This Notice describes how your medical and mental health information may be used and disclosed, and how you can access this information. Please review it carefully.
⚖️ Your Rights
You have the right to:
- 📄 You may request to inspect or obtain a copy of your evaluation records, treatment records, or other protected health information (PHI). We will provide access within 30 days as required by HIPAA.
- If your evaluation was requested, funded, or authorized by a third‑party agency—including Social Security Disability, Vocational Rehabilitation, or similar referral sources—that agency maintains control over the evaluation record. In these cases, you must contact the referring agency directly to obtain copies of your evaluation or documentation, as we are not permitted to release those records without their authorization.
- ✏️ Request corrections
If you believe information is incomplete or incorrect, you may request an amendment. - 🔒 Request confidential communications
You may ask us to contact you in a specific way (phone, email, text) or at a specific location. - 🚫 Request limits on what we use or share
You may ask us not to use or disclose certain information. We will consider your request but are not required to agree. - 📜 Get a list of disclosures
You may request a list of when your information was shared for reasons other than treatment, payment, or healthcare operations. - 📑 Get a copy of this Notice
You may request a paper or electronic copy at any time. - 👤 Choose someone to act for you
A legal guardian or medical power of attorney may exercise your rights. - 🛡️ File a complaint
You may file a complaint with us or with the U.S. Department of Health and Human Services if you believe your rights have been violated. We will not retaliate.
🎛️ Your Choices
You may tell us your preferences about how we share information in certain situations, including:
- Sharing information with family or others involved in your care
- Sharing information in a disaster relief situation
- Receiving appointment reminders
- Receiving billing or administrative communications
You may opt out of email, text messaging, voicemail, or telehealth communication methods at any time.
🩺 Our Uses and Disclosures
We typically use or share your health information in the following ways:
🧠 Treatment
We use your information to provide psychological evaluations, diagnostic clarification, forensic assessments, and recommendations.
💳 Payment
We may use and disclose your information to bill and receive payment from you or third‑party payers (if applicable).
🗂️ Healthcare Operations
We use your information for practice management, quality improvement, and administrative tasks.
🔍 Other Uses and Disclosures
We may share your information without your authorization in the following situations:
- ⚖️ Required by law: We must disclose information when required by federal or state law.
- 🚨 Public health and safety: We may share information to prevent or reduce serious threats to health or safety.
- 🧒 Abuse, neglect, or exploitation: Florida law requires reporting suspected abuse or neglect of children, elders, or vulnerable adults.
- 🏛️ Judicial and administrative proceedings: We may disclose information in response to a court order, subpoena, or other legal process.
- 👮 Law enforcement: We may disclose information for law enforcement purposes when legally required.
- 💼 Workers’ compensation: We may disclose information as authorized by workers’ compensation laws.
- ⚰️ Coroners and medical examiners: We may share information when necessary for identification or determining cause of death.
🧾 Special Rules for Forensic & Court‑Related Evaluations
If you are referred for a forensic evaluation, court‑ordered assessment, fitness for duty, immigration evaluation, or disability determination:
- Your information may be shared with the referring attorney, court, agency, or employer.
- You may not have the right to restrict disclosures.
- You may not have the right to access the evaluation report until legal proceedings are complete.
- Confidentiality is limited by the nature of the evaluation.
These limits will be explained before the evaluation begins.
🍃 Substance Use Information (42 CFR Part 2)
If your record contains information related to substance use treatment:
- We will not disclose this information without your specific written consent.
- Redisclosure is prohibited unless explicitly allowed by law.
💻 Electronic Communication
We offer communication via email, text message, telehealth platforms, and online forms. Electronic communication carries risks. You may opt out at any time.
🛡️ Our Responsibilities
We are required to:
- Maintain the privacy and security of your protected health information
- Notify you if a breach occurs that may compromise your privacy
- Follow the duties and privacy practices described in this Notice
- Provide you with a copy of this Notice
- Not use or share your information other than described here unless you authorize it in writing
🔄 Changes to This Notice
We may update this Notice at any time. The revised Notice will be posted on our website and available in our office.
Ready to Get Started?
Contact the office with any questions or to schedule an appointment.
Phone:
772‑249‑2593