THIS POLICY DETAILS HOW YOUR HEALTH 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
Your Protected Health 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 Medical Record under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes any identifiable information about your health. Medical Records includes your past, present, or future mental health or physical condition and any other related health care services.
Use For Treatment and Payment
Treatment — Your health Information 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 written consent, we may use and disclose your PHI in order to receive payment for treatment and services provided to you from your insurance or other sources.
For example, we give your information to your health insurance so they can pay for your services.
Management Operations — We may share or use your health information for clinical operations like quality assessment, and to contact you when necessary.
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.
Disclosures That Do Not Require Your Authorization
Required by Law — We may disclose your health information if it is required by law, and if in compliance with the law.
Health Oversight — Health information may be disclosed to a health oversight agency when authorized by law, like inspections, investigations, and audits.
Public Health — We may disclose your health information to a public health authority when 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.
Medical Emergencies — Your health information may be used or disclosed, by us, in an emergency medical situation to relevant medical personnel only.
Child Abuse or Neglect — In the case of child abuse or neglect, your information may be disclosed to a state or local agency authorized by law.
Deceased Patients — Your information may be disclosed for the purpose of determining the cause of death of a deceased patient,
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 information.
Criminal Activity On Program Premises/Against Program Personnel — Your information 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 — Your information may be disclosed if a court releases a court order and your health information disclosure is permitted under State and Federal law.
Family And Friends — Your information may be disclosed to friends or family members if you have given a verbal agreement to do so in the event that you’re not capable of giving (because of incapacitation or a medical emergency).
For any other reason, your health information will be used and disclosed only when you give written consent or authorization. You can revoke your consent at any time,
We reserve the right to make any changes to this policy.
You may file a complaint if you feel your rights have been violated. Please contact: firstname.lastname@example.org