Term and conditions
Effective date: July 22, 2023
Allpure Behavioral Health and all members of its Affiliated Covered Entity (collectively, “Allpure Behavioral Health” “we” or “our”) is required by law to maintain the privacy of your health information in accordance with state and federal law. In particular, we protect the privacy and security of your substance use disorder patient records in accordance with 42 U.S.C. § 290dd–2 and 42 C.F.R. Part 2, the Confidentiality of Substance Use Disorder Patient Records (“Part 2”), in addition to HIPAA and applicable state law. This Notice of Privacy Practices (“Notice”) outlines our legal duties and privacy practices with respect to health information. We are required by law to provide you with a copy of this Notice and to notify you following a breach of your unsecured health information.
We will abide by the terms of the Notice. We reserve the right to make changes to this Notice as permitted by law. We reserve the right to make the new Notice provisions effective for all health information we currently maintain, as well as any health information we receive in the future. If we make material or important changes to our privacy practices, we will promptly revise our Notice. Each version of the Notice will have an effective date listed on the first page. If we change this Notice, you can access the revised Notice on our website (www.allpurebh.com).
You have the right to:
- Get a copy of your paper or electronic medical record
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have.
- We will provide a copy or a summary of your health information, usually within 15-30 days of your request. We may charge a reasonable, cost-based fee.
- Correct your paper or electronic medical record
- You can ask us to correct health information about you that you think is incorrect.
- We may say “no” to your request, but we’ll tell you why in writing within 30 days.
- Request confidential communication
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different
- We will say “yes” to all reasonable requests.
- Ask us to limit the information we share
- You can ask us not to use or share certain health information for treatment or payment. We are not required to agree to your request, especially if it would impact your care.
- When you pay for a service out-of-pocket, you can ask us not to share that information for the purpose of payment or our operations with your health insurer if applicable. We will say “yes” unless a particular law requires us to do so.
- Get a list of those with whom we’ve shared your information
- You can ask for an accounting list that indicates the number of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and when it was done.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting per year for free but will charge a reasonable fee if you ask for multiples within a 12 month period.
- Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
- Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health. Please inform us of this if/when applicable.
- File a complaint if you believe your privacy rights have been violated
- You can complain if you feel we have violated your rights by contacting us
- You can file a complaint with the S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/ privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
You have some choices in the way that we use and share information:
In these cases, you have both the right and choice to tell us to:
- Tell family and friends about your condition
- Provide disaster relief
- Include you in a hospital directory
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to anyone’s health or safety.
In these cases we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
We may use and share your information as we:
- Treat you: We can use your health information and share it with other professionals who are treating you.
- Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary.
- Bill for your services: We can use and share your health information to bill and get payment from health plans or other entities.
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
- Help with public health and safety issues: We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
- Do research: We can use or share your information for health research.
- Comply with the law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
- Respond to organ and tissue donation requests: We can share health information about you with organ procurement organizations.
- Work with a medical examiner or funeral director: We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
- Address workers’ compensation, law enforcement, and other government requests:
- We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
- Respond to lawsuits and legal actions: We can share health information about you in response to a court or administrative order, or in response to a subpoena.
- We are required by law to maintain the privacy and security of your protected health
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your
- We must follow the duties and privacy practices described in this notice and give you a copy of
- We will not use or share your information other than as described here unless you tell us we can in If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION:
We will obtain your written authorization to use and disclose your health information unless we are permitted to use or disclose your information without your authorization under applicable law. The following categories describe the ways that we may use and disclose your health information without your written authorization under Part 2. To the extent applicable state law is even more restrictive than Part 2 on how we use and disclose any of your health information, we comply with more restrictive state law.
Within Our Organization. Allpure Behavioral Health personnel who have a need for your information in connection with their duties that arise out of the provision of diagnosis, treatment, or referral for treatment may use and share your information.
NO CONSENT REQUIRED
Emergency Treatment. In the event of a bona fide medical emergency in which your prior authorization cannot be obtained, we may disclose your identifying information to medical personnel. However, we will obtain your authorization prior to disclosing your information for non-emergent treatment.
Allpure Behavioral Health may use and/or disclose your PHI, without a written Consent from you, in the following additional example of instances:
(a) De-identified Information – Information that does not identify you and, even without your name, cannot be used to identify you.
(b) Business Associate – To a business associate if we obtain satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI. A business associate is an entity that assists Allpure Behavioral Health in undertaking some essential function, such as a billing company that assists in payment.
(c) Personal Representative -To a person who, under applicable law, has the authority to represent you in making decisions related to your health care
(d) Emergency Situations –
(i) for the purpose of obtaining or rendering emergency treatment to you provided that we attempt to obtain your Consent as soon as possible; or
(ii) to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating your care with such entities in an emergency situation.
(e) Communication Barriers – If, due to substantial communication barriers or inability to communicate, or we have been unable to obtain your Consent and we determine, in the exercise of its professional judgment, that your Consent to receive treatment is clearly inferred from the circumstances.
(f) Public Health Activities – Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent or control disease and that does not identify you and, even without your name, cannot be used to identify you.
(g) Abuse, Neglect or Domestic Violence – To a government authority if the Practice is required by law to make such disclosure; if we are authorized by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm
(h) Health Oversight Activities – Such activities, which must be required by law, involve government agencies and may include, for example, criminal investigations, disciplinary actions, or general oversight activities relating to the community’s health care system.
(i) Judicial and Administrative Proceeding – For example, we may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.
(j) Law Enforcement Purposes – In certain instances, your PHI may have to be disclosed to a law enforcement official. For example, your PHI may be the subject of a grand jury subpoena. Or, we may disclose your PHI if your death was deemed the result of criminal conduct.
(k) Coroner or Medical Examiner – We may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death.
(l) Organ, Eye or Tissue Donation – If you are an organ donor, we may disclose your PHI to the entity to whom you have agreed to donate your organs.
(m) Research – If Allpure Behavioral Health is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI and that does not identify you and, even without your name, cannot be used to identify you.
(n) Avert a Threat to Health or Safety – Allpure Behavioral Health may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.
(o) Workers’ Compensation – If you are involved in a Workers’ Compensation claim, we may be required to disclose your PHI to an individual or entity that is part of the Workers’ Compensation system.
We may also use and/or disclose your PHI for the purposes of:
(a) Treatment – In order to provide you with the health care you require, Allpure Behavioral Health will provide your PHI to those health care professionals, whether on the Practice’s staff or not, directly involved in your care so that they may understand your health condition and needs. For example, a physician treating you for a condition or disease may need to know the results of your latest physician examination by this office.
(b) Payment – In order to get paid for services provided to you, Allpure Behavioral Health will provide your PHI, directly or through a billing service, to appropriate third party payors, pursuant to billing and payment requirements.
(c) Health Care Operations – In order for Allpure Behavioral Health to operate in accordance with applicable law and to continue to provide quality and efficient care, it may be necessary to compile, use and/or disclose your PHI. For example, we may use your PHI in order to evaluate the performance of the Practice’s personnel in providing care to you.
- INFORMATION COLLECTION AND USE
We collect information about visitors to our Site so that we can provide an experience that is responsive to our users’ and customers’ needs. We do not collect medical information or credit card information through our Site. Our Site may use forms in which you give us contact information (including your name, address, telephone number, and email address) so you can request information or support. We receive and store any information you enter on our Site, or give us in any other way, including through email, telephone, or other communications within our customer services department. You do not need to give us any personal information in order to use our Site.
We will not sell, share, trade or otherwise use any information you provide unless you expressly provide in writing permission for such use.
We collect this information to improve our service, and to help us determine your individual needs so we may serve you better individually, as well as collectively.
We will not sell, share, trade or otherwise use any medical information under any circumstances. If you require medical information, you must request it from us directly via a Medical Release form.
We may also collect non-personally identifiable information about you, such as your use of our web sites, communication preferences, aggregated data relative to your Services, and responses to promotional offers and surveys. We may use or disclose aggregate information only where no individual is identified for a number of purposes, including: (a) Compiling aggregate statistics of usage for improving the web site; (b) Developing, maintaining and administering the web site; and (c) Following up on comments and other messages that you submit to us through the web site.
Please note, to better safeguard your information, please do not include any credit card information in your electronic communication unless it is specifically required by us as part of Services or transaction fulfillment process sites, or our customer contact process.
This Site and our Services may contain links to other websites. Unfortunately, we are not responsible for the privacy practices or the content of such sites.
- GOOGLE ANALYTICS AND COOKIES
We may use a tool called “Google Analytics” to collect information about use of this Site, such as how often users visit the Site, what pages they visit when they do so, and what other sites they used prior to coming to this Site. Google Analytics collects only the IP address assigned to you on the date you visit this Site, rather than your name or other identifying information.
Google Analytics plants a permanent cookie on your web browser to identify you as a unique user the next time you visit this Site. This cookie cannot be used by anyone but Google, Inc. The information generated by the cookie will be transmitted to and stored by Google on servers in the United States.
This Site has security measures in place to protect against the loss, misuse or alteration of the information under our control. If our site allows you to enter sensitive information (such as a credit card number) on order firms, we encrypt the transmission of that information using secure socket layer technology (SSL).
We may also at times provide information about you to third parties to provide various services on our behalf, such as providers who process credit card payments. We will only share information about you that is necessary for the third party to provide the requested service. These companies are prohibited from retaining, sharing, buying, selling, storing or using your personally identifiable information for any secondary purposes.
We follow generally accepted standards to protect the personal information submitted to us, both during transmission and once we receive it. No method of transmission over the Internet, or method of electronic storage, is one hundred percent (100%) secure, however. Therefore, we cannot guarantee its absolute security.
- COLLECTION AND USE OF PERSONAL INFORMATION OF CHILDREN UNDER AGE 13
We are committed to protecting the online privacy of children. In accordance with the Children’s Online Privacy Protection Act (”COPPA”), we will not knowingly collect any personally identifiable information from children under the age of thirteen (13) without first obtaining parental consent. Prior to providing any personally identifiable information (your name, email address, address, phone number etc.), children under the age of thirteen (13) must have a parent or legal guardian complete and return (by email or regular mail) a Parental Consent Form to: email@example.com or
Allpure Behavioral Health
3372 Woods Edge Circle, suite 101, Bonita Springs, Florida 34134
The consent form states that the child’s “Parent” or “Legal Guardian”, by his or her signature, consents to the collection and transfer of the child’s personally identifiable information. Consent may be revoked by completing a “Revocation of Parental Consent Form” and sending it to the email or physical mailing address above. In compliance with COPPA, We are sensitive about children consulting with parents or guardians before furnishing personal information or ordering anything online.
It is also our intention to adhere to the Children’s Advertising Review Unit (CARU) Guidelines on Internet advertising with its special sensitivities regarding solicitations to children under thirteen (13). We encourage parents/guardians to supervise and join their children in exploring cyberspace.
- TRANSFER OF DATA ABROAD
If you are visiting this Site from a country other than the country in which our servers are located, your communications with us may result in the transfer of information across international boundaries. By visiting this Site and communicating electronically with us, you consent to such transfers.
- COMPLIANCE WITH LAWS AND LAW ENFORCEMENT
We cooperate with government and law enforcement officials and private parties to enforce and comply with the law. We will disclose any information about you to government or law enforcement officials or private parties as we, in our sole discretion, believe necessary or appropriate to respond to claims and legal process (including without limitation subpoenas), to protect our property and rights or the property and rights of a third party, to protect the safety of the public or any person, or to prevent or stop activity we consider to be illegal or unethical. We will also share your information to the extent necessary to comply with ICANN’s rules, regulations and policies.
To the extent we are legally permitted to do so, we will take reasonable steps to notify you in the event that we are required to provide your personal information to third parties as part of legal process.
- MODIFICATION TO TERMS AND CONDITIONS AND IN OUR PRACTICES
If we make material changes to this Policy, we will notify you here, by email, or by means of a notice on our home page, at least thirty (30) days prior to the implementation of the changes.
- CORRECTING, UPDATING AND REMOVING PERSONAL INFORMATION
You may alter, update or deactivate your account information or opt out of receiving communications from us at any time. You may send an email to firstname.lastname@example.org or you may send mail directly to:
Allpure Behavioral Health
3372 Woods Edge Circle, suite 101, Bonita Springs, Florida 34134
We will respond to your request for access or to modify or deactivate your information within thirty (30) days.
- MEDICAL PRIVACY NOTICE
This Section describes how medical information about you may be used and disclosed by us and how you can get access to this information.
Please review it carefully.
- Who Will Follow This Notice?
Health care practitioners who treat you at any of our locations, including employees, volunteers, and members of our, all departments and operating units of our organization, and all medical practices operated by us, other members of our workforce, and our business associates.
- Your Medical Information
This Section refers to your “medical information”. This means all information that identifies you and relates to your past, present or future physical or mental health or condition including information about payment and billing for the health care services you receive.
- Our Pledge Regarding Medical Information
We understand that your medical information is personal and we are committed to its protection. We create a record of the care and services you receive to ensure that we are providing quality care and to comply with legal requirements. This notice applies to all your medical information that we maintain, whether created by our staff or others.
We are required by law to give you this notice of our legal duties and privacy practices with respect to your medical information, to follow the terms of this Privacy Notice, and to notify you following a breach of the privacy or security of your unsecured medical information.
- How We May Use and Disclose Medical Information About You
For each category of use and disclosure, we will try to give some examples, although not every use or disclosure in the category will be listed.
- For treatment. We may use your medical information so that we and other health care providers may provide you with medical treatment or services. Different health professionals may also share your medical information in order to coordinate the different services you need. We may disclose your medical information to people outside our offices and/or locations who may be involved in your medical care after you leave our care.
- For Payment. We may disclose your medical information so that treatment and services you receive may be billed by us to a third party. For example, your health plan may need to know about treatment you received so they will pay us for the services provided. We may also disclose your medical insurance information to obtain prior approval from your health plan.
iii. For Healthcare Operations Purposes. We may use and disclose your medical information for our internal operations, such as business management, and administrative activities, legal and auditing functions, and insurance-related activities. We may use medical information to make sure that all of our patients receive quality care, such as reviewing our processes or to evaluate the performance of those caring for you. We may also disclose information to doctors, nurses, technicians, and other personnel for review and learning purposes. We may remove information that identifies you from this set of information so others may use it to study healthcare and healthcare delivery without learning a specific patient’s identity. Under certain circumstances, we may disclose your medical information for the health care operations of other health care providers.
- Health Information Exchange. We may participate in Regional Health Information Organization (“RHIO”) which arranges for the electronic exchange of health information among health care providers in the state where we are located. We may exchange your health information electronically through RHIO for the purposes described in this Notice. You have the right to request that your information not be included in this exchange.
- Individuals Involved In Your Care or Payment of Your Care. We may release your medical information to a friend or family member who is involved in your medical care, or to someone who helped pay for your care.
- Notification. We may release your medical information to notify a family member, personal representative or another person responsible for your care of your location, general condition, or death. We also may release your medical information for certain disaster relief purposes.
vii. Contacts. We may contact you to provide appointment reminders, information about treatment alternatives, or other health related benefits and services that may be of interest to you.
viii. Worker’s Compensation. We may release medical information about you for worker’s compensation or similar programs, which provide benefits for work related injuries or illnesses.
- Mental Health Information. State laws create specific requirements for the release of mental health records. We will obtain your specific authorization to release mental medical information when required by these laws.
- Drug & Alcohol Treatment Records. Specific rules apply to the release of certain drug and alcohol program records, and we will obtain your specific authorization to release those records as required by Federal regulation 42 CFR, Part 2.
- Miscellaneous. We may use or disclose your medical information without your prior authorization for several other reasons. Subject to certain requirements, we may give out your medical information without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, research studies, funeral arrangements, Coroner’s investigations, organ donation, and emergencies. We also may disclose medical information when required by law in response to a request from law enforcement in specific circumstances, for specialized government functions including correctional, military or national security purposes, in response to valid judicial or administrative orders or to avoid a serious health threat. Additional specific rules may apply to mental health records.
xii. Other Disclosures. Other uses and disclosures not described above will be made only with your written authorization. For example, we require your signed authorization for uses and disclosure that constitute the sale of your medical information and for most uses and disclosures of psychotherapy notes. Additionally, we will not use or disclose your medical information for marketing purposes unless we have a signed authorization from you except that an authorization will not be required if (a) a communication occurs face-to-face; (b) consists of marketing gifts of nominal value. You may revoke your authorization at any time unless we have relied on your authorization or your authorization was required as a condition of obtaining health care services.
- Your Rights Regarding Medical Information About You
i. Right to Inspect and Copy. In most cases you have the right to inspect or receive a copy of your medical information (or have a copy provided to an individual whom you designate) when you submit a written request. If your medical record is maintained electronically in a designated record set, you have the right to request a copy of the information in an electronic form and format. We may deny your request in certain circumstances. If you are denied access to your medical information, you may appeal.
- Right to Amend. If you believe the information in your record is incorrect or incomplete, you have the right to request an addendum be added to your record by submitting a written request giving your reason. We may deny your request under certain circumstances. If we deny it, we may advise you in writing of the reason or explain your rights to submit a statement of explanation.
iii. Right to an Accounting of Disclosure. You have the right to a list of those instances where we have disclosed your medical information other than for treatment, payment, healthcare operations, or where a disclosure was specifically authorized., for the Hospital’s directory, to persons involved in your care, and certain other limited situations. To request an accounting of disclosures, you must submit a written request to our Support Department.
- Right to a Paper Copy of this Notice. If this notice was sent to you electronically you have a right to a paper copy of this notice. You may request that we send other communications of protected health information by alternative means, or to an alternative location. This request must be made in writing to the person listed below in Section 13. We are required to accommodate only reasonable requests. Please specify in your correspondence exactly how you want us to communicate with you; and if you are directing us to send it to a particular place, the contact/address information.
- Right to Request Restrictions. You may request in writing that we not use or disclose your medical information except when specifically authorized by you, when required by law, or in an emergency. Except in the case of certain requests related to disclosures to health plans, we are not required by law to agree to your request, but we will consider the request. We will inform you of our decision.
- Right to Request Restrictions on Disclosures to Health Plans. You may request in writing that we restrict disclosures of your medical information to a health plan for purposes of carrying out payment or healthcare operations if the disclosure is not required by law and the medical information pertains solely to a health care item or service for which you (or a person other than the health plan who is acting on your behalf) have paid us out of pocket and in full at the time of service. We must agree to a request that meets these requirements.
- Complaints and Requests
If you have questions about this notice or want to talk about a problem without filing a formal complaint, please contact Allpure Behavioral Health at the following number: (855) 811-7873.
If you believe your privacy has been violated, you may file a complaint with our organization or with the Secretary of the U.S. Department of Health and Human Services. Information about how to file a complaint with the Department of Health and Human Services may be found at the following website: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. You will not be penalized for filing a complaint.
- INDEMNITY AND LIMITATION OF LIABILITY
You will indemnify and hold harmless Allpure Behavioral Health and its officers, directors, employees, clinicians and agents, from and against any claims, disputes, demands, liabilities, damages, losses, and costs and expenses, including, without limitation, reasonable legal and accounting fees arising out of or in any way connected with: (i) your access to or use of the Services or Content, or (ii) your violation of these Terms.
Allpure Behavioral Health and its officers, employees, directors, clinicians, subsidiaries, affiliates, agents, and licensors are neither responsible nor liable for any indirect, incidental, special, consequential, exemplary, punitive, or other damages whatsoever (including, but not limited to, damages for lost profits, goodwill, use, data, or other intangible losses) arising out of or related to your use of the Site, including any content or information contained therein, or Services related thereto, whether based on contract, tort, warranty, statute, or otherwise. Your sole remedy in the event of any problem with the Site is to stop using the Site and the Services.
To the maximum extent permitted by applicable law, the maximum liability of Allpure Behavioral Health to you with respect to your use of the Services is the greater of $100 USD or the amount of fees you have paid for access to and use of the Site or Services in the five-month period immediately preceding the event, or events, giving rise to your claim.
- CONTACT INFORMATION
Allpure Behavioral Health
3372 Woods Edge Circle, suite 101, Bonita Springs Florida, 34134, 855-811-7873