NOTICE OF PRIVACY PRACTICES
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.
For purposes of this Notice "us", "we" and "our" refers to PARC and "you" or "your" refers to persons receiving
PARC services and/or their legal representatives as determined by us in accordance with Florida informed consent law.
This Notice will tell you how we may use and disclose protected health information about you. Protected health
information means any health information about you that identifies you or for which there is a reasonable basis to believe
the information can be used to identify you. That information is referred to as “medical information.” In this Notice, we
simply call all of that protected health information, “health information.”
This notice also will tell you about your rights and our duties with respect to health information about you. In
addition, it will tell you how to complain to us if you believe we have violated your privacy rights.
Florida law and the Health Insurance Portability & Accountability Act of 1996 (HIPAA) require us to maintain the
confidentiality of all your health information in any form, whether electronically, on paper, or orally. HIPAA is a federal law
that gives you significant new rights to understand and control how your health information is used. HIPAA updated
requirements effective March 26, 2013 through the Omnibus Rule are included.
PARC staff, support services, Business Associates (outside contractors hired and/or commissioned by PARC to
assist in conducting PARC business and services), volunteers, and other members of PARC workforce follow the policies
and procedures set forth in this Notice. Business Associates are directly liable for complying with HIPAA regulations.
You will be asked to sign a Consent/Authorization form when you receive this Notice of Privacy Practices. If you
did not sign such a form or need a copy of the one you signed, please contact PARC Compliance Officer 727-345-9111.
If you do not sign and return signed Consent/Authorization for this Notice, services offered and rendered to you may be
negatively impacted, including PARC's receipt of funding, and may result in discontinuing you as actively receiving PARC
How We May Use and Disclose Health Information About You
We may use and disclose health information about you without your permission, consent, or authorization for the purposes described below. We will not share information about health treatment with your health plan without your authorization in cases when out of pocket payment is made in full.
We may use health information about you to provide, coordinate or manage the services, supports, and health care you receive from us and other providers. We may disclose health information about you to doctors, nurses, qualified mental retardation professionals (QMRPs), psychologists, social workers, direct support staff and other agency staff, volunteers and other persons internal and external to PARC who are involved in supporting you or providing care. We may consult with other health care providers concerning you and, as part of the consultation, share your health information with them. For example, staff may discuss your information to develop and carry out your individual service plan. Staff may share information to coordinate needed services, such as medical tests, transportation to a doctor’s visit, physical therapy, etc. Staff may need to disclose health information to entities outside of our organization (for example, another provider or a state/local agency) to obtain new or assist in you obtaining services for you.
We may use and disclose health information about you so we can be paid for the services we provide to you. This can include billing a third party payor, such as Medicaid/Medicaid Waiver or other state agency, or your insurance company. For example, we may need to provide the state Medicaid program information about the services we provide to you so we will be reimbursed for those services.
For Health Care Operations
We may use and disclose health information about you for our own operations. These are necessary for us to operate PARC and to provide best practices and quality services. For example, we may use health information about you to review the services we administer and provide and the performance of our employees supporting you. We may disclose health information about you to train our staff and volunteers. We also may use the information to study ways to more efficiently manage our organization, for accreditation or licensing activities, or for our compliance program.
How We Will Contact You
Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail. We may use and disclose health information about you to contact you to remind you of an appointment for treatment or services. We may call your name in common PARC areas or in public during your participation in PARC activities or within your living facilities. If you want to request that we communicate to you in a certain way or at a certain location, see “Right to Receive Confidential Communications” of this Notice.
Treatment and Service Alternatives
We may use and disclose health information about you to contact you about treatment and service alternatives that may be of interest to you.
Health Related Benefits and Services
We may use and disclose health information about you to contact you about health-related benefits and services that may be of interest to you.
We may use and disclose health information about you to communicate with you about a product or service to initiate awareness of or encourage you to purchase or participate in the product or service. You may opt-out without undue burden (i.e. requiring a letter from you) of receiving such communication and materials. This may be:
- To describe a health-related product or service that is provided by us;
- For your treatment;
- For case management or care coordination for you;
- To direct or recommend alternative treatments, therapies, health care providers, or settings of care.
We may communicate to you about products and services in a face-to-face communication by us to you. We also may communicate about products or services in the form of a promotional gift of nominal value. All other use and disclosure of health information about you by us to make a communication about a product or service to encourage the purchase or use of a product or service will be done only with your written authorization.
We may use and disclose health information about you to raise funds for PARC, but only with your authorization. We may disclose health information to a business associate of PARC, PARC staff involved in development efforts, or acting fund-raising individual(s) so they may contact you or others in efforts to raise money for the benefit of PARC or to seek your authorization. You may opt-out without undue burden (i.e. requiring a letter from you) of receiving such communication and materials.
If you do not want PARC to contact you for fundraising, contact PARC President & CEO, 3190 Tyrone Blvd N., St. Petersburg, FL 33710; 727-345-9111.
We may include your name, PARC programs in which you participate, your condition described in general terms, and your religious affiliation in any directory PARC may need to compile while you receive services. This information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to members of the clergy, such as a minister, priest or rabbi.
Disclosures to Family and Others
We may disclose to a parent/guardian, personal representative, family member, other relative, a close personal friend, or any other person identified by you or identified as a stakeholder, health information about you that is directly relevant to that person’s involvement with the services and supports you receive or payment for those services and supports. We also may use or disclose health information about you to notify, or assist in notifying, those persons of your location, general condition, or death. If there is a family member, other relative, or close personal friend or other stakeholder that you do not want us to disclose health information about you to, please notify PARC President & CEO or PARC Compliance Officer, 727-345-9111.
We may use or disclose health information about you to a public or private entity authorized by law or by its charter to assist in disaster relief efforts. This will be done to coordinate with those entities in notifying a parent/guardian, personal representative, family member, other relative, close personal friend, or other person identified by you or by your legal representative of your location, general condition or death.
Required by Law
We may use or disclose health information about you when we are required to do so by law.
Public Health Activities
We may disclose health information about you for public health activities and purposes. This includes reporting health information to a public health authority that is authorized by law to collect or receive the information for purposes of preventing or controlling disease. Or, one that is authorized to receive reports of child abuse and neglect. It also includes reporting for purposes of activities related to the quality, safety or effectiveness of a United States Food and Drug administration regulated product or activity.
Victims of Abuse, Neglect or Domestic Violence
We may disclose health information about you to a government authority authorized by law to receive reports of abuse, neglect, or domestic violence, if we believe you are a victim of abuse, neglect, or domestic violence. This will occur to the extent the disclosure is: (a) required by law; (b) agreed to by you or your personal representative; or, (c) authorized by law and we believe the disclosure is necessary to prevent serious harm to you or to other potential victims, or, if you are incapacitated and certain other conditions are met, a law enforcement or other public official represents that immediate enforcement activity depends on the disclosure.
Health Oversight Activities
We may disclose health information about you to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions. These and similar types of activities are necessary for appropriate oversight of the health care system, government benefit programs, and entities subject to various government regulations.
Judicial and Administrative Proceedings
We may disclose health information about you in the course of any judicial or administrative proceeding in response to an order of the court or administrative tribunal. We also may disclose health information about you in response to a subpoena, discovery request, or other legal process but only if efforts have been made to tell you about the request or to obtain an order protecting the information to be disclosed.
Disclosures for Law Enforcement Purposes
We may disclose health information about you to law enforcement officials for law enforcement purposes:
- As required by law.
- In response to a court, grand jury or administrative order, warrant or subpoena.
- To identify or locate a suspect, fugitive, material witness or missing person.
- About an actual or suspected victim of a crime and that person agrees to the disclosure. If we are unable to obtain that person’s agreement, in limited circumstances, the information may still be disclosed. To alert law enforcement officials to a death if we suspect the death may have resulted from criminal conduct.
- About crimes that occur at our facility.
- To report a crime in emergency circumstances
Coroners and Medical Examiners
We may disclose health information about you to a coroner or medical examiner for purposes such as identifying a deceased person and determining cause of death.
We may disclose health information about you to funeral directors as necessary for them to carry out their duties.
Organ, Eye or Tissue Donation
To facilitate organ, eye or tissue donation and transplantation, we may disclose health information about you to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue.
Under certain circumstances, we may use, sale or disclose health information about you for research; but only with your authorization. Before we disclose health information for research, the research will have been approved through an approval process that evaluates the needs of the research project with your needs for privacy of your health information. With your authorization, we may, however, disclose health information about you to a person who is preparing to conduct research to permit them to prepare for the project, but no health information will leave PARC during that person’s review of the information.
To Avert Serious Threat to Health or Safety
We may use or disclose protected health information about you if we believe the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public. We also may release information about you if we believe the disclosure is necessary for law enforcement authorities to identify or apprehend an individual who admitted participation in a violent crime or who is an escapee from a correctional institution or from lawful custody.
If you are a member of the Armed Forces, we may use and disclose health information about you for activities deemed necessary by the appropriate military command authorities to assure the proper execution of the military mission. We may also release information about foreign military personnel to the appropriate foreign military authority for the same purposes.
National Security and Intelligence
We may disclose health information about you to authorized federal officials for the conduct of intelligence, counter-intelligence, and other national security activities authorized by law.
Protective Services for the President
We may disclose health information about you to authorized federal officials so they can provide protection to the President of the United States, certain other federal officials, or foreign heads of state.
Inmates; Persons in Custody
We may disclose health information about you to a correctional institution or law enforcement official having custody of you. The disclosure will be made if the disclosure is necessary: (a) to provide health care to you; (b) for the health and safety of others; or, (c) the safety, security and good order of the correctional institution.
We may disclose health information about you to the extent necessary to comply with workers’ compensation and similar laws that provide benefits for work-related injuries or illness without regard to fault.
We may create a collection of information and aggregate statistics that are "de-identified" (e.g., it does not personally identify you by name, distinguishing marks or otherwise and not long can be connected to you).
Other Uses and Disclosures
Other uses and disclosures will be made only with your written authorization. You may revoke such an authorization at any time by notifying the PARC President & CEO or Compliance Officer, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710 in writing of your desire to revoke it. However, if you revoke such an authorization, it will not have any affect on actions taken by us in reliance on it.
Minimum Necessary Rule
Our workforce and Business Associates will not use or access your health information unless it is necessary to do their jobs. Also we disclose to others external to PARC's workforce only as much of your health information as is necessary to accomplish the recipient's lawful purposes. In accordance with the law, we presume that requests for disclosure of health information from another Covered Entity, as defined by HIPAA, are for the minimum necessary amount of health information to accomplish the requester's purpose.
Incidental Disclosure Rule
We will take reasonable administrative, technical and security safeguards to ensure the privacy of your health information when we use or disclose it.
Business Associate Rule
Business Associates and other third parties that receive your health information from us will be prohibited from re-disclosing it unless required to do so by law or you give prior express written consent to the re-disclosure. Our reciprocal agreements with Business Associates of PARC are based on the Business Associates compliance with HIPAA. Your authorization may not be sought when your health information is used and disclosed to Business Associates. Business Associates are directly liable for complying with HIPAA requirements.
Your Rights With Respect to Health Information About You
You have the following rights with respect to health information that we maintain about you.
Right to Request Restrictions
You have the right to request that we restrict the uses or disclosures of health information about you to carry out treatment, payment, or health care operations. You also have the right to request that we restrict the uses or disclosures we make to: (a) a family member, other relative, a close personal friend or any other person identified by you; or, (b) for to public or private entities for disaster relief efforts. For example, you could ask that we not disclose health information about you to your brother or sister. To request a restriction, you may do so at any time. If you request a restriction, you should do so to the PARC Compliance Officer, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710, 727-345-9111 and tell us: (a) what information you want to limit; (b) whether you want to limit use or disclosure or both; and, (c) to whom you want the limits to apply (for example, disclosures to your spouse). We are not required to agree to any requested restriction. However, if we do agree, we will follow that restriction unless the information is needed to provide emergency treatment. Even if we agree to a restriction, either you or we can later terminate the restriction.
Right to Receive Confidential Communications
You have the right to request that we communicate health information about you to you in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. We will not require you to tell us why you are asking for the confidential communication. If you want to request confidential communication, you must do so in writing to PARC Compliance Officer, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710, 727-345-9111. Your request must state how or where you can be contacted. We will accommodate your request. However, we may, if necessary, require information from you concerning how payment will be handled. We also may require an alternate address or other method to contact you.
Right to Inspect and Copy
With a few very limited exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of health information about you, in any format including electronically. To inspect or copy health information about you, you must submit your request in writing to the PARC Programs Executive, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710, 727-345-9111. Your request should state specifically what health information you want to inspect or copy. If you request a copy of the information, we may charge a fee for the costs of copying and, if you ask that it be mailed to you, the cost of mailing. We will act on your request within thirty (30) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying.
We may deny your request to inspect and copy health information if the health information involved is:
- Psychotherapy notes;
- Information compiled in anticipation of, or use in, a civil, criminal or administrative action or proceeding;
If we deny your request, we will inform you of the basis for the denial, how you may have our denial reviewed, and Page 5 of 6 how you may complain. If you request a review of our denial, it will be conducted by a licensed health care professional designed by us who was not directly involved in the denial. We will comply with the outcome of that review.
Right to Amend
You have the right to ask us to amend health information about you. You have this right for so long as the health information is maintained by us. To request an amendment, you must submit your request in writing to the PARC Programs Executive or Compliance Officer, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710, 727-345- 9111. Your request must state the amendment desired and provide a reason in support of that amendment. We will act on your request within sixty (60) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying. If we grant the request, in whole or in part, we will seek your identification of and agreement to share the amendment with relevant other persons. We also will make the appropriate amendment to the health information by appending or otherwise providing a link to the amendment.
We may deny your request to amend health information about you. We may deny your request if it is not in writing and does not provide a reason in support of the amendment. In addition, we may deny your request to amend health information if we determine that the information:
- Was not created by us, unless the person or entity that created the information is no longer available to act on the requested amendment;
- Is not part of the health information maintained by us;
- Would not be available for you to inspect or copy; or,
- Is accurate and complete.
If we deny your request, we will inform you of the basis for the denial. You will have the right to submit a statement of disagreeing with our denial. Your statement may not exceed two (2) pages. We may prepare a rebuttal to that statement. Your request for amendment, our denial of the request, your statement of disagreement, if any, and our rebuttal, if any, will then be appended to the health information involved or otherwise linked to it. All of that will then be included with any subsequent disclosure of the information, or, at our election, we may include a summary of any of that information.
If you do not submit a statement of disagreement, you may ask that we include your request for amendment and our denial with any future disclosures of the information. We will include your request for amendment and our denial (or a summary of that information) with any subsequent disclosure of the health information involved. You also will have the right to complain about our denial of your request.
Right to an Accounting of Disclosures
You have the right to receive an accounting of disclosures of health information about you. The accounting may be for up to six (6) years prior to the date on which you request the accounting but not before April 14, 2003. Certain types of disclosures are not included in such an accounting:
- Disclosures to carry out treatment, payment and health care operations;
- Disclosures of your health information made to you;
- Disclosures that are incident to another use or disclosure;
- Disclosures that you have authorized;
- Disclosures for our facility directory or to persons involved in your care;
- Disclosures for disaster relief purposes;
- Disclosures for national security or intelligence purposes;
- Disclosures to correctional institutions or law enforcement officials;
- Disclosures that are part of a limited data set for purposes of research, public health, or health care operations (a limited data set is where things that would directly identify you have been removed.
- Disclosures made prior to April 14, 2003.
Under certain circumstances your right to an accounting of disclosures to a law enforcement official or a health oversight agency may be suspended. Should you request an accounting during the period of time your right is suspended, the accounting would not include the disclosure or disclosures to a law enforcement official or to a health oversight agency.
To request an accounting of disclosures, you must submit your request in writing to the PARC Programs Executive or Compliance Officer, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710, 727-345-9111. Your request must state a time period for the disclosures. It may not be longer than six (6) years from the date we receive your request and my not include dates before April 14, 2003.
Usually, we will act on your request within thirty (30) calendar days after we receive your request. Within that time, we will either provide the accounting of disclosures in hardcopy format or electronically to you or give you a written or electronic statement of when we will provide the accounting and why the delay is necessary.
There is no charge for the first accounting we provide to you in any twelve (12) month period. For additional accountings, we may charge you for the cost of providing the list. If there will be a charge, we will notify you of the cost involved and give you an opportunity to withdraw or modify your request to avoid or reduce the fee.
Right to Copy of this Notice
You have the right to obtain a paper copy of our Notice of Privacy Practices. You may obtain a paper copy even though you agreed to receive the notice electronically. You may request a copy of our Notice of Privacy Practices at any time. You may obtain a copy of our Notice of Privacy Practices electronically over the Internet at the PARC web site, www.parc-fl.org.To obtain a paper copy of this notice, contact PARC Compliance Officer, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710, 727-345-9111.
Right to Complain and Get More Information
You may complain to us and to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us. To file a complaint with us, submit a Complaint Form to the PARC Compliance Officer, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710, 727- 345-9111. All complaints should be submitted in writing. A copy of the Complaint Form can be obtained from the PARC Compliance Officer.
To file a formal complaint with the United States Secretary of Health and Human Services, send your complaint to him or her within 180 days in care of: Office of Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201 877-696-6775 (toll-free). You will not be retaliated against for filing a complaint.
If you have any questions or want more information concerning this Notice of Privacy Practices, please contact the PARC Compliance Officer, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710, 727-345-9111.
We are required by law to maintain the privacy of health information about you and to provide individuals with notice of our legal duties and privacy practices with respect to health information. We are required to abide by the terms of our Notice of Privacy Practices in effect at the time.
Our Right to Change Notice of Privacy Practices
We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice’s provisions effective for all health information that we maintain, including that created or received by us prior to the effective date of the new notice.
Availability of Notice of Privacy Practices
A copy of our current Notice of Privacy Practices will be posted in the lobby of all areas where PARC services are rendered. A copy of the current notice also will be posted on our web sites, www.parc-fl.org. At any time, you may obtain a copy of the current Notice of Privacy Practices by contacting the PARC Compliance Officer, 3190 Tyrone Blvd. N., St. Petersburg, FL 33710, 727-345-9111.
These privacy practices will be effective April 14, 2003, and will remain in effect until we replace them as specified above. Updates have been made in accordance to the 2013 HIPAA Omnibus Ruling.