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 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

upon request.

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

health information.

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  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.



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).