Privacy Standards Client Notification Form

This policy describes how Medical and certain related information about you may be used and disclosed and how you can get access to this information. Please review carefully.

General Information

Information regarding your health care, including payment for health care, is protected by two federal laws; the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under these laws, Guidance/Care Center may not disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.

Guidance/Care Center must obtain your written consent before it can disclose information about you for payment purposes. For example, Guidance/Care Center must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before Guidance/Care Center can share information for treatment purposes or for health care operations. However, federal law permits Guidance/Care Center to disclose information without your written permission:

  1. Pursuant to an agreement with a qualified service organization / business associate;
  2. For research, audit or evaluations;
  3. To report a crime committed on Guidance/Care Center’s premises or against Guidance/Care Center personnel;
  4. To medical personnel in a medical emergency;
  5. To appropriate authorities to report suspected child abuse or neglect;
  6. As allowed by a court order.

For example, Guidance/Care Center can disclose information without your consent to obtain legal or financial services, or to another medical facility to provide health care to you, as long as there is a qualified service organization / business associate agreement in place.

Before Guidance/Care Center can use or disclose any information about your health in a manner that is not described above, it must first obtain your specific written consent allowing it to make the disclosure. Any such written consent may be revoked by you, in writing.

Your Rights

Under the Health Insurance Portability Accountability Act (HIPAA) you have the right to request restrictions on certain uses and disclosures of your health information. Guidance/Care Center is not required to agree to any restrictions you request, but if it does agree then it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency.

You have the right to request that we communicate with you by alternative means or at an alternative location. Guidance/Care Center will accommodate such requests that are reasonable and will not request an explanation from you. Under HIPAA you also have the right to inspect and copy your own health information maintained by Guidance/Care Center, except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal or administrative proceeding or other limited circumstances as defined in 42 C.F.R.

Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in Guidance/Care Center’s records and to request and receive an accounting of disclosures of your health related information made by Guidance/Care Center during the six years prior to your request. You also have the right to receive a paper copy of this notice.

Guidance/Care Center's Duties

Guidance/Care Center is 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. Guidance/Care Center is required by law to abide by the terms of this notice. Guidance/Care Center reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. Upon request, Guidance/Care Center will mail you our most recent notice

Complaints and Reporting Violations

You may complain to Guidance/Care Center and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. Your complaint may be mailed to Guidance/Care Center’s Privacy Officer (listed below). You will not be retaliated against for filing such a complaint.

For further information, Contact:
Robert L Neri, LMHC, CAP
Privacy Officer
WestCare Foundation, Inc.
PO Box 12019,
St. Petersburg, FL 33702
(305) 434-7660

Eleven CARF Accredited Programs:

  • Case Management/Services Coordination: Mental Health (Adults)
  • Community Integration: Mental Health (Adults)
  • Community Integration: Psychological Rehabilitation (Adults)
  • Crisis Stabilization
  • Detoxification
  • Outpatient Treatment
  • Outpatient Treatment: Alcohol and Other Drugs/Addictions (Children and Adolescents)
  • Outpatient Treatment: Mental Health (Adults)
  • Outpatient Treatment: Mental Health (Children and Adolescents)
  • Prevention/Diversion

Equal Opportunity
GCC does not discriminate on the basis of age, race, sex, religion, color, disability, national origin, sexual orientation, or marital status.