Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Synergy EAP Soultions is required by law to maintain the privacy of certain health care information about our patients. The law also
requires health care providers like Synergy to give you a notice like this one and to follow its standards.
Synergy and your Protected Health Care Information.
As part of our day to day activities, Synergy may need to use and disclose (share) your protected health care information for several
purposes without first getting your written approval. These purposes include:
Your treatment. For example, Synergy might discuss your condition and medications with a psychiatrist we refer you to.
Payment for your treatment. For example, Synergy may need to discuss your condition and the treatment Synergy provided to you
with another EAP that referred you�re here.
Synergy operations. For example, appropriate Synergy staff may discuss your condition in order to provide you proper treatment
Synergy may contact you based on your protected health care information. For example, Synergy may call to change an
appointment, to provide you with information about new mediations, treatments, benefits and services that are available to you.
Synergy may provide information to government officials who oversee health care or are working on threats to public safety from
unsafe products, diseases, abuse, neglect, domestic violence and other crimes.
Synergy may provide information to licensed researchers who are under strict rules regarding how they use and disclose protected
health care information. Those researchers, for example, may use the information about patients with your condition for a study to
improve ways to combat diseases.
No other uses and disclosures of your protected health care information will occur without your written authorization. And, if you sign such
an authorization, you have the right to cancel it at any time.
Your rights regarding your Protected Health Care Information
Under the law, you have several rights that Synergy is committed to upholding. These rights include:
The right to request restrictions on some of the ways Synergy uses and discloses your information. These restrictions can go beyond
the restrictions already in the law. However, Synergy may not always agree to implement these additional restrictions.
The right to receive confidential communications. While Synergy cannot promise to communicate in every possible way a patient
may request, we will work with you to find a practical way of communicating with you in strict confidence if you wish.
The right to inspect and get copies of your health care information held by Synergy by making a request in writing. Synergy, however,
may charge a reasonable fee to cover only the cost of providing this information.
The right to request that Synergy amends or corrects information about you. To make such a change, Synergy will ask you to make
the request in writing with a description of the reason that you want your record changed. Synergy may not always agree to such
The right to a list of the disclosures Synergy has made of your protected health care information that were not authorized by you and
the disclosures that were unrelated to treatment, payment and Synergy operations.
If you have any questions or complaints about the way Synergy EAP handles your protected health care information or if you believe your
privacy rights have been violated, contact the Synergy EAP Privacy Officer at 239-278-7435 or in person. You may also contact the Secretary
of the U. S. Department of Health and Human Services. Please note that there will be no retaliation against you for filing a complaint or making
requests regarding your health care information, or for disagreeing with Synergy EAP related decisions.Synergy may need to change its
privacy practices form time to time. Before making such changes, however, Synergy EAP will modify this notice, and begin distributing it to
patients when they are treated at Synergy. These new practices will then apply to all information held by Synergy EAP. At any time, anyone
has a right to get a paper copy of the latest version of this notice by asking the Synergy EAP receptionist.
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