THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSE AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
Effective date: April 14th, 2003
Ivette M Gomez has been and will always be totally committed to maintaining
client confidentiality. We will only release healthcare information
about you in accordance with federal and state laws and ethics of
the counseling profession.
This notice describes our policies related to the use and disclosure
of the healthcare information.
Uses and disclosures of your health information for the purposes of
providing services: Providing treatment services, collecting payment
and conducting healthcare operations are necessary activities for
quality care; State and Federal laws allows us to use and disclose
your health information for these purposes.
We may need to use or disclose
health information about you to provide, manage or coordinate your
care or related services which could include consultants and potential
referral sources.
Information needed to verify
insurance coverage and/or benefits with your insurance carrier, to
process your claims as well as information needed for billing and
collection purposes. We may bill the person in your family who pays
for your insurance.
Healthcare operation: We may need to use information about you to
review our treatment procedures and business activity. Information
may be used for certification, compliance and licensing activities.
Other uses or disclosures of your information which does not require
your consent: There are some instances where we may be required to
use and disclose information without your consent. For example, but
not limited to: Information you and or your child or children report
about physical or sexual abuse: then, by Florida State Law, we are
obligated to report this to the Department of Children and Family
Services. If you provide information that informs us that you are
in danger of harming yourself or others; Information to remind you
of/or to reschedule appointment or treatment alternatives; information
shared with law enforcement if a crime is committed on our premises
or against our staff or as required by law such as a subpoena or court
order. |
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