Notice of Privacy Practices
As required by the Health Insurance Portability and Accountability Act (HIPAA)

This Notice describes how medical and other information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

You have a right to know how we use and share your personal information. This Notice tells you our responsibilities and your rights.

Family Resources provides services to families in Manatee, Pinellas and Pasco counties. In order to provide you with the best possible care, all professional staff involved in your treatment and employees involved in the operations of the agency may have access to your records. All Family Resources employees follow these Privacy Policies.

Confidential Records

The personal information you give us goes into a confidential (private) written record. We use it to plan for your counseling services and to receive payment for those services from our funding sources. Usually we must have your permission to use or share your personal information. Sometimes, for example in safety situations, we may share it without your permission. This is described more below. The permanent record is kept on paper. We will keep this for at least 7 years after your stop receiving services, and then your record will be destroyed. Some records and billing information are also stored in computers.

Our Responsibilities

• We will follow these Privacy Practices
• We will give you a copy of our Notice of Privacy Practices
• If our Privacy Practices change, we will give you a new copy at your next scheduled appointment or whenever you request one

How We Use and Share Your Personal Information

There are three ways we use and share information about you. The three ways are to:

1. Provide services, with your consent When you apply for services, you are asked to sign a Consent for Treatment. With this consent, we can use and share information about you in these ways
1. For treatment and services
   We may use and share information about you with professionals within the agency who serve you. For example, we will use information about you during staff supervision so that we can ensure that you are getting the best services we can provide. We may share information with team members so that everyone can be sure they are working on the same goals.
2. For Payment
   We may use and share information about you to obtain payment for services we have provided to you. For example, we may give information to those agencies that provide funding for our programs.
3. For Quality Improvement
   We may use and share information about you in order to make sure we are providing good services. For example, we may give information to our peer review teams so they can make sure you are receiving proper services.
2. Provide information to others who need it, with your approval
If we need to share personal information about you for other reasons, we will ask you to sign an Authorization Form to give your approval. This will tell you what information we need to share, who will receive it, and why. For example, you need to sign an Authorization Form for us to share information with your child’s school if you want us to talk with the teacher. Your approval is only good until the date stated on the form, not forever. If you change your mind, tell us in writing and we will not share the information.
3. Provide information to others who need it, without your consent or approval. We may sometimes share personal information about you without your approval. We will do this only when it is lawful and will not share any more information than necessary. The Department of Health and Human Services requires us to list specific situations in which one’s personal information might be released. Most of these situations are not those in which Family Resources would be involved with your family. We have highlighted in bold those situations in which we may be involved.

• Appointments—for appointment reminders of notification when an appointment must be cancelled or rescheduled
• Emergency Treatment—when you need medical care in a crisis
• Health and Safety—to prevent or reduce a serious threat to someone’s health or safety. We will do what is necessary to protect you and others
• Oversight—when we are reviewed by licensing and accreditation agencies or auditors
• Research—for approved research purposes. A Board must review the research to make sure your information remains private (and you must give consent to participate in any research here at Family Resources).
• Legal Proceedings—in response to court orders and other legal actions
• Law Enforcement—if you are missing or in danger. Law enforcement may have access to your information for legal or civil proceedings.
• Abuse or Neglect—to report suspected abuse, neglect or exploitation of any child or vulnerable adult
• Government—to government regulatory agencies, including national security and intelligence agencies
• Required by Law—at other times when the law requires us to
• Public Health—to report diseases, drug reactions or other public health concerns
• Funeral Directors—to the funeral director who will take care of your body
• Organ Donation—for organ, eye or tissue donation purposes
• Coroners—to a coroner or medical examiner for identification or other purposes
• Workers' Compensation—to process a Workers' Compensation claim

Your Rights:

You have a right to read your record and to have a copy of its contents if you would like. We may charge a fee for copying, mailing and supplies. Under limited circumstances, your request may be denied. You may request review of the denial by another licensed mental health professional. We will comply with the outcome of that review. You have the right to correct information in the record that you believe is inaccurate by providing a correction statement.

You have the right to request that certain information not be shared, although Family Resources is not required to follow your request. If we agree, we will comply with your request unless the information is needed for an emergency.

You have the right to confidential communications. You may request that we communicate with you in a certain way or at a certain location. This request needs to be made in writing.

You have the right to receive a list of the disclosures of your personal information that have been made other than for treatment or healthcare operations. This listing begins on April 14, 2003.

You have the right to refuse certain types of treatment or services. If we have alternate services available, you can continue to receive those services at this agency.

We will not use your personal information for any marketing purposes. We would only use your photo or comments in any of the agency’s materials (brochures, videos, etc.) with your written permission. At times, we have asked participants to appear with us at public forums but your refusal to do this would not impact your receiving services at Family Resources.

If you believe your privacy rights have been violated, you may file a complaint with Family Resources or with the HHS Office of Civil Rights. You will not be penalized for making a complaint.

If you have any questions, would like to request restrictions on uses and disclosure for health care treatment or operations, or would like to file a complaint, please contact our Privacy Officer, Stacey Welton, at (727) 521-5203.