THIS NOTICE DESCRIBES HOW BEHAVIORAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOUCAN GET ACCESS TO THIS INFORMATION

1. PURPOSE: ABC’s for Success and its professional staff, employees, and interns follow the privacy practices described in this Notice. We keep your behavioral health information in records that will be maintained and protected in a confidential manner, as required by law. Please note that in order to provide you with the best possible care and treatment all professional staff involved in your treatment and Billing/Administrative staff involved in healthcare functions may have access to your records. ABC’s for Success and Early Steps Programs, HMO Insurance companies (such as United Behavioral Health and Evercare and others) work closely together and collaborate to provide the best services for our clients, therefore some information may be required to be exchanged with them, such as diagnostic summaries, assessments and reports. Your behavioral health record will be shared with Health care providers if you are referred by any of these health care providers. This sharing of information is done for your benefit and to facilitate the continuity of your care.

2. HOW WILL ABC’s for Success USE MY PROTECTED HEALTH INFORMATION? Your personal behavioral health record will be retained by ABC’s for Success for approximately seven (7) years after your last clinical contact with the agency. After that time has elapsed, the record will be shredded or burned or otherwise destroyed in a way that protects your privacy. Until the records are destroyed they may be used, unless you ask for restrictions on a specific use or disclosure, for the following purposes:

· Appointment reminders;

· Notification when an appointment is cancelled or rescheduled by the Center;

· As may be required by law;

For public health purposes such as reporting of child or elder abuse or neglect; reporting reactions to medications; infectious diseasecontrol; notifying authorities of suspected abuse, neglect, or domestic violence (if you agree or as required by law);Mental health oversight activities, e.g., audits, inspections or investigations of administration and management of ABC’s for Success;Lawsuits and disputes (We will attempt to provide you advance notice of subpoena before disclosing information from your record.);Law enforcement (e.g., in response to a court order or other legal process) to identify or locate an individual being sought byauthorities; about victim of a crime under restricted circumstances; about a death that may be the result of criminal conduct; aboutcriminal conduct that occurred in the Center; when emergency circumstances occur relating to a crime; To prevent a serious threat to health or safety;

3. YOUR AUTHORIZATION IS REQUIRED FOR OTHER DISCLOSURES. Except as described previously, we will not use or disclose information from your record unless you authorize (permit) in writing for ABC’s for Success to do so. You may revoke your permission, which will be effective only after the date of your written revocation.

4. YOU HAVE RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION. You have the following rights regarding your health information, provided that you make a written request to invoke the right on the form provided by ABC’s for Success.

Right to request restriction. You may request limitations on your behavioral health information we may disclose, but we are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Right to confidential communications. You may request communications in a certain way or at a certain location, but you must specify how or where you wish to be contacted.

Right to inspect and copy. You have the right to inspect and copy your behavioral health information regarding decisions about yourcare; however, psychotherapy notes may not be inspected and copied. We may charge a fee for copying, mailing, and supplies.Under limited circumstances, your request may be denied; you may request review of the denial by another licensed mental healthprofessional chosen by our agency. ABC’s for Success will comply with the outcome of the review.

Right to request to clarify record. If you believe that the information we have about you is incorrect or incomplete you may ask to add clarifying information. You may ask for a form for that purpose and the form will require certain specific information. ABC’s for Success is not required to accept the information that you propose. Right to accounting of disclosures. You may request a list of the disclosures of your behavioral health information that have been made to persons or entities other than for treatment or health care operations.

5. Right to a copy of this Notice. You may request a paper copy of this Notice at any time, even if you have been provided with an electronic copy.

6. REQUIREMENTS REGARDING THIS NOTICE. ABC’s for Success is required to provide you with this Notice that governs our privacy practices. ABC’s for Success may change its policies or procedures in regard to privacy practices. If and when changes occur, the changes will be effective for behavioral health information we have about you as well as any information we receive in the future. Any time you come in to ABC’s for Success for an appointment, you may ask for and receive a copy of the Privacy Notice that is in effect at the time.

7. COMPLAINTS: If you believe your privacy rights have been violated, you may file a complaint with ABC’s for Success, or with the Florida Department of Health or Agency for Healthcare Administration. You will not be penalized or retaliated against in any way for making a complaint.Contact: Call ABC’s for Success at 786-536-9714 and ask to speak to the Clinical Director if: you have a complaint;· you have any questions about this notice· you wish to request restrictions on uses and disclosure for health care treatment or operations; or ·· you wish to obtain any of the forms mentioned to exercise your individual rights described above.