NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
Protected health information is health information created or received by a health care provider, health plan, employer, or health care clearinghouse. Peaceful Mind Therapy of Florida, LLC is a mental health counseling provider. Your mental health information is used by Peaceful Mind Therapy of Florida in many ways throughout the counseling process and while performing normal business activities.
Protected health information includes demographic and medical information that concerns the past, present, or future physical or mental health of an individual. Demographic information could include your name, address, telephone number, date of birth, insurance ID number, social security number and any other means of identifying you as a specific person. Protected health information contains specific information that identifies a person or can be used to identify a person.
Your protected health information may be used or disclosed by Peaceful Mind Therapy for purposes of treatment, payment, and mental health care operations. Health care professionals use this information to take care of you. Your protected health information may be shared, with your consent, with another health care provider for purposes of your treatment. Peaceful Mind Therapy may use or disclose your health information for case management and services, or send the medical information to insurance companies, Medicaid, or community agencies to pay for the services provided you. Your information will be used to improve your mental health care services.
We may also send you appointment reminders, information about treatment options or other mental health-related benefits and services.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
You can ask to see or get an electronic or paper copy of a summary of your mental health record and other health information we have about you.
You can ask us to correct your mental health record if any information is has changed
You can ask us to correct mental health information about you that you think is incorrect or incomplete.
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
You can ask us to use or share certain health information with specific individuals or entitities with your written permission
If you pay for a service or health care item outof-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
Some protected health information can be disclosed without your written authorization as allowed by law. Those circumstances include:
Reporting abuse of children, adults, or disabled persons.
Investigations related to a missing child;
Court orders, warrants, or subpoenas;
Law enforcement purposes, administrative investigations, and judicial and administrative proceedings.
Other uses and disclosures of your protected health information will require your written authorization on a release of information document to be kept on file in this office.
You have the right to limit disclosures to individuals involved with your care.
You have the right to be assured that your information will be kept confidential. Peaceful Mind Therapy agrees to make contact with you in the manner and at the address or phone number you select. You may be asked to put your request in writing.
Peaceful Mind Therapy cannot give you access to psychotherapy notes or certain information being used in a legal proceeding. Records are maintained for specified periods of time in accordance with the law. If your request covers information beyond that time the information may no longer be available.
In the event of a personal crisis, clients are instructed to call 911 or go to the nearest emergency room. NCH (350 7th Street North, Naples, FL (239) 624-5000) provides psychiatric health practitioners for individuals in crisis with mental health and substance abuse issues. Park Royal Hospital in Ft. Myers is a private psychiatric hospital providing inpatient and outpatient treatment - 9241 Park Royal Drive, Fort Myers, FL (239) 985-2760. You may also call 24-hour crisis hotlines of Project Help (239) 262-7227 or David Lawrence Center (239) 455-8500. As soon as possible, please make a follow-up call to Jane at 239-302-7801 to advise her of your current situation.
To leave a non-crisis message, to cancel or change an appointment with Jane, please call 239-239-302-7801 and leave a message. You may also send an email or text provided you have signed the informed consent for the use of electronic messaging.
Peaceful Mind Therapy of Florida - 1185 Immokalee Road, Suite 220 - Naples, FL 34110 (239) 302-7801