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HIPAA

This Notice of Privacy Practices (NPP) describes how we may use and disclose your protected
health information to carry out treatment, payment or health care operations and for other
purposes that are permitted or required by law. It also describes your rights to access and
control your protected health information. Protected Health Information (PHI) is information
about you, including demographic information, that may identify you and that relates to your
past, present or future physical or mental health or condition and related health care services.

How We May Use and Disclose your Medical Information.

We will use your medical information as part of rendering patient care, for use by nurse or
therapist treating you, in order to bill for services and to review the quality of the care you
receive.

We will only use and/or disclose your information in accordance with federal and state laws. The
following uses and disclosures will only be made with your written authorization (i) most uses
and disclosures of psychotherapy notes (if recorded by a covered entity); (ii) uses and
disclosures of PHI for marketing purposes, including subsidized treatment communications; (iii)
disclosures that constitute a sale of PHI, and (iv) other uses and disclosures not described in the
NPP. You may revoke such authorization in accordance with §164.508(b)(5).

Treatment Information.

We may contact you with information about treatment times, schedules, physicians, or other
health related issues.

Disclosure to Department of Health and Human Services.

We may disclose medical information when required by the United States Department of Health
and Human Services as part of an investigation or determination of our compliance with
relevant laws.

Family and Caregivers

Unless you object, we may disclose your medical information to family members, other relatives
or caregivers when the medical information is directly relevant to that person(s) involvement
with your care.

Notification.

Unless you object, we may use or disclose your medical information to notify a family member,
a personal representative or another person responsible for your care of your location, general
condition or schedule. We will notify you of any breach of your unsecured PHI.

Disaster Relief.

We may disclose your medical information to a public or private entity, such as the American
Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts.

Health Oversight Activities.

We may use or disclose your medical information for public health activities, including the
reporting of disease, injury, vital events and the conduct of public health surveillance,
investigation and/or intervention. We may disclose your medical information to a health
oversight agency for oversight activities authorized by law, including audits, investigations,
inspections, licensure or disciplinary actions, administrative and/or legal proceedings.

Abuse or Neglect.

We may disclose your medical information when it concerns abuse, neglect or violence to you in
accordance with federal and state law.

Legal Proceedings.

We may disclose your medical information in the course of certain judicial or administrative
proceedings.

Law Enforcement.

We may disclose your medical information for law enforcement purposes or other specialized
governmental functions.

Coroners, Medical Examiners and Funeral Directors.

We may disclose your medical information to a coroner, medical examiner or a funeral director.

Organ Donation.

If you are an organ donor, we may disclose your medical information to an organ donation and
procurement organization.

Public Safety.

We may use or disclose your medical information to prevent or lessen a serious threat to the
health or safety of another person or the public.

Workers Compensation.

We may disclose your medical information as authorized by laws relating to workers
compensation or similar programs.

Business Associates.

We may disclose your health information to a business associate with whom we contract to
provide services on our behalf. To protect your health information, we require our business
associates to appropriately safeguard the health information of our patients.

Authorizations.

We will not use or disclose your medical information for any other purpose without your written
authorization. Once given, you may revoke your authorization in writing at any time. To
request Revocation of Authorization form, you may contact our Privacy Officer at (727) 846-
1919 or (352) 666-2771.

Your Rights Regarding Your Medical Information.

You have the following rights with respect to your medical information:

You may ask us to restrict certain uses and disclosures of your medical information to health
plans if you have paid for services out of pocket in full.

You have the right to receive communications from us in a confidential manner.

You may ask us to amend your medical information. We may deny your request for certain
specific reasons. If we deny your request, we will provide you with a written explanation for the
denial and information regarding further rights you may have at that point.

You have the right to complain to us and/or to the United States Department of Health and
Human Services if you believe that we have violated your privacy rights. If you choose to file a
complaint, you will not be retaliated against in any way. To complain to us, please contact our
Privacy Officer at (727) 846-1919 (Pasco and Pinellas Counties) or (352) 666-2771 (Hernando,
Citrus, Lake Marion, Sumter, Levy, Gilchrist, Dixie, Alachua Counties).

If you would like further information regarding your rights or regarding the uses and disclosures
of your medical information, you may contact our Privacy Officer at (727) 846-1919 (Pasco and
Pinellas Counties) or (352) 666-2771 (Hernando, Citrus, Lake Marion, Sumter, Levy, Gilchrist,
Dixie, Alachua Counties).

Revisions Of Notice Of Privacy Practices.

We reserve the right to change the terms of the Notice, making any revision applicable to all the
protected health information we maintain. If we revise the terms of this Notice, we will post a
revised copy at our office and will make paper copies of the revised Notice of Privacy Practices
available upon request.