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.

Southwest Florida Employee Assistance Programs (SWFEAP) is required by law to maintain the privacy of certain health care information about our patients.  The law also requires health care providers like SWFEAP to give you a notice like this one and to follow its standards.

SWFEAP and your Protected Health Care Information.

As part of our day to day activities, SWFEAP may need to use and disclose (share) your protected health care information for several purposes without first getting your written approval.  These purposes include:

• Your treatment.  For example, SWFEAP might discuss your condition and medications with a psychiatrist we refer you to.
• Payment for your treatment.  For example, SWFEAP may need to discuss your condition and the treatment SWFEAP provided to you with another EAP that referred you’re here.
• SWFEAP operations.  For example, appropriate SWFEAP staff may discuss your condition in order to provide you proper treatment or referrals.
• SWFEAP may contact you based on your protected health care information.  For example, SWFEAP may call to change an appointment, to provide you with information about new mediations, treatments, benefits and services that are available to you.
• SWFEAP may provide information to government officials who oversee health care or are working on threats to public safety from unsafe products, diseases, abuse, neglect, domestic violence and other crimes.
• SWFEAP may provide information to licensed researchers who are under strict rules regarding how they use and disclose protected health care information.  Those researchers, for example, may use the information about patients with your condition for a study to improve ways to combat diseases.

No other uses and disclosures of your protected health care information will occur without your written authorization.  And, if you sign such an authorization, you have the right to cancel it at any time.

Your rights regarding your Protected Health Care Information  

Under the law, you have several rights that SWFEAP is committed to upholding.  These rights include:

• The right to request restrictions on some of the ways SWFEAP uses and discloses your information.  These restrictions can go beyond the restrictions already in the law.  However, SWFEAP may not always agree to implement these additional restrictions.
• The right to receive confidential communications.  While SWFEAP cannot promise to communicate in every possible way a patient may request, we will work with you to find a practical way of communicating with you in strict confidence if you wish.
• The right to inspect and get copies of your health care information held by SWFEAP by making a request in writing.  SWFEAP, however, may charge a reasonable fee to cover only the cost of providing this information.
• The right to request that SWFEAP amends or corrects information about you.  To make such a change, SWFEAP will ask you to make the request in writing with a description of the reason that you want your record changed.  SWFEAP may not always agree to such requests.
• The right to a list of the disclosures SWFEAP has made of your protected health care information that were not authorized by you and the disclosures that were unrelated to treatment, payment and SWFEAP operations.

If you have any questions or complaints about the way SWFEAP handles your protected health care information or if you believe your privacy rights have been violated, contact the SWFEAP Privacy Officer at 239-278-7435 or in person.  You may also contact the Secretary of the U. S. Department of Health and Human Services.  Please note that there will be no retaliation against you for filing a complaint or making requests regarding your health care information, or for disagreeing with SWFAEP related decisions.SWFEAP may need to change its privacy practices form time to time.  Before making such changes, however, SWFAEP will modify this notice, and begin distributing it to patients when they are treated at SWFEAP.  These new practices will then apply to all information held by SWFEAP.  At any time, anyone has a right to get a paper copy of the latest version of this notice by asking the SWFEAP receptionist.

Version 1.0
5/24/06