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| FDVA NOTICE OF PRIVACY PRACTICES |
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FLORIDA DEPARTMENT OF VETERANS' AFFAIRS
NOTICE OF PRIVACY PRACTICES
Effective Date: April 7, 2003
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 Florida Department of Veterans' Affairs provides services for certain veterans in need of health care. FDVA staff must collect information about you to provide these services. The information that is collected about you and your health is private, and we are required to protect this information by Federal and State law. This information is called "protected health information" (PHI). Not all situations will be described. FDVA is required to give you this Notice of Privacy Practices for the information that is collected about you. FDVA is required to follow the terms of the notice. This Notice of Privacy Practices will tell you how FDVA may use or disclose the information.
FDVA May Use and Disclose Certain Information Without Your Authorization
For Treatment. FDVA may use or disclose information with health care providers who are involved in your health care. For example, information may be shared to create and carry out a plan for your treatment.
For Payment. FDVA may use or disclose information to get payment or to pay for the health care services you receive. For example, FDVA may provide PHI to bill your health plan for health care provided to you.
For Health Care Operations. FDVA may use or disclose information in order to manage its programs and activities. For example, FDVA may use PHI to review the quality of services you receive.
As Required by Law and For Law Enforcement. FDVA will use and disclose information when required or permitted by federal or state
law or by a court order.
For Abuse Reports and Investigations. FDVA is required by law to investigate and report allegations of abuse.
For Government Programs. FDVA may use and disclose information for public benefits under other government programs. For example, FDVA may disclose information for the determination of Medicaid
benefits.
To Avoid Harm. FDVA may disclose PHI to law enforcement in order to avoid a serious threat to the health and safety of a resident in one of its facilities.
Disclosures to Family, Friends, and Others. FDVA may disclose information to your family or other persons who are involved in your medical care. You have the right to object to the sharing of this information.
Other Uses and Disclosures Require Your Written Authorization. For other situations, FDVA will ask for your written authorization before using or disclosing information. You may cancel this authorization at any time in writing. FDVA cannot take back any uses or disclosures that you have previously authorized. For example, you must give your written authorization for FDVA to use and disclose your mental health and chemical dependency treatment records.
Right to See and Get Copies of Your Records. In most cases, you have the right to look at or get copies of your records. You must make the request in writing. Depending on how often you request copies of your records, you may be charged a fee for the cost of copying your records.
Right to Request to Amend or Update Your Records. You may ask FDVA to change or add missing information to your records if you think there is a mistake. You must make the request in writing, and provide a reason for your request.
Right to Get a List of Disclosures. You have the right to ask FDVA for a list of disclosures made after April 14, 2003. You must make the request in writing. This list will not include the times that information was disclosed for treatment, payment, or health care procedures. The list will not include information provided directly to you or your family, or information that was sent with your authorization.
Right to Request Limits on Uses or Disclosures of PHI. You have the right to ask that FDVA limit how your information is used or disclosed. You must make the request in writing, and tell FDVA what information you want to limit and to whom you want the limits to apply.
FDVA form 2095 may be used for this purpose. FDVA is not required to agree to the restriction. You can request that the restrictions be terminated in writing or verbally.
Right to Revoke Permission. If you are asked to sign an authorization to use or disclose information, you can cancel that authorization at any time. You must make the request in writing. This will not affect information that has already been shared.
Right to Choose How We Communicate with you. You have the right to ask that FDVA share information with you in a certain way or in a certain place. For example, you may ask FDVA to send information to your work address instead of your home address. You must make this request in writing. You do not have to explain the basis for your request.
Right to File a Complaint. You have the right to file a complaint if you do not agree with how FDVA has used or disclosed information about you.
Right to Get a Paper Copy of this Notice. You have the right to ask for a paper copy of this notice at any time.
How to contact FDVA to Review, Correct, or Limit Your Protected Health Information (PHI)
You may contact the FDVA Privacy Officer at the address listed at the end of this notice to:
Ask to look at or copy your records
Ask to correct or change your records
Ask to limit how information about you
Ask for a list of the times FDVA used or disclosed information about you
Ask to cancel your authorization
FDVA may deny your request to look at, copy or change your records. If FDVA denies your request, you will be sent a letter that tells you why your request is being denied and how you can ask for a review of the denial. You will also receive information about how to file a complaint with FDVA or with the U.S. Department of Health and Human Services, Office for Civil Rights.
How to File a Complaint or Report a Problem
You may contact the people listed below if you want to file a complaint or to report a problem with how FDVA has used or disclosed information about you. Your benefits or treatment will not be affected by any complaints you make. FDVA cannot retaliate against you for filing a complaint, cooperating in an investigation, or refusing to agree to something that you believe to be unlawful.
Office for Civil Rights
Medical Privacy, Complaint Division
U.S. Department of Health and Human Services 200 Independence Avenue, SW, HHH
Building, Room 509H Washington, D.C. 20201
Phone: 866-627-7748 TTY: 886-788-4989 Email: www.hhs.gov/ocr
For More Information
If you have any questions about this notice or need more information, please contact:
FDVA Privacy Officer
4040 Esplanade Way #180
Tallahassee, Florida 32399-7016
1-850-487-1533
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