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.

ACTS is required by law to maintain the privacy of certain health care information about our patients.  The law also requires health care providers like ACTS to give you a Notice like this one and to follow its standards.

ACTS and Your Protected Health Care Information
As a part of our day-to-day activities, ACTS may need to use and disclose (share) your protected health care information for several purposes without first getting your written approval.  Those purposes include:
· Your treatment.  For example, ACTS might discuss your condition and medications with your pharmacist.
· Payment for your treatment.  For example, ACTS may need to discuss your condition and the treatments ACTS provided to you with your insurance company.
· ACTS operations.  For example, appropriate ACTS staff must discuss your condition in order to provide you proper treatment.
· ACTS may contact you based upon your protected health care information.  For example, ACTS may call to arrange your appointments, provide you with information about new medications, treatments, benefits and services that are available to you, and also to raise funds for ACTS.
· ACTS 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.
· ACTS may provide information to licensed researchers who are under strict rules regarding how they use and disclose protected health care information.  Those researchers, as an 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 ACTS is committed to upholding.  Those rights include:
· The right to request restrictions on some of the ways ACTS uses and disclosures your information.  These restrictions can go beyond the restrictions already in the law.  However, ACTS may not always agree to implement these additional restrictions.
· The right to receive confidential communications.  While ACTS cannot promise to communicate in every possible way patients might 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 ACTS by making a request in writing.  ACTS, however, may charge a reasonable fee to cover only the cost of providing this information.
· The right to request that ACTS amend or correct information about you.  To make such a change, ACTS will ask you to make the request in writing with a description of the reason you want your record changed.  ACTS may not always agree to such requests.
· The right to a list of ACTS disclosures of your protected health care information that were not authorized by you and the disclosures that were unrelated to treatment, payment and ACTS operations.

If you have any questions or complaints about the way ACTS handles your protected health care information or if you believe your privacy rights have been violated, contact the ACTS Privacy Officer at 813 246-4899 x230 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 ACTS-related decisions.

ACTS may need to change its privacy practices from time to time.  Before making such changes, however, ACTS will modify this Notice and begin distributing it to patients when they are treated by ACTS.  These new practices will then apply to all information held by ACTS.  At any time, anyone has a right to get a paper copy of the latest version of this Notice by asking the ACTS' receptionist.