Solutions 4 Life Inc.
6727 1st Ave S. Ste 110
St. Petersburg, FL 33707
727-341-1000

Client Handbook

Table of Contents

Privacy Practices / 3
Confidentiality / 9
Client Rights / 11
Grievance Procedure / 13
Fees Agreement / 16
Application for Reduced Fees / 17
What to expect in treatment / 19
Program Rules/ Client Responsibilities / 22
Infectious Disease/Infection Control / 25
Admission Agreement / 27
Helpful Telephone Numbers / 28
Local Open AA Meetings / 29
Group Days and Times
Your Counselors
Julius Sukhram, MS Sonja Kari-Platero, CAP
Wednesday: 6pm______Tuesday: 2pm_____
Saturday: 10:30am_____ Wednesday: 9am______
Individual Sessions:
Cathy Coscia, LMHC______Julius Sukhram, MS ______
Kim Donat Ali, LCSW______Sonja Kari-Platero ______

Client Name:______Date of Admission:______

Your second individual counseling session date and time:______
This session must be completed within 30 days of your admission into the program. There is a penalty for not giving a 24 hour notice to change this appointment time.

Your third individual counseling session date and time:______
Your fourth individual counseling session date and time: ______
Discharge/Exitsession time and date:______

Note: You will also be required to attend _____ AA/NA meeting, _____ within the first thirty (30) days of the program.

Bus routes: PTSA #35, 79 and 90 provide services from South Pasadena, St Pete Beach, Treasure Island, Gulfport and central St. Petersburg. Solutions 4 Life Inc. is also in the process of obtaining licensing and insurance to provide transportation to our clients for an additional fee. When this option becomes available, we will notify all of our clients.

Contact Information:

Kim Donat Ali, LCSW, Executive Director, Privacy Officer, Owner
phone: 727-341-1000
email:

Our phones are staffed from 8:30-5:00 daily, excluding holidays and weekends. Solutions 4 Life Inc. closes our offices the Wednesday before Thanksgiving and will not open again until the following Monday. The offices are also closed from the 23rd of December until the 2nd of January.

Client Signature: ______Date:______

Counselor Signature:______Date:______

Solutions For Life Inc.
Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

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.

Your Rights

You have the right to:

•Get a copy of your paper or electronic medical record

•Correct your paper or electronic medical record

•Request confidential communication

•Ask us to limit the information we share

•Get a list of those with whom we’ve shared your information

•Get a copy of this privacy notice

•Choose someone to act for you

•File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

•Tell family and friends about your condition

•Provide disaster relief

•Include you in a hospital directory

•Provide mental health care

•Market our services and sell your information

•Raise funds

Our Uses and Disclosures

We may use and share your information as we:

• Treat you
•Run our organization
•Bill for your services
•Help with public health and safety issues
•Do research
•Comply with the law
•Respond to organ and tissue donation requests
•Work with a medical examiner or funeral director
•Address workers’ compensation, law enforcement, and other government requests
•Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

•You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

•We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

•You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

•We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

•You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

•We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

•You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

•If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

•You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

•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 a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

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. We will provide you with a paper copy promptly.

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 information.

•We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

•You can complain if you feel we have violated your rights by contacting us using the information on page 1.

•You can file a complaint with the U.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 .

•We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

•Share information with your family, close friends, or others involved in your care

•Share information in a disaster relief situation

•Include your information 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 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.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

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: .

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.

Our Responsibilities

•We are required by law to maintain the privacy and security of your protected health information.

•We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

•We must follow the duties and privacy practices described in this notice and give you a copy of it.

•We will not use or share your information other than as described here unless you tell us we can in writing. 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: .

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Other Instructions for Notice

•May 4, 2014 is the Effective Date of this Notice

•Kim Donat Ali, LCSW- Privacy Officer 727-341-1000

•Office for Civil Rights – US Dept. of Health and Human Services
200 Independence Ave. S.W. Room 509F, HHH Bldg
Washington, DC 20201

•We never market or sell personal information.

Solutions 4 Life Inc.

Confidentiality

The notice of privacy practices is on the first pages of this booklet. It is also posted in the waiting area.

•Solutions 4 Life Inc. staff may not give anyone information about you or your treatment unless you sign a written consent to release treatment.

•The consent to release information:

  • Must be dated at the time you sign;
  • Give a date when the permission to release information expires;
  • The information sent to another agency cannot be released by them to any other agency or person;
  • You are entitled to a copy of any consent to release information that you sign;
  • You may revoke consent to release information at any time. One exception is if the sharing of information is specifically related to your treatment;
  • You may specify information you do not want disclosed as long as it is not specifically related to your treatment;
  • You must never sign consents to release information if there are any blank lines.

• There are some limitations to confidentiality. All staff are mandated reporters and must respond accordingly in the following situations:

  • If we have reason to believe you are in immediate danger of harming yourself or someone else;
  • If we have evidence or belief that you are committing child or elder abuse or neglect;
  • You have a medical emergency.We may tell medical staff the nature of the emergency;
  • To report a crime committed on the Solutions 4 Life Inc. property or upon a staff member;
  • As allowed by court.

• When we do release confidential information, we include the least amount possible.

•If you have a legal guardian, that person may have access to information and may participate in treatment planning.

•Solutions 4 Life Inc., professional staff works as a team and have access to your client information. Limited information will be shared. Any discussion about you will not occur at a time or place where others may overhear the conversation.

•Our licensing agency, The Department of Children and Families, has designated persons who will have access to your record. These individuals are mandated by federal laws to protect confidential information.

•You have the right to have reasonable access to your records.

  • You must request to see your record in writing and a time will be arranged for you to review your record with a professional staff member;
  • You may request amendment or correction of information about you;
  • You may request a listing of agencies or persons where information has been disclosed.

•Your client chart/record is stored in a locked filing cabinet in a locked room.

  • Only professional staff members have access to your records.
  • Your records are stored for seven years at which time they are shredded.

•It is a program rule that you keep all information about you and other persons in the program confidential. This means you may not give out other client’s names or circumstances.

•If you believe your confidentiality has been violated you may:

  • Report and discuss the situation with the agency Privacy Officer, Kim Donat Ali, LCSW
  • District Alcohol, Drug Abuse and Mental Health Program Office
  • 813-558-5700
  • 727-542-0778

Client Rights

All clients receiving treatment or other services from Solutions 4 Life Inc. have the right to:

  1. No discrimination against them on the basis of race, religion, age, creed, sex, sexual orientation, national origin, handicap, or source of financial support.
  2. Competent and timely treatment delivered in a respectful way and dignified manner by staff that is free of alcohol and mood altering drugs.
  3. To have a complete orientation to programs providing you services and activities including explanation of all rules and regulations.
  4. Each client has the right to know the costs of treatment.
  5. Be assigned a primary counselor.
  6. Placement in the least restrictive treatment available based on your individual needs.
  7. Each client has the right to sufficient information to provide informed consent prior to the start of treatment. This shall include the specific nature and duration of treatment and the risks and benefits of any modality, and approximate length of time in treatment.
  8. Every client has the right to participate in developing an individual treatment evaluated regularly according to his/her needs. You may request family or friends to participate in treatment.
  9. Have information pertaining to your participation in treatment and client identifying information held confidential in accordance with Federal and State laws and regulations.
  10. Have the least amount of information disclosed. If a counselor determines the client may be at risk to harm him/her or others, or is suspected of committing child or elder abuse or neglect, a report to the agency, even in this case, the least amount of information possible will be disclosed.
  11. Be free from neglect, physical, or psychological abuse, exploitation of any form of corporal punishment by Solutions 4 Life Inc. staff.
  12. Have any search or seizure executed in a manner consistent with the program standards and only to ensure the safety and security of the clients and staff.
  13. The right to request the opinion of a consultant at personal expense or to request an in-house review of their individual treatment plan.
  14. Reasonable access to your client record, including the right to copies of some information and the right to attach amendments.
  15. Each client can expect assistance in planning an aftercare program following discharge from this treatment that will continue to the client’s continued recovery.
  16. The right to know of the existence of alternatives to this program’s care, and to have treatment in the least restrictive environment.
  17. Each client has the right to refuse treatment and to be fully advised of the risk and potential consequences of such refusal.
  18. Each client has the right to express opinions, recommendations, and grievances and to receive responses to such expressions.
  19. Each client has the right to call any of the following telephone numbers to report cases of client abuse:
  1. Local Florida Advocacy1-800-342-9154
  2. Abuse Hotline: 1-800-962-2873
  3. District Alcohol, Drug Abuse and Mental Health Program Office
  1. 813-558-5700
  2. 727-542-0778

CLIENT GRIEVANCE POLICY INFORMATION FORM

As a client, or parents and/or legal guardians of a client, participating in one of Solutions 4 Life, Inc. treatment programs you have the right to file a complaint for any reason with cause, through the following grievance procedure without fear of discharge or reprisal.

  1. Grievance means any written complaint about treatment, including assessment, intervention, and decisions about placement and discharge as well as any complaint concerning staff or operations.
  1. Whenever such a complaint is filed, the President/CEO is notified via the designated management structure.
  1. The grievance procedure is considered part of the treatment process. Every attempt will be made to resolve the grievance.
  1. A client filing a grievance may choose other people to accompany him/her through the grievance process.
  1. The grievance process includes the following steps:
  1. You may want to consider writing your concerns/grievance on a piece of paper (grievance forms are in the lobby and/or reception area).
  2. The client talks about the complaint with the staff member involved or responsible for the area of concern.
  3. Together they try to solve the matter informally.
  4. The staff member will schedule a meeting with the client within two working days of the grievance being filed and provide a written response as well as an opportunity to discuss all concerns.
  1. If the grievance is not resolved, you may request a meeting with the Executive Director and all parties involved in Step A. The Executive Director will schedule and hold the meeting within five working days of your request.
  1. The Executive Director and all parties involved will address the grievance and a final decision issued.
  1. Depending upon the nature and/or severity of the complaint, the Executive Director may recommend eliminating one or more steps in order to resolve the complaint more quickly.
  1. The staff member hearing the complaint or a designated agency recorder must document each step of the grievance process.
  1. The problem and its resolution will be documented in writing and included in the patient’s clinical record.
  1. Written notification of the decision will be given to the individual filing the grievance.

Solutions 4 Life, Inc.