FLORIDA DEPARTMENT OF VETERANS’ AFFAIRS
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
The Florida Department of Veterans’ Affairs (FDVA) is required by law to maintain the privacy of your protected health information, to provide you with notice of its legal duties and privacy practices, and to notify affected persons regarding a breach of unsecured protected health information. FDVA is also required to abide by the terms of this notice and its privacy policies.
How FDVA May Use or Disclose Your Health Information
Federal law allows us to use or disclose your health information without your permission for the following purposes:
- Treatment. FDVA may use or share your information to provide you with health care services. For example, we may contact your doctor about a treatment plan.
- Payment. FDVA may use or share information to pay for your health care services, or to obtain payment, such as billing your health plan.
- Health Care Operations. FDVA may use or share information in order to manage its programs and activities. For example, to conduct a review of the quality of our services.
- Eligibility and Enrollment for Government Benefits. For example, we may submit information to the Veterans Administration or to the Medicaid Program to help you apply for public benefits.
- Abuse Reports and I nvestigations. FDVA is required by law to investigate and report allegations of abuse to the appropriate authorities.
- To Avoid Harm. FDVA may share information with law enforcement in order to avoid a serious threat to the health and safety of our residents.
- Family Members or Designated I ndividuals Assisting with Your Care. FDVA may share your information with persons involved with your care.
- When Required by Law and for Law Enforcement. FDVA will disclose information when required or permitted by state or federal law, or a court order.
FDVA will make no other uses or disclosures of your health information without your prior written authorization.
Your Privacy Rights
- Right to See and Get Copies of Your Records. You have the right to look at or get copies of your records.You must make the request in writing. There is a fee charged for the costs of copying records.
- Right to Request to Amend Your Records. You may ask FDVA to change or add missing information to your records if you think there is a mistake. You must make the request in writing, and provide a reason for your request.
- Right to a List of Disclosures. You have the right to ask for a list of the times your
information may have been disclosed. You must make the request in writing. This list will not include the times that information was disclosed for treatment, payment, health care operations, information provided directly to you or your family, or information that was sent with your authorization.
- Right to Request Limits on Uses or Disclosures of Health Information. You may ask FDVA to limit how your information is used or shared. You must make the request in writing, and tell FDVA what information you want to limit and to whom you want the limits to apply.
- Right to Revoke Permission. If you are asked to sign an authorization to share information, you can cancel that authorization at any time. You must make the request in writing. This will not affect information that has already been shared.
- Right to Choose How We Communicate with You. You may ask FDVA to share information with you in a certain way or in a certain place. For example, you may ask FDVA to send information to your work address instead of your home. You must make this request in writing. You do not have to explain the basis for your request.
- Right to File a Complaint. You have the right to file a complaint if you believe that your privacy rights have been violated.
- Right to Get a Paper Copy of this Notice. You may ask for a paper copy of this notice at any time.
Please contact the persons listed below if you desire more information or wish to make one of the requests listed above.
If you are a resident of a State Veterans’ Home, contact the Home Administrator:
- Alexander Nininger State Veterans’ Home (Pembroke Pines) (954) 985-4824
- Baldomero Lopez State Veterans’ Home (Land O’Lakes) (813) 558-5000
- Clifford Chester Sims State Veterans’ Home (Springfield) (850) 747-5401
- Clyde E. Lassen State Veterans’ Home (St. Augustine) (904) 940-2193
- Douglas Jacobson State Veterans’ Home (Port Charlotte) (941) 613-0919
- Emory L. Bennett State Veterans’ Home (Daytona) (386) 274-3460
- Robert Jenkins State Veterans’ Domiciliary Home (Lake City) (386) 758-0600
If you are a veteran or claimant seeking assistance in obtaining federal benefits, contact the FDVA Director, Division of Veterans’ Benefits and Assistance:
9500 Bay Pines Blvd, Room 214, Bay Pines, FL 33744 Telephone: (727) 319-7421, Fax: (727) 319-7780
Otherwise, please contact: the FDVA General Counsel
400 South Monroe Street, Suite 2105, Tallahassee, FL 32399
TEL: (850) 487-1533 FAX: (850) 488-4001
If you are concerned that your privacy rights have been violated, you may file a complaint with the FDVA General Counsel at the contact information listed above, or with the U.S. Department of Health and Human Services, Office of Civil Rights. FDVA cannot retaliate against you for filing a complaint, cooperating in an investigation, or refusing to agree to something that you believe to be unlawful.
FDVA 2090 (Revised September 18, 2013)