HIPAA Privacy Practices

I am required by law to follow the practices described herein. This letter is a summary of our Privacy Practices but does not replace the full version, which has been made available to you. This notice applies to personal medical/mental health information that I have about you, and which are kept in my facility. With some exceptions, I must obtain your authorization to disclose (or release) your healthcare information. There are some situations in which I am not required to obtain your authorization. I am permitted to use your protected health information and share it with members of an organized health care arrangement (like a community provider). Neither this pamphlet nor the full Notice of Privacy Practices covers every possible use or disclosure. If you have any questions, please contact the Privacy Office.

Who Has Access To Your Personal Information?

Medical/Mental health information about you can be used to:

• Plan your treatment and services.

• Submit bills to your insurance, Medicaid, Medicare, or third party payers if applicable.

• Obtain approval in advance from your insurance company if applicable.

• Exchange information with Social Security, Employment Security, or Social Services.

• Measure quality of services.

• Decide if I should offer more or fewer service to clients.

Without your permission, I may use your personal information:

• To exchange information with other State agencies as required by law.

• To treat you in an emergency.

• To treat you when there is something that prevents me from communicating with you.

• To inform you about possible treatment options.

• To send you appointment reminders.

• For agencies involved in a disaster situation.

• For certain types of research.

• When there is a serious public health or safety threat to you or others.

• As required by State, Federal or local law. This includes investigations, audits, inspections, and licensure.

• When ordered to do so by a court.

• To communicate with law enforcement if you are a victim of a crime, involved in a crime at our facility, or you have threatened to commit a crime.

• To communicate with coroner, medical examiners, and funeral homes when necessary for them to do their jobs.

• To communicate with federal officials involved in security activities authorized by law.

• To communicate with a correctional facility if you are an inmate.

What Are Your Rights?

• To view and secure a copy of your record (with some exceptions).

• To appeal if I decide not to permit you to see all or some parts of your record.

• To ask for the record to be changed if you believe you see a mistake or something that is not complete.

• You must make this request in writing. I may deny your request if:

1. I did not create the entry;

2. The information is not part of the file I keep; or

3. The information is not part of the file that I would permit you to see.

• To know to whom I have sent information about you for up to the last six years.

• The first request in a 12 month period is free. I may charge you for additional requests.

• To limit how I use or disclose information about you. For example, not to release information to your spouse or a particular provider agency. This must be made in writing, and I am not required to agree to the request.

• To ask that I communicate with you about medical matters in a certain way or at a certain location. This must be made in writing.

• To tell me (authorize) other releases of your personal information not described above.

You may change your mind and remove the authorization at any time in writing.