Notice of Privacy
Confidentiality Agreement (HIPAA)
Policy Form (“Notice”) is issued by HH to Pt/Client as underlying privacy terms.
Notice describes how medical information about Pt/Client may be used/disclosed and confirms how Pt/Client should efficiently obtain access to this information, particularly as it relates to HH’s confidential wellness & medical Services.
The terms of this Notice of Privacy Practices (“Notice”) apply to HH and to its affiliates/employees. HH will share Pt/Client’s protected health information (PHI) as necessary in order to carry out treatment, payment, and health care operations as permitted by law.
HH is required by law to maintain the privacy of Pt/Client's protected health information and to provide Pt/Client with a notice of HH’s legal duties and privacy practices with respect to PHI. HH is required to abide by the privacy terms of this Notice for as long as it remains in effect. HH reserves the right to change the terms of this Notice as necessary and to make a new or updated notice of privacy practices effective for all PHI maintained by HH.
HH is required to notify Pt/Client in the event of a breach of their unsecured PHI.
HH is also required to inform Pt/Client that there may be provisions of Florida and/or other state laws that relate to the privacy of their health information that may be more stringent than a standard/requirement under the (federal) Health Insurance Portability and Accountability Act (“HIPAA”).
A copy of a revised Notice of Privacy or information pertaining to a specific State law may be obtained by making a request to HH at (407)-701-4500 or via the contact information shown at the bottom of this page.
Uses and Disclosures of Client’s Protected Health Information (PHI):
Authorization and Consent: Except as outlined below, HH will not use or disclose Client’s protected health information for any purpose other than treatment, payment, or care operations unless Pt/Client has given written authorization for such use and/or disclosure. Pt/Client has the right to revoke such an authorization (in writing), effective once HH has received the revocation; however, such a revocation shall not be effective to the extent that HH has taken any action in reliance on the authorization, or if the authorization was obtained as a condition of coordinating existing terms. Certain laws or member policies may give insurance carriers the right to access Pt/Client PHI, for instance.
Uses and Disclosures for Treatment: HH will make uses and disclosures of Pt/Client protected health information as it is necessary for treatment. Physicians, clinicians/counselors, technicians, administrative personnel, and/or other professionals involved in Pt/Client care will use information in their medical record and information that Pt/Client provides about symptoms, reactions, etc to a course of Tx that may include procedures, medications, tests, medical history, etc.
Uses and Disclosures for Payment: HH will make uses and disclosures of Pt/Client protected health information as it is necessary for payment purposes. During the normal course of business operations and/or treatment/services, HH may forward information regarding Pt/Client medical procedures or counseling sessions to Pt/Client’s designated insurance company and/or to other authorized third parties in order to arrange payment for scheduled/rendered Services. HH may also use Pt/Client information to prepare/issue billing records.
Uses and Disclosures for Care Operations: HH will make uses and disclosures of Pt/Client protected health information as it is necessary, and as permitted by law, for HH’s general care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, HH may use and disclose Pt/Client PHI for the purposes of further developing counseling methods/protocols.
Individuals Involved In Your Care: HH may from time to time disclose Pt/Client protected health information to designated family, friends, and others who are involved in Pt/Client’s care and/or case management. Such individuals may be involved in Pt/Client receiving Services and/or fulfilling financial responsibilities to an extent that it requires HH to share/facilitate PHI. However, if Pt/Client is unavailable, incapacitated, or facing an emergency medical situation and HH determines that a limited disclosure may be in Pt/Client’s best interest, then HH may share limited PHI with such individuals without Pt/Client’s approval. HH may also choose to disclose limited PHI of Pt/Client to a public or private entity that is authorized to inquire about Services. Such an entity may be engaged in disaster relief efforts and may need to locate the family of Pt/Client, for instance. HH will act in the best clinical & safety interests of Pt/Client in this type of scenario.
Business Associates: Certain aspects and components of HH’s Services are performed through contracts with outside persons or organizations, such as auditing, accreditation, outcomes data collection, legal services, etc. At times it may be necessary for HH to provide Pt/Client PHI to one or more of these outside persons or organizations who assist HH with business operations. In any such cases, HH requires that these associates, like Provider Collective, appropriately safeguard the privacy of Pt/Client information.
Appointments and Services: HH may contact Pt/Client to provide appointment updates and/or to give information about Treatment as well as other health-related benefits that may be of interest to Pt/Client. It is within the rights of Pt/Client to make a request for preferences in this regard, and HH will accommodate reasonable requests by Pt/Client. Such preferences may determine how Pt/Client receives updates/information (communications) or could lay forth certain specifications in terms of how their PHI is handled before it is sent/issued to an authorized third party. For instance, if Pt/Client wishes for appointment reminders to not be left on their voicemail, HH will work to accommodate this requested preference only if Pt/Client offers a reasonable messaging alternative. Pt/Client also has the right to request that HH does not send future marketing materials, and HH will use its professional judgement and deploy its good faith efforts to honor such a request. Pt/Client must make such requests to HH in writing via contact information shown at the bottom of this page.
Research: In limited circumstances, HH may use and disclose Pt/Client PHI for research purposes. In all cases where Pt/Client’s specific authorization is not obtained, their privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board which oversees the research or by representatives of the researchers that limit their use and disclosure of Pt/Client personal data.
Other Uses and Disclosures: HH is permitted and/or required by law to make certain other uses and disclosures of Pt/Client PHI without their consent or authorization for the following:
- Any purpose required by law;
- Public health activities such as required reporting of immunizations, disease, injury, birth and death, or in connection with public health investigations;
- If HH suspects child abuse/neglect;
- if HH believes you to be a victim of abuse, neglect, domestic violence;
- To the Food and Drug Administration to report adverse events/product defects or to participate in recalls;
- To Client’s employer when HH has provided Services to Client at the request of their employer;
- To a government oversight agency conducting audits, investigations, civil or criminal proceedings;
- Court or administrative ordered subpoena or discovery request;
- To law enforcement officials if it is suspected that Pt/Client has been the victim of abuse, neglect or domestic violence. HH will only make this disclosure if Pt/Client agrees or when required or authorized by law;
- If Pt/Client is a member of the military, HH may also release their PHI for national security or intelligence activities
- To workers' compensation agencies for workers' compensation benefit determination.
Disclosures Requiring Authorization:
Psychotherapy Notes: HH must obtain Pt/Client’s specific written authorization prior to disclosing any Treatment notes unless otherwise permitted by law. However, there are certain purposes for which HH may disclose Treatment notes, without obtaining Pt/Client written authorization, including the following:
(1) To carry out certain treatment, payment or care operations (e.g., use for the purposes of Pt/Client Tx, for HH’s own training, and to defend HH in a legal action or other proceeding brought by Pt/Client), (2) to the Secretary of the Department of Health and Human Services to determine HH’s compliance with the law, (3) as required by law, (4) for health oversight activities authorized by law, (5) to medical examiners or coroners as permitted by state law, or (6) for the purposes of preventing or lessening a serious or imminent threat to the health or safety of a person or the public.
Genetic Information: HH must obtain Pt/Client’s specific written authorization prior to using or disclosing their genetic information for treatment, payment or care operations purposes. HH may use or disclose Pt/Client behavioral & medical profile, or the profile of Client’s child, without written authorization only where it is permitted by law.
Marketing: HH must obtain Pt/Client’s authorization for any use or disclosure of their PHI for marketing efforts, except if the communication is in the form of (1) a face-to-face Client communication, or (2) a promotional gift of nominal value.
Sale of Protected Information: HH must obtain Pt/Client’s authorization prior to receiving direct or indirect remuneration in exchange for Pt/Client PHI; however, such authorization is not required where the purpose of the exchange is for:
- Public health activities;
- Research purposes, provided that HH receives only a reasonable fee to cover the cost to prepare/transmit the information for research purposes;
Treatment and payment purposes;
- Care operations involving the sale, transfer, merger or consolidation of all or part of our business and for related due diligence;
- Payment that HH provides to a business associate for activities involving the exchange of protected health information that the business associate undertakes on our behalf (or the subcontractor undertakes on behalf of a business associate) and the only remuneration provided is for the performance of such activities;
- Providing Pt/Client with a copy of their protected health information or an accounting of disclosures;
- Disclosures required by law;
- Disclosures of Pt/Client PHI for any other purpose permitted by and in accordance with the Privacy Rule of HIPAA, as long as the only remuneration HH receives is a reasonable fee to cover the cost to prepare and transmit Pt/Client PHI for such purpose or is a fee otherwise expressly permitted by other law;
- Any other exception allowed by Department of Health and Human Services.
Rights of Client Regarding Their Protected Health Information (PHI):
Access to Protected Health Information: Pt/Client has the right to copy and/or inspect much of the protected health information that HH retains on their behalf. For protected health information that HH maintains in any electronic designated record set, Pt/Client may request a copy of such health information in a reasonable electronic format, if readily producible. Requests for access must be made in writing and signed by Pt/Client or legal representative. Pt/Client may obtain "Access to Health Information" by contacting HH’s Administrative Team. Pt/Client may be charged reasonable copying, mailing, and/or administrative fees for their protected health information requests.
Amendments to Your Protected Health Information: Pt/Client has the right to request in writing that protected health information about them that is maintained by HH is amended or corrected. HH is not obligated to make requested amendments but will give any such requests careful consideration. All amendment requests, must be in writing, signed by Pt/Client or legal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, HH may notify other affiliated parties, like Provider Collective, if HH believes that such an update is necessary. Pt/Client may obtain “Amendment Request" by contacting HH’s Administrative Team.
Accounting for Disclosures of Your Protected Health Information: Pt/Client has the right to receive an accounting of certain disclosures made by HH as it relates to their protected health information after January 1, 2009. Such requests must be made in writing and need to be signed by Pt/Client or legal representative. Pt/Client may obtain "Care Settlement Request" via HH’s Administrative Team. The first settlement request for financial reconciliation in any 12-month period is typically free of charge; Pt/Client may be charged a reasonable fee for subsequent settlement requests within the same 12-month period. Pt/Client will be reminded/notified of the fee at the time of their request.
Restrictions on Use and Disclosure of Protected Health Information: Pt/Client has the right to request restrictions on uses and disclosures of their protected health information for treatment, payment, or care operations. HH is not required to agree to restriction requests but will attempt to accommodate reasonable requests as it is deemed appropriate. Pt/Client does, however, have the right to enforce the restriction of disclosing their protected health information to a designated party, if such a disclosure is for the purpose of carrying out payment or care operations and is not otherwise required to be disclosed by law, and should the protected health information pertain solely to an item or Service for which Pt/Client, or someone authorized to act on Pt/Client’s behalf, has paid HH in full. If HH agrees to any discretionary restrictions, it reserves the right to remove such restrictions as deemed appropriate. HH will notify Pt/Client if removing a restriction imposed in accordance with this paragraph. Pt/Client also has the right to withdraw, in writing, any restriction of PHI by communicating a desire for such action to HH’s administrative personnel.
Right to Notice of Breach: HH takes seriously the confidentiality of Pt/Client information, and HH is required by law to protect the privacy and security of Pt/Client protected health information through appropriate safeguards. HH will notify Pt/Client in the event that a breach occurs which involves or potentially involves Pt/Client’s unsecured health information, HH must do this to inform Pt/Client of what steps may be necessary for them to mitigate risk/exposure.
Paper Copy of Notice: Pt/Client has a right, even if opting for electronic forms, to obtain a paper copy of this Notice. To do so, make “Hardcopy Forms Request" to Administrative Team via contact information shown at the bottom of this page.
Complaints: If Pt/Client believes their privacy rights have been violated, Pt/Client should file a complaint in writing. Pt/Client may file a complaint with the Secretary of the U.S. Department of Health and Human Services at the US Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. There will be no retaliation for filing a complaint.
For Further Information: If Pt/Client has questions, needs further assistance regarding PHI, or would like to submit a request pursuant to this Notice, they may contact HH’s Administrative Team via contact information at the bottom of this page or by visting HH's facility located at 1199 N Orange Avenue, Orlando, Florida 32804.
By submitting | Client Profile | form, Pt/Client acknowledges that they have received a copy of and agree to Notice of Privacy effective 2025.