Health Management Institute
And
Canopy Cove Eating Disorder Treatment Center

Notice of Privacy Practices
Effective April 14, 2003

This notice describes how health information about you may be used
and disclosed and how you can get access to this information.

Health Management Institute and Canopy Cove are required by law to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information. This notice applies to all of the records and information of your care generated by our office.

Uses and Disclosures of Your Health Information

We use your health information to make sure we can appropriately treat you, receive payment for our services and conduct our necessary health care operations. Some examples include:

Treatment: We may use health information about you to provide you with treatment or services. We may disclose health information about you to the practice’s office personnel who are involved in taking care of you at the office or elsewhere. We also may disclose health information about you to people outside our office who may be involved in your care after you leave the office, such as family members or others we use to provide services that are part of your care provided you have consented to such disclosure. These entities include third party physicians, hospitals, pharmacies, nurses or clinical labs with whom the office consults or make referrals.

Payment: We may disclose health information to your insurance provider for the purpose of payment of health care operations. We will submit an itemized billing statement to your insurance carrier for the purpose of payment for health care services rendered. The billing statement contains medical/health information, including diagnosis, date of condition, and codes which describe the health care services received.

Health Care Operations: We may use and disclose health information about you for medical office operations. These uses and disclosures are necessary to run our office and make sure that all of our patients receive quality care.

Appointment Reminders: We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or health care at the office, following the procedures agreed upon in the authorization form.

Treatment Alternatives: We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care: We may release health information about you to a friend or family member who is involved in your health care provided you have consented to such information to someone who helps pay for your care.

Emergencies: We may disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

As Required By Law: We will disclose medical information about you when required to do so by federal, state or local law.

SPECIAL SITUATIONS:

Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order.

Law Enforcement: We may disclosure your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.

Coroners, Medical Examiners and Funeral Directors: We may release health information to a coroner or medical examiner.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. We may charge a fee for the costs associated with your request. We may deny your request in certain very limited circumstances.

Right to Amend: If you feel that medical information we have about you is incorrect or incomplete, you have the right to request an amendment for as long as the information is kept by or for our office. However, we are not required to agree to amend your protected health information. Should your request be denied, you will be provided with an explanation of our denial reasons and how you can disagree with the denial.

Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures,” of your protected health information made by Health Management Institute or Canopy Cove.

Right to Request Restrictions: You have the right to request a restriction on certain uses or disclosures of your health information. We are not required to agree to your request.

Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.

CHANGES TO THIS NOTICE:

Health Management Institute and Canopy Cove reserve the right to amend this Notice of Privacy Practices at any time in the future and will make the new provisions effective for all information that it maintains. Until such amendment is made, Health Management Institute and Canopy Cove, is required by law to comply with this Notice.

Health Management Institute and Canopy Cove are required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions concerning any part of this notice or if you want more information about your privacy rights, please contact: the Privacy Officer at 850-893-8800.

COMPLAINTS:

Complaints about your Privacy rights, or how Health Management Institute or Canopy Cove has handled your health information should be directed to the Privacy Officer by calling our office at 850-893-8800. If the Privacy Officer is unavailable you may make an appointment for a personal conference in person or by telephone.

If you are not satisfied with the manner in which you complaint was handled, you may submit a formal complaint to:

DHHS, Office of Civil Rights; 200 Independence Avenue, S.W.; Room 509F HHH Building, Washington, DC 20201

You will not be penalized or retaliated against for filing a complaint.

OTHER USES OF MEDICAL INFORMATION:

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission.