of certain disclosure of your PHI made by ARC during the period of up to six (6) years prior to the date on which you make your request. Any accounting you request will not include: 1) disclosures made to carry out treatment, payment or health care operations; 2) disclosures made to you; 3) disclosures made pursuant to an authorization given by you; 4) disclosures made to other people involved in your care or made for notification purposes; 5) disclosures made for national security or intelligence purposes; 6) disclosure made to correctional institutions or law enforcement officials; or 7) disclosures made prior to April 14, 2003. The right to receive an accounting is subject to certain other exceptions, restrictions and limitations set forth in applicable statutes and regulations.
To request an accounting of the disclosures of your PHI, please send a written request to the Privacy Officer. Your written request must set forth the period for which you wish to receive an accounting. ARC will provide one free accounting during each twelve (12) month period. If you request additional accountings during the same twelve (12) month period, you may be charged for all costs incurred in preparing and providing that accounting. ARC will inform you of the fee for each accounting in advance and will allow you to modify or withdraw your request in order to reduce or avoid the fee.
25. Obtaining a Copy of this Notice: You have the right to request and receive a paper or electronic copy of this Notice at any time.
26. If you believe that your privacy rights have been violated, you may file a complaint with ARC or with the Secretary of Health and Human Services. To file a complaint with ARC, please contact the Privacy Officer at the address listed on page 1 of this notice. All complaints must be submitted in writing. ARC WILL NOT RETALIATE AGAINST YOU FOR FILING A COMPLAINT.
Horizons of Okaloosa County
123 Truxton Ave.
Fort Walton Beach, Florida 32547
Phone: 850-863-1530 Fax: 850-862-4589