Notice of Privacy Practices - Women's Center of Brevard
THIS NOTICE DESCRIBES HOW PRIVACY AND HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY.
The privacy of your personal and health information is important to us. The Women's Center has adopted the following policies and procedures for protection of the privacy of the people we serve:
Our Legal Duty
We are required by federal and state law to maintain the privacy of your personal information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your private personal information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect immediately and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. The new terms of our notice may be effective for all private personal information that we maintain, including private personal information we received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice, post it, and make the new notice available upon request. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
How We Use and Disclose Your Private Personal Information
To provide services we may share limited information with members of our staff, volunteers, independent contract providers, registered intern therapists, and student therapists. The purpose of this information sharing may be to coordinate multi-disciplinary care, set appointments, or for billing purposes relating to counseling services. Additionally, if you are seeing a student therapist or a registered intern therapist, their supervisor will have access to your clinical record including your personal and health information. We may contact you to set the initial appointment, to remind you of ongoing appointments, or to cancel appointments if necessary, unless you have given us notice otherwise. Upon your approval, we may also disclose your private personal information to another health care provider, a member of your family, or other person who is involved in your care.
If you are receiving services for advocacy or counseling under a grant, otherwise confidential information may be released due to auditing conducted by the funding sources.
All incoming mail received by the Women's Center, regardless of who the mail is addressed to, is opened by a designated Women's Center intake staff member. Personal letters or notes will not be read except by the intended addressee.
Uses or Disclosures That Require Your Written Authorization
If you receive services through our counseling program. we will ask your written permission to use or disclose your protected health information for coordination of treatment, for referrals, for payment, or for health care purpose. Upon your approval, we will use or disclose your protected health information as needed to arrange for payment of service to you. For example, information about your diagnosis and the services we render is included in the bills that we submit to your health insurance plan or to the Victim's Crime Compensation agency. Your health plan may require health information in order to confirm that the service rendered is covered by your benefit program and medically necessary, or to review your records to be sure that we meet national standards for quality care, or to authorize treatment or counseling sessions.
HMIS (Homeless Management Information Systems) is a centralized case management system that allows authorized participating agency personnel throughout Brevard County to collect client data, produce statistical reports, and share information with select partner agencies. If you are receiving victim services at the Women's Center, agency personnel may request your permission to utilize the HMIS database. This will be done so only with your express, written permission.
If you are utilizing victim advocacy services and your needs require coordination between your victim advocate and outside agencies, you will be asked to complete a written authorization form. Without your written permission, your advocate will neither confirm nor deny your status as a Women's Center client in response to contact by any outside agency or persons.
Required Disclosures, as Permitted by Law, Without Your Authorization
Emergencies: If there is a medical emergency while you are in our facility, we will disclose your protected health information as needed to enable appropriate care for you.
Disclosures to child or adult protection agencies: We will disclose protected health information as needed to comply with state law requiring reports of known or suspected incidents of abuse or neglect of a child, elderly person, or disabled adult.
Duty to Warn and Protect: If you are a danger to yourself or to others, we may disclose personal information to protect you or others, as allowed by law.
Other Disclosures without Written Permission: There are other circumstances in which we may be required by law to disclose protected health information without your permission. They may include disclosures made:
- Pursuant to some court orders;
- To public health authorities, in some circumstances;
- To law enforcement officials in some circumstances;
- To correctional institutions regarding inmates;
- To federal officials for lawful military or intelligence activities;
- To coroners, medical examiners and funeral directors; and
- As otherwise required by law.
We will follow the provisions of 42 CFR Part 2 governing disclosure of protected health information. Except for the circumstances described above, we will not disclose protected health information to a third party without your written permission or a court order. If a request for disclosure of your patient record is received, and there is no written authorization accompanying the request, and we do not have your written permission on record, you will be contacted and asked whether you wish to authorize disclosure. If you refuse to authorize disclosure, or it is not possible for us to contact you in person, we will not disclose your information without a court order signed by a judge. You may cancel an authorization at any time by notifying our Compliance Office in writing of your desire to cancel it. If you cancel an authorization it will not have any effect on information that we have already disclosed.
Your Legal Rights
Right to request confidential communications: You may request that communications to you, such as appointment reminders, bills, or explanations of health benefits be made in a confidential manner. We will accomodate any such request, as long as you provide a means for us to process payment transactions.
Right to review and copy record: You have the right to see records used to make decisions about you. We will allow you to review your record unless a clinical professional determines that it would create a substantial risk of harm to you or someone else or if the professional determines that it would not be in your best interest. A written report of examination and treatment may be provided in lieu of complete copies of your records, consistent with Florida statute 455.667(4). At your written request, we will make a copy of your record or provide a written report for you. We may deny your request under certain limited circumstances. If your request is denied, we will notify you in writing. You may request a review of our denial. If another person provided information about you to our clinical staff in confidence, that information will be removed form the record before it is shared with you. We will also delete any protected health information about other people. In accordance with federal law, personal psychotherapy notes which may be in your personal folder cannot be reviewed or copied by you. Disclosures will only be made in accordance with the law.
Right to Request Amendments to Your Protected Personal Information: You have the right to request we correct your private personal information. If you believe that any private personal information in your record is incorrect, or that important information is missing, you must submit your written request for an amendment to our Compliance Officer. We do not have to agree to your request. If we deny your request, we will notify you of our reasons. You have the right to submit a statement disagreeing with our decision.
Right to An Accounting of Disclosures of Private Personal Information: You have the right to find out what disclosures of your private personal information have been made. The list of disclosures is called an accounting. The accounting may be for up to six(6) years prior to the date on which you request the accounting. We are not required to include disclosures for services, payment, operations, or for national security or intelligence purposes, or to correctional institutions and law enforcement officials. The right to have an accounting may be temporarily suspended if it will impede the agency's activities. The notice of suspension should specify the time for which such a suspension is required. Requests for an accounting of disclosures must be submitted in writing to our Compliance Officer. You are entitled to one free accounting in any twelve (12) month period. We may charge you for the cost of providing additional accounting.
Right to Obtain a Copy of the Notice: You have the right to request and get a paper copy of this notice and any revisions we make to the notice at any time. This notice is also posted in our lobby.
Complaints: If you have any complaints or concerns about our privacy policies or practices, you may submit a complaint to our Compliance Officer by phone, e-mail, or fax, or in writing.
Compliance Officer:
Becky Lemstrom, Director, Grants Administrator 1565 Sarno Rd. Suite C Melbourne, FL 32935. Tel: 321-499-6535 email: blemstrom@womenscenter.net
You can also submit a complaint to the United States Department of Health and Human Services. Send you complaint to: Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F, HHH Building Washington, D.C. 20201 OCR Hotlines-Voice: 1-800-368-1019
We support your right to protect the privacy of medical information. We will not retaliate in any way if you choose to file a complaint with us.
Effective Date: These policies and procedures are effective as of June 2022
1425 Aurora Road * Melbourne, FL 32935 *321-242-3110 * TTY (321) 242-8603 * Fax (321) 242-7464
400 Julia Street * Titusville, FL 32796 * PH (321) 607-6811 * Fax: (321) 607-6918