Mental Health Care, Inc.
5707 North 22nd St.
Tampa, FL 33610
(813)272-2244

E.P.T.
(813)236-3593

Employee Email

Mental Health Care, Inc.

HIPAA Notice Of Privacy Practices

NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.

Mental Health Care, Inc. is required by law to protect certain aspects of your health care information know as Protected Health Information or PHI and to proved you with this Notice of Privacy Practices.

This Notice describes our privacy practices, your legal rights, and lets you know, how Mental Health Care, INC. is permitted to:

Use and disclose PHI about you
How you can access and copy that information
How you may request amendment of that information
How you may request restrictions on our use and disclosure of your PHI.

In most situations we may use this information described in this Notice without your permission, but there are some situations where we may use it only after we obtain your written authorization, if we are required by law to do so.

Mental Health Care respects your privacy, and treats all health care information about our patients with care under strict policies of confidentiality that all of our staff are committed to following at all times.

PLEASE READ THE FOLLOWING DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT THE: HIPAA Privacy Officer at 813-236-3594.

Mental Health Care, Inc. is permitted by law to use your PHI:

For treatment: This includes such things as verbal and written information that we obtain about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel (including doctors and nurses who give orders to allow us to provide treatment to you). It also includes information we give to other healthcare personnel to whom we transfer your care and treatment, and includes transfer of PHI via radio or telephone to the hospital or dispatch center as well as providing the hospital, dispatch center, or the hospital with a copy of the written record we create in the course of providing you with treatment and transport.

For payment: This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such things as organizing your PHI and submitting bills to insurance companies (either directly or through a third party billing company), management of billed claims for services rendered, medical necessity determinations and reviews, utilization review, and collection of outstanding accounts.

For health care operations: This includes quality assurance and improvement activities, licensing and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, audit functions, including fraud and abuse detection and compliance, creating reports that do not individually identify you for data collection purposes.

Mental Health Care, Inc. may also contact you:

To remind you about appointments and give you information about treatment alternatives or other health- related benefits and services that may be of interest to you.

Use and Disclosure that does not require Mental Health Care, Inc. to have an Authorization:

Use and Disclosure of PHI Without Your Authorization: Mental Health Care Inc. is permitted to use PHI without your written authorization, or opportunity to object in certain situations, including:

For Mental Health Care’s use in treating you or in obtaining payment for services provided to you or in other health care operations;
For the treatment activities of another health care provider;
To another health care provider or entity for the payment activities of the provider or entity that receives the information(such as your hospital or insurance company);
To another health care provider ( such as the hospital to which you are transported or First Responder Agencies) for the health care operation activities of the covered entity that receives the information as long as the covered entity receiving the information has or has had a relationship with you and the PHI pertains to that relation;
For health care fraud and abuse detection or for activities related to compliance with the law;
To a family member, other relative, or close personal friend or other individual involved in your care or payment of care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family, relatives or friends if we infer from the circumstances that you would not object. For example, we may assume you agree to our disclosure of your personal health information to your spouse when your spouse has called the ambulance for you. In situation were you are not capable of objecting (because you are not present or due to your incapacity or medical emergency), we may in our professional judgment, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation, we will disclose only health information relevant to that person’s involvement in your care. For example we may tell your family or friends your condition and that you are in a hospital. In addition, we may disclose health information about you to assist in disaster relief efforts;
To a public health authority in certain situations( such as reporting a birth, death or disease as required by law, as part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse events such as product defects, or to notify a person about exposure to a possible communicable disease as required by law;
For health oversight activities including audits or government investigations, inspections disciplinary proceedings and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system;
For judicial and administrative proceedings as required by a court or administrative order;
For law enforcement activities in limited situations, such as when there is a warrant for the request, when the information is needed to locate a suspect or to stop a crime;
For military, national defense and security and other special government functions;
To avert a serious threat to the health and safety of a person or the public at large;
For workers’’ compensation purposes, and in compliance with workers’ compensation laws;
To coroners, medical examiners and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law;
For research projects, but this will be subject to strict oversight and approvals and health information will be released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the law;
If you are an organ donor, we may release health information to organizations that handle organ procurement or organs, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation and transplantation;
To the food and drug administration(FDA) relating to problems with food, supplements and products;
We may use or disclose health information about you in a way that does not personally identify or reveal who you are;
To the Department of corrections should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof , health information necessary for your health and the safety of other individuals;
Any other use or disclosure of PHI, other than those listed above will only be made with your written authorization, (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it.) You may revoke your authorization at any time, in writing except to the extent that we have already used or disclosed medical information based upon that authorization.

Your Health Information Rights:

Your Health Information Rights: As a patient, you have a number of rights with respect to the protection of your PHI, including:

The right to access copy or inspect your PHI: This means you may come to our office and inspect and copy most of the medical information that we maintain. We will normally provide you with access to this information within 30 days of your request; We may also charge you a fee for you to copy any medical information that you have the right to access. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials.

We have forms available for you to request access to your PHI. We will provide a written response if we deny you access and let you know your appeal rights. If you wish to inspect and copy your medical information, you should contact the privacy liaison listed at the end of this Notice.

The right to request amending your PHI: You have the right to ask us to amend written medical information that we may have about you. If errors are found, we will generally amend your information within 60 days of your request and will notify you when we have amended the information. We are permitted by law to deny your request to amend your medical information, but only in certain circumstances. For example, if we believe the information is correct and no errors exist, your request will be denied. If you wish to request that we amend the medical information that we have about you, you should contact in writing the privacy officer listed at the end of this Notice. You have a right to amend your PHI for as long as we keep it.

The right to request an accounting of our use and disclosure of your PHI: You may request an accounting from us of certain disclosure of your medical information that we have made in the last six years prior to the date of your request. We are not required to give you an accounting of information we have used or disclosed for purpose of treatment, payment, or health care operations, or when we share your health information with our business associates such as our billing company or a medical facility from / to which we have transported you.

We are also not required to give you an accounting of our uses of protected health information for which you have already given us written authorization. If you wish to request an accounting of the medical information about you that we have used or disclosed that is not exempt from the accounting requirement, you should contact the privacy officer listed at the end of this Notice.

The right to request that we restrict the uses and disclosures of your PH: You have the right to request that we restrict how we use and disclose your medical information that we have about you for treatment, payment or health care operations, or to restrict the information that we have about you for treatment, payment, or health

care operations, or to restrict the information that is provided to family, friends, and other individuals involved in your health care. However, if you request a restriction and the information you ask us to restrict is needed to provide you with emergency treatment, then we may use the PHI or disclose the PHI to a health care provider to provide you with emergency treatment. Mental Health Care Inc. is not required to agree to any restrictions you request, but any restrictions agreed to by Mental Health Care Inc. are binding on Mental Health Care Inc.

Copy of Paper Notice on Request: A copy of this Notice will be posted and made available through the Mental Health Care, Inc. Web site, you also may always request a paper copy of the Notice.

Revision to the Notice: Mental Health Care, Inc. reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all protected health information that we maintain. Any material changes to the Notice will be promptly posted in our facilities and posted to our web site. You can get a copy of the latest version of this Notice by contacting the Privacy Officer identified below.

Your legal Rights and Complaints: You also have the right to complain to us, or the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments or complaints you may direct all inquires to the privacy officer listed at the end of this Notice. Individuals will not be retaliated against for filing a complaint.

Complaints:

If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact :

Renika Jordan

HIPAA Privacy Officer Liaison

5707 N 22^nd St Tampa., Fl 33610

813-236-3594

You can also submit a complaint to the United States Department of Health and Human Services. Send your complaint to:

Office for Civil Rights

U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
OCR Hotlines-Voice: 1-800-368-1019

Privacy Notice for

Mental Health Care, Inc.

Full Notice

Version 2.0

A. What This Notice Covers

1. This notice describes the privacy policy and practices of Mental Health Care, Inc. Our main office is 5707 N. 22^{nd Street}^{Tampa FL 33610}^{, our website is}^{www.mhcinc.org}^{and we can be reached by phone at (813)272-2244.}

^{2. The policy and practices in this notice cover the processing of protected personal information for clients of Mental Health Care, Inc.}

^{3. Protected Personal information (PPI) is any information we maintain about a client that:}

^{a. allows identification of an individual directly or indirectly}

^{b. can be manipulated by a reasonably foreseeable method to identify a specific individual, or}

^{c. can be linked with other available information to identify a specific client. When this notice refers to personal information, it means PPI.}

^{4. We adopted this policy because of standards for Homeless Management Information Systems issued by the Department of Housing and Urban Development. We intend our policy and practices to be consistent with those standards. See 69 Federal Register 45888 (July 30, 2004).}

^{5. This notice tells our clients, our staff, and others how we process personal information. We follow the policy and practices described in this notice.}

^{6. We may amend this notice and change our policy or practices at any time. Amendments may affect personal information that we obtained before the effective date of the amendment.}

^{7. We give a written copy of this privacy notice to any individual who asks.}

^{8. We maintain a copy of this policy on our website:}

^{www.mhcinc.org}

^{B. How and Why We Collect Personal Information}

This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.

^{1. We collect personal information only when appropriate to provide services or for another specific purpose of our organization or when required by law. We may collect information for these purposes:}

^{a. to provide or coordinate services to clients}

^{b. to locate other programs that may be able to assist clients}

^{c. for functions related to payment or reimbursement from others for services that we provide}

^{d. to operate our organization, including administrative functions such as legal, audits, personnel, oversight, and management functions}

^{e. to comply with government reporting obligations}

^{f. when required by law}

^{2. We only use lawful and fair means to collect personal information.}

^{3. We normally collect personal information with the knowledge or consent of our clients. If you seek our assistance and provide us with personal information, we assume that you consent to the collection of information as described in this notice}

^{4. We may also get information about you from:}

^{a. Individuals who are with you}

^{b. Other private organizations that provide services (identify)}

^{c. Government agencies (identify)}

^{d. Telephone directories and other published sources}

^{5. We post a sign at our intake desk or other location explaining the reasons we ask for personal information. The sign says:}

^{"We collect personal information directly from you for reasons that are discussed in our privacy statement. We may be required to collect some personal information by law or by organizations that give us money to operate this program. Other personal information that we collect is important to run our programs, to improve services for homeless individuals, and to better understand the need of homeless individuals. We only collect information that we consider to be appropriate."}

^{C. How We Use and Disclose Personal Information}

^{1. We use or disclose personal information for activities described in this part of the notice. We may or may not make any of these uses or disclosures with your information. We assume that you consent to the use or disclosure of your personal information for the purposes described here and for other uses and disclosures that we determine to be compatible with these uses or disclosures:}

^{a. to provide or coordinate services to individuals We share client records with other organizations that may have separate privacy policies and that may allow different uses and disclosures of the information.}

^{b. for functions related to payment or reimbursement for services}

^{c. to carry out administrative functions such as legal, audits, personnel, oversight, and management functions}

^{d. to create de-identified (anonymous) information that can be used for research and statistical purposes without identifying clients}

^{e. when required by law to the extent that use or disclosure complies with and is limited to the requirements of the law}

^{f. to avert a serious threat to health or safety if}

^{(1) we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public, and}

^{(2) the use or disclosure is made to a person reasonably able to prevent or lessen the threat, including the target of the threat}

^{g. to report about an individual we reasonably believe to be a victim of abuse, neglect or domestic violence to a governmental authority (including a social service or protective services agency) authorized by law to receive reports of abuse, neglect or domestic violence}

^{(1) under any of these circumstances:}

^{(a) where the disclosure is required by law and the disclosure complies with and is limited to the requirements of the law}

^{(b) if the individual agrees to the disclosure, or}

^{(c) to the extent that the disclosure is expressly authorized by statute or regulation, and}

^{(I) we believe the disclosure is necessary to prevent serious harm to the individual or other potential victims, or}

^{(II) if the individual is unable to agree because of incapacity, a law enforcement or other public official authorized to receive the report represents that the PPI for which disclosure is sought is not intended to be used against the individual and that an immediate enforcement activity that depends upon the disclosure would be materially and adversely affected by waiting until the individual is able to agree to the disclosure. and}

^{(2) when we make a permitted disclosure about a victim of abuse, neglect or domestic violence, we will promptly inform the individual who is the victim that a disclosure has been or will be made, except if:}

^{(a) we, in the exercise of professional judgment, believe informing the individual would place the individual at risk of serious harm, or}

^{(b) we would be informing a personal representative (such as a family member or friend), and we reasonably believe the personal representative is responsible for the abuse, neglect or other injury, and that informing the personal representative would not be in the best interests of the individual as we determine in the exercise of professional judgment.}

^{h. for academic research purposes}

^{(1) conducted by an individual or institution that has a formal relationship with the CHO if the research is conducted either:}

^{(a) by an individual employed by or affiliated with the organization for use in a research project conducted under a written research agreement approved in writing by a designated CHO program administrator (other than the individual conducting the research), or}

^{(b) by an institution for use in a research project conducted under a written research agreement approved in writing by a designated CHO program administrator. and}

^{(2) any written research agreement:}

^{(a) must establish rules and limitations for the processing and security of PPI in the course of the research}

^{(b) must provide for the return or proper disposal of all PPI at the conclusion of the research}

^{(c) must restrict additional use or disclosure of PPI, except where required by law}

^{(d) must require that the recipient of data formally agree to comply with all terms and conditions of the agreement, and}

^{(e) is not a substitute for approval (if appropriate) of a research project by an Institutional Review Board, Privacy Board or other applicable human subjects protection institution.}

^{i. to a law enforcement official for a law enforcement purpose (if consistent with applicable law and standards of ethical conduct) under any of these circumstances:}

^{(1) in response to a lawful court order, court-ordered warrant, subpoena or summons issued by a judicial officer, or a grand jury subpoena}

^{(2) if the law enforcement official makes a written request for PPI that:}

^{(a) is signed by a supervisory official of the law enforcement agency seeking the PPI}

^{(b) states that the information is relevant and material to a legitimate law enforcement investigation}

^{(c) identifies the PPI sought}

^{(d) is specific and limited in scope to the extent reasonably practicable in light of the purpose for which the information is sought, and}

^{(e) states that de-identified information could not be used to accomplish the purpose of the disclosure.}

^{(3) if we believe in good faith that the PPI constitutes evidence of criminal conduct that occurred on our premises}

^{(4) in response to an oral request for the purpose of identifying or locating a suspect, fugitive, material witness or missing person and the PPI disclosed consists only of name, address, date of birth, place of birth, Social Security Number, and distinguishing physical characteristics, or}

^{(5) if}

^{(a) the official is an authorized federal official seeking PPI for the provision of protective services to the President or other persons authorized by 18 U.S.C. 3056, or to foreign heads of state or other persons authorized by 22 U.S.C. 2709(a)(3), or for the conduct of investigations authorized by 18 U.S.C. 871 and 879 (threats against the President and others), and}

^{(b) the information requested is specific and limited in scope to the extent reasonably practicable in light of the purpose for which the information is sought.and}

^{j. to comply with government reporting obligations for homeless management information systems and for oversight of compliance with homeless management information system requirements.}

^{2. Before we make any use or disclosure of your personal information that is not described here, we seek your consent first.}

^{D. How to Inspect and Correct Personal Information}

^{1. You may inspect and have a copy of your personal information that we maintain. We will offer to explain any information that you may not understand.}

^{2. We will consider a request from you for correction of inaccurate or incomplete personal information that we maintain about you. If we agree that the information is inaccurate or incomplete, we may delete it or we may choose to mark it as inaccurate or incomplete and to supplement it with additional information.}

^{3. To inspect, get a copy of, or ask for correction of your information, ask any staff member for access.}

^{4. We may deny your request for inspection or copying of personal information if:}

^{a. the information was compiled in reasonable anticipation of litigation or comparable proceedings}

^{b. the information is about another individual (other than a health care provider or homeless provider)}

^{c. the information was obtained under a promise or confidentiality (other than a promise from a health care provider or homeless provider) and if the disclosure would reveal the source of the information, or}

^{d. disclosure of the information would be reasonably likely to endanger the life or physical safety of any individual.}

^{E. Data Quality}

^{1. We collect only personal information that is relevant to the purposes for which we plan to use it. To the extent necessary for those purposes, we seek to maintain only personal information that is accurate, complete, and timely.}

^{2. We are developing and implementing a plan to dispose of personal information not in current use seven years after the information was created or last changed. As an alternative to disposal, we may choose to remove identifiers from the information.}

^{3. We may keep information for a longer period if required to do so by statute, regulation, contract, or other requirement.}

^{F. Complaints and Accountability}

^{We accept and consider questions or complaints about our privacy and security policies and practices. Complaints must be submitted in writing to this Agency and to:}

^{UNITY Grievance Committee}

^{Homeless Coalition of Hillsborough County}

^{P.O. Box}³⁶⁰¹⁸¹

^Tampa^{, FL 33673-0181}

^{The UNITY Grievance Committee will attempt to resolve your complaint. Should further review be required your complaint will be escalated to the UNITY Steering Committee to determine a voluntary resolution of the complaint. Resolution of the complaint will be provided in writing to the agency and the individual filing the complaint. This Agency and the UNITY Information Network are prohibited from retaliating against you for filing a complaint.}

^{1. All members of our staff (including employees, volunteers, affiliates, contractors and associates) are required to comply with this privacy notice. Each staff member must receive and acknowledge receipt of a copy of this privacy notice.}

^{G. Privacy Notice Change History}

^{1. Version 2.0. July 1, 2007. Initial Policy}