Your Rights

When it comes to your health information, you have certain rights.

Get an electronic or paper copy of your medical record

• You, or your designee, can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Your request must be in writing to the program office or service provider that maintains your records.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
• We are not required to allow you to see or copy psychotherapy notes, information prepared for use in legal actions or proceedings, or where access is prohibited by law.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Your request must be in writing to the program office or service provider that maintains your records.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, if you are an outpatient client, you could request we contact you at your workplace or via email) or send mail to a different address. Your request must be in writing to the program office or service provider that maintains your records.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information. We are not required to agree to your request, and we may say “no” if it would affect your care.
• You can ask us not to share certain health information with family members. We are not required to agree to your request, and we may say “no” if it would affect your care.
• These requests must be in writing to the program office or service provider that maintains your records.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is you legal guardian, that person can exercise your rights and make choices about your health information. Your request must be in writing to the program office or service provider that maintains your records.
• We will make sure the person has this authority and can act for you before we take any action.

Receive breach notifications

• You will receive notification if there is a breach of your unsecured protected health information (PHI).

Get a list of those with whom we’ve shared Information

• You can ask for a list (Accounting of Disclosures) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. (Note: the list will not include any uses or disclosures made before April 14, 2003.) Your request must be in writing to the program office or service provider that maintains your records.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one Accounting of Disclosures a year for free but may a reasonable, cost-based fee if you ask for another one within twelve months.

Get a copy of this Privacy Notice

• You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. Please contact the office, facility or program where you receive services and we will provide you with a paper copy promptly.
• You may also view and download a copy of this Notice at: www.myflfamilies.com/hipaa.

File a complaint if you feel your rights are violated

If you feel your privacy rights have been violated, or you disagree with a decision we made about your protected health information (PHI), you may file a complaint with the Secretary of the U. S. Department of Health and Human Services and/or the Department of Children and Families by contacting either agency at the addresses below. No retaliatory actions will be taken against you for filing a complaint.

• The Department of Children and Families, Office of Civil Rights
  HIPAA Privacy Officer
  2415 North Monroe Street
  Suite 400
  Tallahassee, FL 32303-4190
  Phone: (850) 487-1901
  FAX: (850) 921-8470
• U. S. Department of Health and Human Services
  Sam Nunn Atlanta Federal Center, Suite 16T70
  61 Forsyth Street, SW
  Atlanta, GA 30303-8909
  Voice Phone: (404) 562-7453
  FAX: (404) 562-7881
  TDD: (404) 562-7884