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.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
Protected health information includes demographic and medical information that concerns the
past, present, or future physical or mental health of an individual. Demographic information
could include your name, address, telephone number, social security number and any other
means of identifying you as a specific person. Protected health information contains specific
information that identifies a person or can be used to identify a person.
Protected health information is health information created or received by a health care provider,
health plan, employer, or health care clearinghouse. The Poverello can act as each
of the above business types. This medical information is used by the Poverello in
many ways while performing normal business activities.
Your protected health information may be used or disclosed by the Poverello for
purposes of treatment, payment, and health care operations. Health care professionals use
medical information in the clinics or hospital to take care of you. Your protected health
information may be shared, with or without your consent, with another health care provider for
purposes of your treatment. The Poverello may use or disclose your health
information for case management and services. The Poverello clinic or hospital
may send the medical information to insurance companies, Medicaid, or community agencies to
pay for the services provided you.
Your information may be used by certain department personnel to improve the department’s
health care operations. The department also may send you appointment reminders, information
about treatment options or other health-related benefits and services.
Some protected health information can be disclosed without your written authorization as
allowed by law. Those circumstances include:
- Reporting abuse of children, adults, or disabled persons.
- Investigations related to a missing child.
- Internal investigations and audits by the department’s divisions, bureaus, and offices.
- Investigations and audits by the state’s Inspector General and Auditor General, and the
legislature’s Office of Program Policy Analysis and Government Accountability.
- Public health purposes, including vital statistics, disease reporting, public health
surveillance, investigations, interventions, and regulation of health professionals.
- District medical examiner investigations;
- Research approved by the department.
- Court orders, warrants, or subpoenas;
- Law enforcement purposes, administrative investigations, and judicial and administrative
Other uses and disclosures of your protected health information by the department will require
your written authorization. These uses and disclosures may be for marketing and for research
purposes, certain uses and disclosure of psychotherapist notes, and the sale of protected health
information resulting in remuneration to the Poverello.
This authorization will have an expiration date that can be revoked by you in writing.
You have the right to request the Poverello to restrict the use and disclosure of your
protected health information to carry out treatment, payment, or health care operations. You
may also limit disclosures to individuals involved with your care. The department is not required
to agree to any restriction.
You have the right to be assured that your information will be kept confidential. The Department
of Health will contact you in the manner and at the address or phone number you
select. You may be asked to put your request in writing. If you are responsible to pay for
services, you may provide an address other than your residence where you can receive mail and
where we may contact you.
You have the right to inspect and receive a copy of your protected health information that is
maintained by the Poverello within 30 days of the Department’s receipt of your
request.to obtain a copy of your protected health information. You must complete the
Department’s Authorization to Disclosure Confidential Information form and submit the request
to the county health department or Children’s Medical Services office. If there are delays in
getting you the information, you will be told the reason for the delay and the anticipated date
when you will receive your information.
Your inspection of information will be supervised at an appointed time and place. You may be
denied access as specified by law.
If you choose to receive a copy of your protected health information, you have the right to
receive the information in the form or format you request. If the Department cannot produce it in
that form or format, it will give you the information in a readable hard copy form or another
form or format that you and the Department agree to.
The Department cannot give you access to psychotherapy notes or certain information being
used in a legal proceeding. Records are maintained for specified periods of time in accordance
with the law. If your request covers information beyond that time the Department is required to
keep the record, the information may no longer be available.
If access is denied, you have the right to request a review by a licensed health care professional
who was not involved in the decision to deny access. This licensed health care professional will
be designated by the department.
You have the right to correct your protected health information. Your request to correct your
protected health information must be in writing and provide a reason to support your requested
correction. The Poverello may deny your request, in whole or part, if it finds the
protected health information:
- Was not created by the department.
- Is not protected health information.
- Is by law not available for your inspection.
- Is accurate and complete.
If your correction is accepted, the department will make the correction and tell you and others
who need to know about the correction. If your request is denied, you may send a letter
detailing the reason you disagree with the decision. The department may respond to your letter
in writing. You also may file a complaint, as described below in the section titled Complaints.
You have the right to receive a summary of certain disclosures the Poverello may
have made of your protected health information. This summary does not include:
- Disclosures made to you.
- Disclosures to individuals involved with your care.
- Disclosures authorized by you.
- Disclosures made to carry out treatment, payment, and health care operations.
- Disclosures for public health.
- Disclosures to health professional regulatory purposes.
- Disclosures to report abuse of children, adults, or disabled.
- Disclosures prior to April 14, 2003.
This summary does include disclosures made for:
- Purposes of research, other than those you authorized in writing.
- Responses to court orders, subpoenas, or warrants.
You may request a summary for not more than a 6 year period from the date of your request.
If you received this Notice of Privacy Practices electronically, you have the right to a paper copy
The Poverello may mail or call you with health care appointment reminders.
The Poverello is required by law to maintain the privacy of your protected health
information. This Notice of Privacy Practices tells you how your protected health information
may be used and how the department keeps your information private and confidential. This
notice explains the legal duties and practices relating to your protected health information. The
department has the responsibility to notify you following a breach of your unsecured protected
As part of the department’s legal duties this Notice of Privacy Practices must be given to you.
The department is required to follow the terms of the Notice of Privacy Practices currently in
The Poverello may change the terms of its notice. The change, if made, will be
effective for all protected health information that it maintains. New or revised notices of privacy
practices will be posted on the Poverello website at https://poverello.org/notice-of-privacy-practices-clients/ and will be available by email and at all Poverello buildings.
Also available are additional documents that further explain your rights to inspect and copy and
amend your protected health information.
If you believe your privacy health rights have been violated, you may file a complaint with the:
Poverello’s Inspector General at 2056 N Dixie Hwy, Wilton Manors, FL 33305.
The complaint must be in writing, describe the acts or omissions that you believe violate your
privacy rights, and be filed within 180 days of when you knew or should have known that the act
or omission occurred. The Poverello will not retaliate against you for filing a complaint.
FOR FURTHER INFORMATION
Requests for further information about the matters covered by this notice may be directed to the
person who gave you the notice, to the director or administrator of the Poverello
facility where you received the notice.
This Notice of Privacy Practices is effective beginning 03/18/2020, and shall be in effect until a
new Notice of Privacy Practices is approved and posted.
“Standards for the Privacy of Individually Identifiable Health Information; Final Rule.” 45 CFR
Parts 160 through 164. Federal Register 65, no. 250 (December 28, 2000).
“Standards for the Privacy of Individually Identifiable Health Information; Final Rule” 45 CFR
Part 160 through 164. Federal Register, Volume 67 (August 14, 2002).
HHS, Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification
Rules under the Health Information Technology for Economic and Clinical Health Act and the
Genetic Information and Nondiscrimination Act; Other Modifications to the HIPAA Rules, 78
Fed. Reg. 5566 (Jan. 25, 2013).