Notice of Privacy Practices Clay Behavioral Health Center

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Clay Behavioral Health 1 enter has adopted the following policies and procedures for the protection of the privacy of the people we serve.

Our Obligation to You                                   ·

We at Clay Behavioral Health Center respect your privacy. This is part of our code of ethics. We are required by law to maintain the privacy of "protected health information" about you, to notify you of our legal duties and your legal rights, and to follow the privacy policies described in this notice. "Protected health information" means any information that we create or receive that identifies you and relates to your health or payment for services to you.

We will not ask your written permission to use or disclose your protected health information for treatment, payment or healthcare operations purposes. It is our policy to obtain specific written permission for every disclosure of protected health information to third parties, for any purpose other than for treatment, payment or health care operations. You will be asked to sign an Authorization form for disclosure to each person or organization that receives the information.

How We May Use and Disclose Information about You

We may use and disclose your protected health information to others as necessary to provide treatment to you. Here are some examples:

• Various members of our staff may see your clinical record in the course of our care for you. This includes clinical assistants, nurses, physicians and other
• It may be necessary to send urine samples to a laboratory for analysis to help us evaluate the progress of your
• We may provide information to your health plan or another treatment provider in order to arrange for a referral or clinical consultation.
• We will contact you to remind you of
• We may contact you to tell you about treatment services that we offer that might be of benefit to

We may use and disclose your protected health information as needed to arrange for payment for service to you. For example, information about your diagnosis and the service we render is included in the bills that we submit to your health insurance plan. Your health plan may require health information in order to confirm that the service rendered is covered by your benefits program and medically necessary. A healthcare provider that delivers service to you, such as a clinical laboratory, may need information about you in order to arrange for payment for its services. It may also be necessary to use or disclose protected health information for our healthcare operations or those of another organization that has a relationship with you. For example, our quality improvement staff reviews records to be sure that we deliver appropriate treatment of high quality. Our accrediting and licensing agencies require a review of a percentage of our medical records to ensure that we meet quality standards. Your health plan may wish to review your records to be sure that we meet national standards for quality of care.

Emergencies. If there is an emergency, we may disclose your protected health information as needed to enable people to care for you. Disclosure to health oversight agencies. We are legally obligated to disclose protected health information to certain government agencies, including the Federal Department of Health and Human Services.

Disclosure to business associates. We may disclose health information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Disclosures to child protection agencies. We will disclose protected health information as needed to comply with state law requiring reports of suspected incidents of child abuse or neglect.

Other disclosures without written permission. There are other circumstances in which we may be required by law to disclose protected health information without your permission. They include disclosures made:

• Pursuant to court order; To federal officials for lawful military or intelligence activities;
• To public health authorities; To coroners, medical examiners, and funeral directors;
• To law enforcement officials in some circumstances; To researchers involved in approved research projects; and
• To correctional institutions regarding inmates; As otherwise required by law.

Other disclosures. We will follow the provisions of CFR Part 2 governing disclosure of protected health information. Except for the circumstances described above, we will not disclose protected health information to a third party without your written permission from the individual or a court order. If a request for disclosure of your patient record is received, you will be contacted and asked whether you wish to authorize disclosure. If you refuse to authorize disclosure, or it is not possible for us to contact you in person, we will not disclose your information without a court order.

Your Written Authorization is Required for Other Uses and Disclosures

The following uses and disclosures of your Protected Health Information will be made only with your written authorization for:

• Most uses and disclosures of psychotherapy notes and documentation associated with your treatment (where appropriate);
• Uses and disclosures of Protected Health Information for marketing purposes; and
• Disclosures that constitute a sale of Protected Health Information

Disclosure to your family and friends. If you are an adult, you have the right to control the disclosure of information about you to any other person, including family members or friends. If you ask us to keep your information confidential, we will respect your wishes. If you authorize us to do so, we will share information with family members or friends involved in your care as needed to enable them to help you. A minor acting alone has the legal capacity to voluntarily apply for and obtain substance abuse treatment. Any written

Consent for disclosure may be given only by the minor. This restriction includes, but is not limited to, any disclosure of identifying information to the parent, legal guardian, or custodian of a minor for the purpose of obtaining financial reimbursement.

Your Legal Rights

Right to request confidential communications. You may request that communications to you, such as appointment reminders, bills, or explanations of health benefits be made in a confidential manner. We will accommodate any such request, as long as you provide a means for us to process payment transactions.

Right to get notice of a breach. You have the right to be notified upon a breach of any of your unsecured Protected Health information.

Right to request restrictions. You have the right to request a restriction or limitation on the health information we use or disclose for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request in writing. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your Protected Health lnfo1mation to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us "out-of-pocket" in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Out-of-pocket payments. If you paid out-of-pocket in fu11 for a specific item or service, you have the right to ask that your Protected Health information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.

Right to revoke a consent or authorization. You may revoke a written consent or authorization for us to use or disclose your protected health information. The revocation will not affect any previous use or disclosure of your information.

Right to review and copy record. You have the right to see records used to make decisions about you. We will allow you to review your record unless a clinical professional determines that would create a substantial risk of harm to you or someone else. If another person provided information about you to our clinical staff in confidence, that information may be removed from the record before it is shared with you. We will also delete any protected health information about other people. At your request, we will make a copy of your record for you. We will charge a reasonable fee for this service.

Right to "amend" record. If you believe your record contains an error, you may ask us to amend it. If there is a mistake, a note will be entered in the record to correct the error. If not, you will be told and allowed the opportunity to add a short statement to the record explaining why you believe the record is inaccurate. This information will be included as part of the total record and shared with others if it might affect decisions they make about you.

Right to an accounting of disclosures. You have the right to request a list of certain disclosures we made of health information for purposes other than treatment, payment, and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request in writing g. If requested by law enforcement authorities that are conducting a criminal investigation, we will suspend the accounting of disclosures made to them.

Right to a paper copy of this Notice. You have the right to a paper copy of this Notice of Privacy Practices.

How to Exercise Your Rights

Questions about our policies and procedures requests to exercise individual rights, and/or complaints should be directed to our Privacy Officer. Our Privacy Officer is Tina Swathwood, Vice President of Business Operations. The Privacy Officer can be reached at (904) 278-5644, extension 2026.

Personal representatives. A "'personal representative" of a patient may act on their behalf in exercising their privacy rights. This includes the parent or legal guardian of a minor. In some cases, adolescents who are "mature minors" may make their own decisions about receiving treatment and disclosure of protected health information about them. If an adult is incapable of acting on his or her own behalf, the personal representative would ordinarily  be his or her spouse or another member of the immediate family. An individual can also grant another person the right to act as his or her personal representative in an advance directive or living will. Disclosure of protected health information to personal representatives may be limited in cases of domestic or child abuse.

Complaints

If you have any complaints or concerns about our privacy policies or practices, please submit a complaint to our Privacy Officer. If you wish, the Privacy Officer will give you a form that you can use to submit a complaint. The complaint should be addressed to: Tina Swathwood, Vice President of Business Operations and Privacy Officer

Clay Behavioral Health Center 3292 County Road 220, Middleburg, FL 32068

904-291-5561

You can also submit a complaint to the United States Department of Health and Human Services. Send your complaint to:

Office for Civil Rights

U.S. Department of Health and Human Services 200 Independence Avenue, S.W.

Room 509F, HHH Building Washington, D.C. 2020 I

OCR Hotlines-Voice: 1-800-368-1019

We will never retaliate against you for filing a complaint.

We reserve the right to change our Notice of Privacy Practice.