Privacy Policy

Notice of Privacy Practices

Notice of Privacy Practices

Beginning April 14, 2003 all health care organizations began to comply with the provisions of federal legislation entitled “Health Insurance Portability and Accountability Act” (HIPAA). The purpose of this legislation is to safeguard the security of protected health information (PHI) while also standardizing the electronic transmittal of health information for payment, treatment and health care operations. Additional regulations went into effect in 2013 and were added to Child Guidance Center operations as well as this privacy notice.

Child Guidance Center has historically protected the release of PHI by requiring that the adult client/legal guardian of a child sign a release for each disclosure to an individual or organization. This policy will continue for most disclosures.

There are a few situations in which Child Guidance Center is required to release information, with or without your consent:

  1. State law requires that any suspicion of child abuse or neglect, domestic violence in a home where a child resides, or abuse or neglect of an elderly or disabled individual must be reported to the Department of Children and Families. 
  1. Relevant clinical information may be shared with a Child Protective Investigator if an abuse or neglect report is under investigation.
  2. Relevant clinical information may be shared with a detective/police officer if the Florida Abuse Registry transfers a report of sexual abuse to the Jacksonville Sheriff’s Office.
  1. State law requires that when clients communicate specific threats to cause serious bodily injury or death to an identified or readily available person, and the provider reasonably believes that the client has the apparent intent and ability to imminently or immediately carry out such threat, this information must be communicated to law enforcement. 
  2. Laws covering public health require reporting public health risks when someone is exposed to a disease or is at risk for contracting or spreading a disease or condition.
  3. When a CGC staff member is compelled to testify by a valid court order.

The client’s PHI may be sent electronically, for example: secure fax, e-mail (within the agency), encoded Internet sites, or data warehouses held by our funders or other business partners. This information is protected and is kept confidential by everyone involved as there are stiff federal fines and prison terms if someone is found guilty of misuse of PHI information.

Procedural Information Regarding Your Rights

  1. Child Guidance Center is obligated to provide clients and their guardians with a Notice of Privacy Practices.
  1. The Privacy Rule (federal law) permits Child Guidance Center to disclose the minimum necessary PHI to obtain payment, provide treatment or for other health care operations (HCO) without your express consent.
    • Treatment—the client’s PHI may be shared for the following reasons:
  1. The client’s case may be discussed in the course of clinical supervision.
      1. If there is substantial likelihood that the client will cause serious bodily harm to him/herself or others and a Baker Act is warranted, relevant information will be shared with the transporting police officer and the Baker Act receiving facility.
      2. Care coordination and consultation amongst the client’s Child Guidance Center practitioners.
    • Payment and Health Care Operations—the client’s PHI may be shared according to the following conditions:
      1. If insurance or Medicaid is being billed for treatment, the diagnosis, method of treatment and dates of visits are submitted to the carrier. The carrier may also request other specific information such as expected length of treatment. However, if you have self-paid for all of the client’s services at Child Guidance Center you may restrict disclosure of the PHI to your insurance carrier.
      2. The client’s PHI may be shared with the representatives of funding sources, i.e. The Substance Abuse and Mental Health division of the Florida Department of Children and Families, LSF Health Systems, and the Kids Hope Alliance. Charts are also reviewed by the Commission on Accreditation of Rehabilitation Facilities (CARF) as part of our agency’s accreditation process. This information is used to receive payment or to assist with health care operations such as quality improvement clinical guidelines development.
      3. Kids Hope Alliance and United Way requests basic applicant information to determine who is accessing this program. The information you provide is for use by us and the Commission and will not be shared unless you specifically authorize it.
      4. HCO includes quality improvement activities, employee performance evaluation, health care fraud and abuse detection or compliance activities, and other administrative needs.
  1. If information is to be shared with the school, additional Department of Children and Families staff or any other person or agency, you will be asked to sign an Authorization for Release of Information form for each person or agency.
  1. As required by FS 397.501, written consent for disclosure of a minor’s PHI related to substance use or substance disorder treatment may only be given by the minor. This restriction includes disclosure to the minor’s parent or legal guardian; this information will not be disclosed to the parent or guardian without the client’s written consent.
  1. You can revoke your authorization for the release of this information. This may result in Child Guidance Center not being able to provide services to the client.
  2. You have the right to request restriction on the use or disclosure of the client’s protected health information, including for the purposes of treatment, payment and HCO. To request restrictions, you must submit a Request to Restrict the Use or Disclosure of Protected Health Information form to our Administrative Support Specialist via mail to Medical Records, 5776 St. Augustine Road, Jacksonville, FL 32207 or by fax at (904) 448-4717. Your request must specify the limitations you wish to place on any disclosure. You will be notified of approval/denial in writing.
  1. You have the right to request a copy of documentation contained in the client’s record. The request may be made in writing and submitted to any CGC employee; via mail to Medical Records, 5776 St. Augustine Road, Jacksonville, FL, 32207; by fax at (904) 448-4717; or by phone at (904) 448-4700 x2033. Child Guidance Center has the right to deny all or part of your request if a licensed therapist feels that releasing the PHI could reasonably result in causing substantial harm to you or someone else. If your request is denied, you will be notified in writing and given the procedure to appeal the denial.
  2. You have the right to request that a copy of the client’s record be sent to a designated person or entity of your choice. This request must be made in writing by completion of the Child Guidance Center Authorization for Release of Information or a comparable HIPAA compliant authorization.  CGC Authorization forms may be obtained at any CGC site, or you may call (904) 448-4700 x2033 and request that a form is sent to you via mail, email, or fax.  Written requests may be submitted in person to any Child Guidance Center site, mailed to Medical Records at 5776 St. Augustine Road, 32207, or faxed to 904-448-4717.
  1. You have the right to request an amendment to the record. To request an amendment, you must complete a Request to Amend Protected Health Information form and submit it to the Chief Clinical Officer via mail to Beth Oberlander, 5776 St. Augustine Road, Jacksonville, FL, 32207 or by fax at (904) 448-4717. In addition, you must provide a reason that supports your request.  If your request is denied you will be informed in writing and be given the procedure to appeal the denial. The federal Privacy Standards allow Child Guidance Center to deny your request if you ask us to amend information that:
    • Was not created by Child Guidance Center
    • Is not part of the information kept by or for Child Guidance Center
    • Is not part of the information you would be permitted to inspect and copy, or
    • Is accurate and correct.
  2. You have the right to know where the client’s PHI has been sent. You may request an accounting of the disclosures made by submitting a Request for an Accounting of Disclosures form to the Administrative Support Specialist via mail to Medical Records, 5776 St. Augustine Road, Jacksonville, FL, 32207 or by fax at (904) 448-4717. Your request can be for a history of disclosures after April 14, 2003 and can be for no longer than six years.
  3. You have the right to notice of a privacy breach involving the client’s PHI which includes unauthorized acquisition, access, use or disclosure.
  4. Child Guidance Center reserves the right to change its privacy practices and make the changes effective for all existing PHI. You will be notified of changes to the privacy notice by the posting of these changes at all of our outpatient office sites and on our web site at
  5. You have the right to confidential communication of the client’s PHI and the right to choose the method by which you receive it i.e. by mail at home, phone at work or only at home. If you have a preference, you may let any of our staff know in person or by calling (904) 448-4700 and contacting the program in which the client is currently receiving services (i.e. Outpatient, Full Service Schools).
  6. You have the right to opt out of receiving fundraising or marketing communications.
  7. If you believe that the client’s privacy rights have been violated, you have the right to complain to Child Guidance Center or to the Secretary of the Department of Health and Human Services in Washington, D.C. at 1-877-696-6775 toll free. To file a complaint with Child Guidance Center, you may complete a Grievance Form, which is available at all sites, and turn it into any employee. You may also file a complaint by calling the Chief Clinical Officer at (904) 448-4700 x2410.
  8. You will not be retaliated against for filing a complaint.

Child Guidance Center is required by law to protect the client’s health information in all forms: electronic, written or spoken as outlined in this policy notice. All of our employees and business partners that have access to the client’s protected health information are responsible for protecting that information.

However, if there should be a breach that resulted in the unauthorized acquisition, access, use or disclosure of protected health information which compromises the security or privacy of the individual’s protected health information, we are required to notify you in no more than 60 days in a written format.

Last revision 9/29/2023