Notice of Privacy Practices
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.
Your Information. Your Rights. Our Responsibilities. This notice applies to the information that we have about your health care and services that you receive through APD. APD is required by law to notify you of our legal duties and privacy practices, your rights, and describe the ways we may access, use, and disclose your protected health information. We must maintain the privacy of your health information and follow the terms of this notice.
Your Rights. When it comes to your health information, you have certain rights. You have the right to:
HIPAA Privacy Official Office of the General Counsel Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399 Telephone: (850) 922-9512
Centralized Case Management Operation
US Department of Health and Human Services
200 Independence Avenue, SW—Room 509F HHH Building Washington, DC 20201
Telephone: (800) 368-1019
TDD toll-free: (800) 537-7697 | Fax: (202) 619-3818
OCRComplaint@hhs.gov
Your Choices. For certain health information, you can tell us your choice about what we share.
Our Uses and Disclosures of Your Protected Health Information. APD is permitted to use or disclose your health information for treatment, payment, and health care operations. If you are an APD Medicaid Waiver applicant or recipient, APD uses your health information to determine your eligibility for the Developmental Disabilities Individual Budgeting Medicaid Waiver program and to determine the amount of assistance that you need for your care. We also use it to manage the Developmental Disabilities Individual Budgeting Medicaid Waiver program. Here are some examples of how we typically access, use, and/or disclose your health information: We share information about your
diagnosis and care needs to determine your initial or ongoing eligibility for the program, as well as to coordinate supported living services and placement in a care facility. We share information to pay for your health care products and services, including federal and state funding programs such as Medicaid. It is used and disclosed to appropriate APD staff members, business associates, volunteers, as well as other government agencies who are involved in your treatment, payment for your care, health care operations and oversight, including those who evaluate the performance of people involved in your care.
How else can we use or share your health information? APD is allowed or required to share your information in other ways without your written authorization—usually in ways that help public health, safety, and research. We have to meet many conditions in the law before we can share your information for these purposes. Examples of other times when we can share your information include:
Other Uses and Disclosures. Other uses and disclosures not described in this notice will be made only with your written authorization. If you give us written authorization, you may revoke it at any time.
Our Responsibilities. We are required by law to maintain the privacy and security of your protected health information. We are required to follow the duties and privacy practices described in this notice and give you a copy of it. We are required to let you know promptly if a breach occurs that may have compromised the privacy or security of your health information. We will not use or share your information other than described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time.
Changes to this notice. APD reserves the right to change the terms of this notice; and, the changes apply to all information that we have about you. The new notice will be on our web site and we will mail a copy to you.
Contact Information. If you have any questions, requests, or would like a printed copy of this notice, please contact your APD office in your area at the telephone number listed below. We may ask that you make a request in writing. Northwest Region (for Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, and Washington counties) call (850) 487-1992; Northeast Region (for Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Lafayette, Levy, Madison, Nassau, Putnam, St. Johns, Suwannee, Taylor, Union, and Volusia counties) call (904) 992-2440; Central Region (for Brevard, Citrus, Hardee, Hernando, Highlands, Lake, Marion, Orange, Osceola, Polk, Seminole, and Sumter counties) call (407) 245-0440; Suncoast Region (for Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee, Pasco, Pinellas, and Sarasota counties) call (813) 233-4300; Southeast Region (for Broward, Indian River, Martin, Okeechobee, Palm Beach, and Saint Lucie counties) call (561) 837-5564; Southern Region (for Dade and Monroe counties) call (305) 349-1478; Sunland Center call (850) 482-9210; and Tacachale Center call (352) 955-5580
Who receives this Notice of Privacy Practices. APD sends this notice to every recipient household. This notice applies to all consumers served by the Agency. To comply with Section 504 of the Rehabilitation Act of 1973 or the Americans with Disabilities Act of 1990, please contact the HIPAA Privacy Official at the address shown on this Notice if you would like to receive this Notice in an alternate format such as Braille, large print, or audio.
APD OGC HIPAA Form #0000 (Effective date: August 11, 2017)
Serving developmentally and physically disabled persons throughout the Treasure Coast
Florida