THIS NOTICE DETAILS HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. AS SUCH, IT SHOULD BE CAREFULLY REVIEWED.
If you have any questions about this notice, please contact us:
As per 45 CFR 164.520, this Notice of Privacy Practices (the Notice) details how your medical information may be used or disclosed. It also describes how you can access this information. Personal health records contain confidential information about your health, which is private. Both Federal and State laws govern and protect the confidentiality of this information. Your Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes any individually identifiable information about your health. PHI includes your past, present, or future mental health or physical condition and any other related health care services.
The following sections provide examples of the possible uses and disclosures we may make of your Protected Health Information (PHI). The examples do not cover every possible instance, but describe some possible uses and disclosures of your PHI.
Treatment — Your PHI may be used or disclosed by your counselor, physician, our program staff, and others outside of our program that are involved in your care for the purpose of coordinating or managing your healthcare treatment and providing any related services. For example, during your treatment you may require management or coordination from a third party, referral to another provider for healthcare treatment, or consultation with other healthcare providers. In addition, we may disclose your protected health information to another healthcare provider or physician who becomes part of your care.
Payment — With your consent, we may use and disclose your PHI in order to receive payment for treatment and services provided to your from your insurance or other sources. For example, we give your information to your health insurance so they can pay for your services.
Healthcare Operations — We may share or use your health info to run our business, contact you when necessary, and improve your care. This can include employee review activities, business activities, quality assessment activities, and licensing. For example, We may ask you to use a sign-in-sheet where you will be asked to not only sign your name, but also include your physician, counselor, or staff. We may share your PHI with third parties that perform various business activities for us, like a billing company. Furthermore, we may call you to remind you of your appointments or to provide additional information about treatment and other health benefits.
Special Rules Regarding Disclosure Of Behavioral Health, Substance Abuse, And HIV-Related Information
Special restrictions may apply to any disclosures concerning protected health information associated with care for psychiatric conditions, substance abuse, and HIV-related testing and treatment. Consider the following restrictions.
HIV-Related Information — We may use or disclose HIV-related information as required or permitted by State law. For example, any HIV-related information can be disclosed without your consent or authorization for the following reasons: certain health oversight activities, treatment purposes, court order, event of exposures to HIV by the company, another person, or a known partner.
Minors — We comply with State law when we use or disclose PHI of minors. For example, if you are a minor (in-emancipated) consenting to a healthcare service that relates to HIV/AIDS, abortion, venereal disease, outpatient mental health treatment, or alcohol/drug dependence treatment, and you neglected to request another person be treated as your personal representative, then you you may have the authority to authorize the use and disclosure of your health information.
Required by Law — We may use or disclose your PHI if it is required by law, made in compliance with the law, and limited to the relevant requirements of the law. We notified you, as you required by law, of any disclosure. We must make disclosure of your PHI, under the law, to you upon your request. Additionally, we also must make disclosures to the Secretary of the Department of Health and Human Services in order to investigate and determine our compliance with the Privacy Rule.
Health Oversight — PHI may be disclosed to a healthy oversight agency for activities authorized by law, like inspections, investigations, and audits. These agencies include government organizations that offer financial assistance to the program and others that perform quality control. Disclosing a PHI to a health oversight agency requires them to protect your privacy and information.
Public Health — We may disclose your PHI to a public health authority authorized by law to gather or obtain said information in order to prevent or control disease, disability, or injury, or if directed by a public health authority, to an agency of the government that is collaborating with that public health authority. In certain circumstance, we may disclose your PHI to a person who is subject to the jurisdiction of the Food and Drug Administration with respect to the reporting of certain occurrences involving drugs, food, or other products. Other circumstances may requires us to disclose your PHI to someone who may have been exposed to a disease and risks spreading or contracting it, if authorized by law. For example, we may disclose PHI in way that details you have contracted said disease to a public health authority that is authorized to collect this information.
Medical Emergencies — You protected health information (PHI) may be used or disclosed, by us, in an emergency medical situation to relevant medical personnel only. Staff will do their best to provide you a copy of this notice as soon as possible after the emergency is resolved.
Child Abuse or Neglect — In the case of child abuse or neglect, your PHI may be disclosed to a state or local agency authorized by law to receive reports regarding such issues. The information we disclose, however, will only be applicable to make the initial necessary mandated report.
Deceased Patients — Your PHI may be disclosed for the purpose of determining the cause of death of a deceased patient, because there may be laws that require the collection of death or other statistics, as well as permitting inquiry into the cause of death.
Research — Your PHI may be disclosed to researchers for the following reasons: an Institutional Review board approves relevant research and a waiver to the required authorization; the researchers lay out protocols to guarantee the privacy of your PHI; the researchers concur to protect and maintain the security of your PHI in agreement with relevant laws and regulations; the researchers concur to not re-disclose your PHI, expect for when returning it back to the company.
Criminal Activity On Program Premises/Against Program Personnel — You PHI may be disclosed to law enforcement if there is a crime committed by you on the premises of our program, or a if you commit a crime against program personnel.
Court Order — You PHI may be disclosed if a court of a competent jurisdiction releases a court order and PHI disclosure is permitted under State and Federal law.
Interagency Disclosures — Parts of your PHI may be disclosed in order to coordinate services among government programs (with an interagency agreement) that offer services related to mental health.
Public Safety — For a mental health treatment program only, we may disclose PHI to avoid a serious threat to safety or health, like a mental or physical injury that causes your or others harm.
Specialized Government Functions — If you are a member of the U.S. Armed Forces, or have been, we may disclose your PHI as it is required by authorities of military command. Your PHI may also be disclosed, in this case, to authorized officials for reasons of intelligence or national security. Or, to the Department of State for medical determinations.
Family And Friends — Your PHI may be disclosed to friends or family members if you have given a verbal agreement to do so, or if you have the opportunity to object and fail to do so. Your PHI may also be disclosed to friends and family members if we base our professional judgement, and infer from the circumstances, that you would not raise any objections. For example, we might assume you agree to disclosing your PHI to your husband or wife because they brought you into treatment and took part in treatment discussions. In the event that you’re not capable of giving (because of incapacitation or a medical emergency), we may use our professional judgement to determine that a disclosure to your family member or friends serves your best interest. In this particular situation,we would only disclose PHI that is relevant to the your loved one’s place in your care.
Other protected health information (PHI) will be used and disclosed only when you explicitly give written consent or authorization. You can revoke your consent at any time, unless the program or staff have acted on this consent and relied on the authorization of disclosure for the purposes of the act. If consent is revoked, we will no longer disclose your PHI for the reasons you gave during written authorization, unless we are required to do so by law. Please understand that we are prohibited from taking back any uses or disclosure we have made with your authorization and that we are mandated to retain said information in our records of treatment and care.
Explained below are your rights with respect to your PHI. If you wish to make a request with respect to these rights, it must be done in writing and brought to the attention of the Privacy Officer.
You Have The Right To Inspect And Copy Your PHI — You have the right to inspect and obtain a copy of your PHI (in a designated record set), as long as we maintain the record. “Designated record set” refers to medical and billing records, as well as any other records, that the program used to make decisions about your care. The request must be in writing. A reasonable fee may be charged for the copies. We can deny you the right to access your PHI in particular circumstances. In some cases, you may have the right to appeal any denial of access.
You May Have The Right To Amend Your PHI — In writing, you may request we amend your PHI that we included in your designated record set. In some cases, we can deny your request to amend. If we deny said request, you retain the right to file a statement of disagreement. Be prepared for us write a rebuttal to your statement, which we will provide you a copy.
You Have The Right To Receive An Accounting Of Some Types Of PHI Disclosures — You may request the accounting of uses and disclosures for up to six years, except for disclosures made for treatment purposes, as a result of your authorization, or made to you. We may charge a reasonable fee if you request more than one accounting in a 12-month period.
You Have a Right To Receive A Paper Copy Of This Notice — We can mail or email you a copy of this notice, for which you have the right.
You Have The Right To Request Added Restrictions On Disclosures And Uses Of Your PHI — It is your right to ask us not to use or disclose any aspect of your PHI for treatment, healthcare operations, or payment, as well as to family members involved in your care. These restrictions must be requested in writing, and we are in no way obligated to grant or agree with your request.
You Have A Right To Request Confidential Communications — By alternative means or at an alternative locations, you retain the right to request to receive confidential communications from us. We will do our best to accommodate any reasonable, written requests. This accommodation may be conditioned by asking you for any information regarding the handling of payment, another method of contact, or an alternative address. We will not inquire or ask why you are making such a request.
You Have A Right TO Receive Notification Of Unauthorized Disclosure Of Your PHI (Breach Notification) — In the case of a breach of unsecured PHI, we are required to notify you. The notice is required to be made without any unreasonable delay, and should occur not later than 60 days after discovering the breach.
It is our right to make any changes to this notice. We also reserve the right to make the changed or revised notice effective for any medical information we already have about you, or may receive in the future. Our current notice will be posted on our location(s) with its effective date in the top right-hand corner. WildernessDrugRehab.org we post a new notice, and we can mail a copy to you if requested.
You may file a complaint if you feel your rights have been violated. Please contact: [email protected]