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.

The Village is required by law to maintain the privacy of certain health care information about our patients. The law also requires health care providers like The Village to give you a Notice like this one and to follow its standards.

The Village and Your Protected Health Care Information

As a part of our day-to-day activities, The Village may need to use and disclose (share) your protected health care information for several purposes without first getting your written approval. Those purposes include:

• Your treatment. For example, The Village might discuss your condition and medications with your pharmacist.
• Payment for your treatment. For example, The Village may need to discuss your condition and the treatments The Village provided to you with your insurance company.
• The Village operations. For example, appropriate The Village staff must discuss your condition in order to provide you proper treatment.
• The Village may contact you based upon your protected health care information. For example, The Village may call to arrange your appointments, provide you with information about new medications, treatments, benefits and services that are available to you, and also to raise funds for The Village.
• The Village may provide information to government officials who oversee health care or are working on threats to public safety from unsafe products, diseases, abuse, neglect, domestic violence and other crimes.
• The Village may provide information to licensed researchers who are under strict rules regarding how they use and disclose protected health care information. Those researchers, as an example, may use the information about patients with your condition for a study to improve ways to combat diseases.
• Emergencies. For example, should you require emergency medical care, The Village will provide emergency medical personnel information about your medical condtion in order for them to provide care to you,.
• Public Health Activities. For example, the Village will report certain infectious diseases to the Department of Health, as required by law. It may report suspicious of child abuse or neglect to the State of Florida Child Abuse Hotline, as required by law.

No other uses and disclosures of your protected health care information will occur without your written authorization. And, if you sign such an authorization, you have the right to cancel it at any time. Note that disclosures in some of the situations described above are also regulated by Federal and State laws specifically govererning substance abuse treatment records. When these laws apply, your consent will be obtained before the Village discloses any health information.

The Village and Your Protected Health Care Information
Under the law, you have several rights that The Village is committed to upholding. Those rights include:

• The right to request restrictions on some of the ways The Village uses and discloses your information. These restrictions can go beyond the restrictions already in the law. However, The Village may not always agree to implement these additional restrictions.
• The right to receive confidential communications. While The Village cannot promise to communicate in every possible way patients might request, we will work with you to find a practical way of communicating with you in strict confidence if you wish.
• The right to inspect and get copies of your health care information held by The Village by making a request in writing. The Village, however, may charge a reasonable fee to cover only the cost of providing this information.
• The right to request that The Village amend or correct information about you. To make such a change, The Village will ask you to make the request in writing with a description of the reason you want your record changed. The Village may not always agree to such requests.
• The right to a list of The Village disclosures of your protected health care information that were not authorized by you and the disclosures that were unrelated to treatment, payment and The Village operations, and when such disclosures occured after April 13, 2003.

If you have any questions or complaints about the way The Village handles your protected health care information or if you believe your privacy rights have been violated, contact the The Village Privacy Officer at 305-571-2603 or in person. You can also contact the Secretary of the U.S. Department of Health and Human Services. Please note that there will be no retaliation against you for filing a complaint or making requests regarding your health care information, or for disagreeing with The Village-related decisions.

The Village may need to change its privacy practices from time to time. Before making such changes, however, The Village will modify this Notice and begin distributing it to patients when they are treated by The Village. These new practices will then apply to all information held by The Village, from the effective date of the new notice. At any time, you have a right to get a paper copy of the latest version of this Notice by asking your therapist or case manager.

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