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PASTORAL COUNSELING SERVICES

NOTICE OF PRIVACY PRACTICES
SUMMARY OF NOTICE
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.

As a client at Pastoral Counseling Services, we keep medical information about you. This information is personal and private. We need to use this information in many ways. First, we use the information when we treat you or refer you for treatment.

Second, we use the information in seeking payment for your care. Finally, we use this information for our health care operations and quality assurance.
Under the law, each patient has certain rights to the medical information kept at Pastoral Counseling Services. The rights are:

• Access: You can ask to look at your information.
• Restriction: You can ask to limit who is provided your information. You can ask to limit what information is released.
• Accounting: You can ask to see the list of places where your information has been sent.
• Amending: You can ask to change medical information if it is wrong.

A complete notice with explanations of uses, disclosures, rights and information on how to file a privacy complaint is available at the following:

• in person at our office.
• or by telephone at (904) 398-2437.

A client also has the right to file a complaint regarding privacy with the Secretary of Health and Human Services toll free 1-877-696-6775.

For further information contact our privacy official.

Florida Statutes: Florida statutorily grants patients the right of access to medical records maintained by health care practitioners. The disclosure of patient information by providers is generally prohibited without the patient's consent, subject to specified exceptions. Florida also has numerous laws protecting the confidentiality of health information held by a variety of entities and government agencies.
Effective date of policy April 14, 2003.