Hope Floats 

Case Management

Services

Notice of Privacy Practices for Protected Health Information

45 CFR 164.520

Background

The HIPAA Privacy Rule gives individuals a fundamental new right to be informed of the privacy practices of their health plans and of most of their health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of these rights and practices. The notice is intended to focus individuals on privacy issues and concerns, and to prompt them to have discussions with their health plans and health care providers and exercise their rights.Notice of Privacy Practices for Protected Health Information

1. Authorized persons to use and disclose protected health information:

     Hope Floats Case Management Services will be authorized to disclose identified protected health information

     for case  management services.   This includes all past, present, and future periods of healthcare information.

2. Purpose of the use or disclosure: 

     The purpose of the disclosure is to allow proper treatment from a number of healthcare providers

3. Acknowledgement:

     Participants understand that the information used or disclosed under this Authorization may be subject to re-

     disclosure by the person or facility receiving it and then will no longer be protected by federal privacy

     regulations.  Participants  have the right to refuse to sign this authorization form. If signed, participants have

     the right to revoke this authorization, in writing, at any time. Participants understand that any action already

     taken in reliance on this authorization cannot be reversed, and my revocation will not alter those actions.