The following are general statements of your rights and responsibilities. Your rights and responsibilities as a patient in programs such as crisis stabilization unit, or specific residential programs, will be given to you in writing upon your admission to those programs. If you would like assistance in reading this or if you want more detailed information provided to you verbally, please speak with the staff person who is assisting you with the services you are receiving.
All SalusCare patients have the same civil rights as do all citizens of the State of Florida and the United States of America. SalusCare does not discriminate in the provision of services on the basis of age, race, color, national origin, ethnicity, gender, marital status, sexual orientation, religion, disability or any other characteristic protected by law. Patient rights, as outlined in Florida’s Patient Bill of Rights and/or federal regulations include, but are not limited to: The right to quality treatment, the right to refuse services, the right to confidentiality, the right to dignity, the right to privacy, the right to receive humane care, the right to access one’s own record, and the right to a fair and equitable procedure to a register a complaint. Exceptions to any of these described rights do exist and will be discussed on an individual basis at the request of the individual.
What our patients think of the services they received at SalusCare is very important to us. Please feel free to tell staff members when you are satisfied or dissatisfied with our services. At appropriate times you will receive customer satisfaction surveys. We appreciate your answering the questions and offering any comments, criticisms, or suggestions that will help us to continue to improve our quality of customer care.
SalusCare provides patients, their relatives, legal representatives, and other concerned persons with the right to initiate and file a written complaint when there is dissatisfaction with the organization’s operation, the delivery of services, staff actions, and/or a perceived violation of rights. If you are unhappy with the services you are receiving or feel you have been treated unfairly, you may discuss your concern with the involved staff person or the program supervisor. If you wish, you may share your concerns with us by filing a written complaint. Complaint forms are available at any reception desk or from any SalusCare staff member at any facility. Please complete the form and return it to the reception desk or mail it to the supervisor of the involved program at: SALUSCARE, INC., 3763 EVANS AVE., FORT MYERS, FL 33901. Staff will be happy to assist you in completing this form if requested to do so. SalusCare follows specific procedures for responding to written complaints. These include, but are not limited to, reviews and investigations of the problem by supervisors of involved programs as part of the Quality Management process. You will be contacted by staff about your concern within a reasonable period of time. Staff will work with you to resolve the complaint. If you are still not satisfied with the results, you may contact the Executive Assistant at 239-931-9688 or the Welcome Center Manager at 239-275-3222. If you remain dissatisfied with the outcome, you may contact the following State of Florida Children & Families Departments: FL Dept. of Children & Families, Central Florida Behavioral Health Network Regional Office: (877) 355-2377 Disability Rights Florida: (800) 342-0823 (Voice) * (800) 346-4127 (TTY/TTD)
We are able to provide services to our community at a reasonable rate, in part, because of financial support by the State of Florida, Lee County, and United Way. Persons are expected to pay at the time services are delivered. Patients may qualify for reduced fees based upon the gross income of all family members living in the same household. You are expected to discuss frankly and honestly sources of income and provide verification of income so that we can establish a fee and satisfy State and Federal requirements. If no proof of income can be provided, the patient will be charged the standard full fee for service. Patients who have health insurance benefits will be expected to assign the insurance to the SalusCare so a claim can be filed. The patient will be responsible for his/her portion of the fee at the time service is rendered. SalusCare will not be liable for payment of any medical services that you may require while here if not provided by SalusCare.
SalusCare staff abides by state and federal regulations regarding abuse and neglect/exploitation reporting. We will not knowingly abuse, neglect, or exploit patients. Any patient, adult or child, who feels they have experienced abuse, neglect, or exploitation at SalusCare, should call: The Florida Abuse Hotline – 1-800-962-2873
This notice originally became effective on April 14, 2003. This notice describes how information about you (our patient) may be used and disclosed and how you can get access to this information. Please review it carefully. SalusCare is required by law to maintain the privacy of your information, and to provide you with this notice of our legal duties and privacy practices with respect to this information.
We will use your information for treatment. For example: Information obtained by your clinician, resource coordinator, or service provider will be recorded in your clinical record and used to help determine the course of treatment that you and your treatment team believe will work best for you. The clinician, resource coordinator, or service provider will record the actions they took and their observations. Other members of your treatment team will review your clinical record to assess how your treatment is progressing. We will use your information in our day-to-day operations to assess your care and to seek to provide you with the best possible care. For example: Members of the SalusCare clinical staff, in order to perform quality improvement or risk management activities, may use information in your clinical record to evaluate the care and outcomes in your situation and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of your care and the service we provide to all people we serve. We may use your information to contact you to remind you of your appointments. We may disclose your information to our business associate so that they can perform the job we’ve asked them to do. There are some services provided to our organization through contracts with external business associates. A dietician and a pharmacist also provide services to some individuals served by SalusCare. To protect your information, we require the business associate to appropriately safeguard your information. At your request, we will disclose to you who these associates are and share with you how these associates protect your information.
Other uses and disclosures of your confidential information will be made only with your written authorization, unless otherwise permitted or required by law. You must give specific written permission before being filmed, taped, etc., or becoming part of a research project. You have the right to determine the amount and type of information to be released to anyone outside of SalusCare. You also have the right to determine the amount and type of information to be sent to SalusCare from outside persons or agencies. You have the right to determine the length of time that information can be released. SalusCare procedures allow permission to be valid for one time only or up to 365 days. You may cancel your permission to release the information at any time, except for information already released.
There are several important instances when confidential information may be released to others without your permission. If we have reason to believe that you are abusing or neglecting your children, or if you tell us your spouse or someone else is abusing your or any other children, we are obligated by law to report this to the appropriate agency. The law is designed to protect children from harm and the obligation to report suspected abuse or neglect is clear in this regard. If you are receiving mental health services, and we have reason to believe that you are abusing, neglecting, or exploiting an aged person or disabled adult, or if you tell us that someone is abusing, neglecting, or exploiting and aged person or disabled adult, we are obligated to report this to the appropriate agency. If you indicate you intend to harm either yourself or someone else, and we believe your intent to be serious, we are obligated under the law to take action to protect you and/or other people from harm. This may include initiating a Baker Act, contacting law enforcement, or other means to keep you and others free from harm. If we diagnose you as having a reportable communicable disease such as TB, hepatitis, HIV/AIDS, or a sexually transmitted disease, we are required by law to report this to the Health Department. If you are experiencing a life-threatening or potentially disabling medical emergency, we are required to release to medical personnel the minimum amount of information necessary to quickly aid the situation (for example: diagnosis, medication). The information will be given only on a need to know basis. In some instances, a court of law can obtain information about you without your permission. Although SalusCare does not automatically release information about you to the court when it receives a court order, a judge may set aside your rights to privileged communication. If you have been referred by the court (court-ordered), you should discuss with us exactly what information you wish included or not included in a report to the court. You should also be aware that failure to release information to a court or a referral agency may have adverse consequences for you. The state of Florida may require that some of our programs release your social security number and other personal information to qualified state personnel for the purpose of auditing, reporting, and/or program evaluation. The state is also governed by federal regulations and state laws that protect your right to confidentiality. Considering the exceptions to confidentiality, you should remember that you have the right to tell us only what you want us to know. If you have concerns about confidentiality, please discuss them with us before you share personal information.
You have the right to see your record and/or obtain a copy of it for a fee after a written request has been received. You have the right to amend or enter notes into your clinical record, or record your own observations and comments at any time. This applies to receiving services in any program. Please contact our Privacy Officer/Health Information Management (HIM) Director if you have questions about this. Even though all disclosures we already make are minimally necessary, you have the right to request a restriction or limitation on the information we use or disclose about you for treatment, payment, or healthcare operations. Also, you have the right to request a restriction on the people who are able to obtain the information we disclose. To request a restriction or limitation, please send your request in writing to the Privacy Officer/HIM Director. However, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. You have the right to request to receive confidential communication from us by alternative means or at an alternative location. We will accommodate requests. We may ask you for information as to how payment will be handled or how to contact you (by address or phone number). We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer/HIM Director. You have the right to receive an accounting of disclosures we have made (with the exception of those we are not permitted to disclose), if any, of your confidential information. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You have the right to receive a paper copy of this notice from us, upon request. We are required to abide by the terms of this Privacy Practices Notice. If we revise this notice, we will distribute copies to active patients. The revised notice will be effective for all confidential information that we maintain at any time. You may also obtain a copy of the notice by accessing our website (www.saluscareflorida.org), calling SalusCare and requesting that a copy be sent to you, or asking for one at the time of your next visit. If you have any questions about this notice please contact the Privacy Officer/HIM Director, or Compliance Director at: (239) 275-3222. Auxiliary Aids and Services Plan For Patients Who Are Deaf or Hard-of-Hearing SalusCare, Inc. provides all necessary accommodations for patients and their companions who are deaf or hard-of-hearing. Please contact us at (239) 275-3222 to ensure we are aware of any needs you have before your arrival. We also will, as soon as you identify yourself as deaf or hard-of-hearing, will provide the necessary services, at no cost to you. Our Auxiliary Aids and Service Plan contains the following items. Documents
Michele Hordinski, RMR, CRR Court Reporter, Von Ahn Associates, Inc. (239) 332-7443 (office) (239) 223-0463 (cell) Tmds70@gmail.com
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