THIS NOTICE EXPLAINS HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW THE FOLLOWING CAREFULLY.
Your health record contains personal information regarding you and your health. State and federal laws protect this information’s confidentiality. “Protected health information” (PHI) includes information about you, such as demographics that may identify you and which relates to your past, present, or future mental or physical health condition(s) and related health care services. The confidentiality of substance abuse patient records is specifically protected by Federal law and regulations.
Just Believe Recovery is required to comply with these additional restrictions. With very few exceptions, this includes a prohibition on informing anyone outside the program that you are attending or disclosing any information that identifies you as a substance abuser.
The violation of Federal regulations or laws by this program is considered a crime. Therefore, if you believe there may have been a violation, you may file a report with the relevant authorities in accordance with Federal regulations.
Personal Health Information Uses and Disclosures with Your Written Authorization
We must receive written authorization from you for certain uses and disclosure of your PHI. You may withdraw this authorization at any time unless the program, or its staff, has already taken action in reliance on the authorization of the use or disclosure you formerly permitted.
You have the following rights concerning PHI we maintain about you:
You have the right to access to inspect and copy PHI – You have the right, which may be limited in some situations, to inspect and copy PHI that can be used to enact decisions regarding your care. You may inspect and receive a copy of your PHI stored in a designated record set for as long as we maintain the record. This designated set contains medical and billing records and any other records that the program uses for enacting decisions regarding you and your care. Your request must be in writing. We can deny you access to your personal health information in certain circumstances. In some of those instances, you will have a right to appeal the decision.
You may have the right to amend your PHI – If you believe that the PHI we are maintaining about you is incomplete or incorrect, you may ask us to amend the information—however, we are not required to agree to the proposed amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may, however, prepare a rebuttal to your statement and will also provide you with a copy of it.
You have the right to receive an accounting regarding some types of PHI disclosures – You may request an accounting of such disclosures for up to six years, excluding disclosures made to you, for treatment purposes, or as a result of your authorization.
You have the right to request additional restrictions on disclosures and uses of your PHI – You have the right to ask us not to use or disclose any part of your PHI for treatment, payment, or healthcare operations, or to family members involved with your care. Your request for restrictions must be in writing. We are not required by law to consent to proposed restrictions.
You have the right to request confidential communication – You have the right to ask that we communicate with you regarding medical matters in a specific way or at certain locations. We will do what we can to accommodate written requests that are reasonable. We may also condition this accommodation by requesting information concerning how payment will be handled or the specification of an alternative address or other contact methods. We will not ask you why you are making the request.
You have a right to have a copy of this notice – Any questions should be directed to our Privacy Officer.
You have a right to file a complaint in writing to us – If you believe we have violated your health information privacy rights, you have the right to file a complaint in writing to us and the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.
Just Believe Recovery
1802 Northeast Jensen Beach Boulevard
Jensen Beach, FL 34957
You must also file a complaint with the U.S. Secretary of Health and Human Services at:
200 Independence Avenue, S.W.
Washington, D.C. 20201
How We May Use and Disclose PHI
Listed below are examples of the uses and disclosures that Mountain Springs Recovery may make of your protected health information. These examples are not meant to be exhaustive. Instead, they describe the types of uses and disclosures that may be made.
Uses and Disclosures of PHI for Treatment, Payment and Health Care Operations
For Treatment – We may use clinical and medical and clinical information about you in an effort to provide you with treatment or services. For example, your PHI may be used and disclosed by your physician, counselor, program staff, referrals to another provider, and others outside of our program involved in your care to provide, coordinate, or manage your healthcare treatment and related services. Your protected health information may be provided to the state agency that initially referred you to our program to ensure that you participate in treatment. In addition, we may disclose your PHI occasionally to another physician or health care provider who becomes involved with your care at the request of the program.
For Payment – With your written authorization, we may use and disclose medical information about you and your care so that we can receive payment for treatment services we have provided to you. Examples of payment-related activities include making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities.
For Health Care Operations – We may use and disclose your protected health information for certain purposes in association with the operation of our program.
We may use or disclose, as necessary, your PHI to support the business activities of our program, including, but not limited to, the following:
- Quality assessment activities
- Employee review activities
- Student training
- Conducting or arranging for other business activities
For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your health provider or counselor.
We may also call you by name in the waiting room when it is time to be seen. In addition, we may share your PHI with third parties that perform various business activities (e.g., billing or typing services) for Just Believe Recovery, provided we have a written contract with the business or organization that prohibits it from redisclosing your PHI and requires it to safeguard your privacy.
We may contact you to remind or inform you of future appointments or to provide information to you about treatment options or other health-related benefits and services that may be of interest to you.
Uses and Disclosures That Do Not Require Your Written Authorization
Applicable law permits us to disclose information about you without your authorization in a limited number of other circumstances, such as with a court order. These situations are explained below.
Health Oversight – We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program and peer review organizations performing utilization and quality control. If we do disclose PHI to a health oversight agency, we will have an agreement in place that requires the agency to safeguard the privacy of your information.
Medical Emergencies – We may use or disclose your protected health information in a medical emergency situation to medical personnel only. Our staff will try to provide you with a copy of this notice as soon as possible after the emergency resolution.
Child Abuse or Neglect – We may disclose your PHI to a state or local agency authorized by law to receive reports of child abuse or neglect. However, the information we disclose is restricted to only the necessary information to make the initial mandated report.
Deceased Patients – We may disclose PHI regarding deceased clientele to determine the cause of death, in connection with laws requiring the collection of death records or other vital statistics, or permitting inquiry into the cause of death.
Research – We may disclose PHI to scientific researchers in the following situations:
- An Institutional Review Board reviews and approves the research and waiver regarding the authorization requirement.
- Researchers have established protocols to ensure the privacy of your PHI.
- Researchers have agreed to preserve the security of your PHI in accordance with relevant laws and regulations.
- Researchers have agreed to not redisclose your PHI except back to Just Believe Recovery.
Criminal Activity on Program Premises or Against Program Personnel – We may disclose your PHI to law enforcement agencies if you have committed a crime on program premises or against program staff or other participants.
Court Order – We may disclose your PHI if a court issues an appropriate order and follows the required procedures.