Specialized Treatment, Education
and Prevention Services, Inc.
A Non-profit alcohol and drug treatment program
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STEPS - 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. STEPS is required by law to maintain the privacy of certain health care information about our patients. The law also requires health care providers like STEPS to give you a Notice like this one and to follow its standards. STEPS and Your Protected Health Care Information - As a part of our day-to-day activities, STEPS may need to use and disclose (share) your protected health care information for several purposes without first getting your written approval. Those purposes include:
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 STEPS is committed to upholding. Those rights include:
If you have any questions or complaints about the way STEPS handles your protected health care information or if you believe your privacy rights have been violated, contact the STEPS Privacy Officer at 407-522-2144 or in person. You can 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 STEPS-related decisions. STEPS may need to change its privacy practices from time to time. Before making such changes, however, STEPS will modify this Notice and begin distributing it to patients when they are treated by STEPS. These new practices will then apply to all information held by STEPS. At any time, anyone has a right to get a paper copy of the latest version of this Notice by asking the STEPS’ receptionist. I have received a copy of STEPS’ Notice of Privacy Practices. I understand that if STEPS uses my personal health information in a manner that is different than described by the Notice, STEPS must first get my permission in writing. I am accepting this Notice on behalf of: ___Myself or ___Another person as his or her personal representative (parent, guardian, family member etc.)
SIGNATURE: Effective Date:
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