NOTICE OF PRIVACY
PRACTICES
This notice describes how medical, health, and
behavioral health information about you may be used and disclosed, and how you
can get access to this information.
Please review it carefully.
EFFECTIVE DATE:
The San Luis Valley
Comprehensive Community Mental Health Center is committed to protecting health
and personal information about you. The
Center and its providers collect information about you and create a record of
the care and services you receive. We
need this record to provide you with quality care and to comply with certain
legal requirements. This Notice of
Privacy Practices applies to all of the records of your care generated or
maintained by the Center and its providers, including the following people and
organizations:
This notice tells you about
the ways in which we may use and disclose health and treatment information
about you. It also describes your rights
and certain obligations we have regarding the use and disclosure of health and
treatment information.
The
HOW WE MAY USE OR DISCLOSE HEALTH AND TREATMENT INFORMATION ABOUT YOU
The following information
describes different ways we use and disclose health and treatment
information. If you are receiving
services for the evaluation or treatment of substance abuse conditions,
specific rules apply to the information related to those services. Please refer to the section entitled Substance
Abuse Health Information for those rules.
For Treatment: We may use health
and treatment information about you to provide you with behavioral health
treatment or services. We may disclose
information about you to psychiatrists, therapists, case managers, your primary
care physician, and other behavioral health professionals involved in your
care. For example, a psychiatrist
treating you may need to know if you have allergies to certain medications. Your primary care physician may need to know
what psychiatric medications you are using to coordinate care, or we may need
to speak to the pharmacist about your prescriptions. Different departments or groups within our
Center may also share information in order to coordinate the services you need,
such as medications, individual therapy, group therapy, and case
management. We may ask for you to
authorize a release of information for some treatment disclosures even though
it is not required as a way to inform and involve you with the course of your
treatment.
For Payment: We may use and
disclose health and treatment information about you so we may bill for the
services you receive and collect from appropriate payers, such as Colorado
Mental Health Services (CMHS), Medicaid, an insurance company, or other third
parties. For example, we may need to
give the agency paying for your care information about the treatment you
received in order for them to pay. We
may also need to request prior approval or authorization to determine whether
your insurance or the responsible payer will cover services.
For Health Care Operations: We may use and
disclose health and treatment information about you for the healthcare
operations of the
Individuals
Involved in Your Care: We may release health or treatment
information about you to a family member actively involved in your care or
treatment as allowed by
Research: Under certain
limited circumstances, we may use and disclose health or treatment information
about you for research purposes. For
example, a research project may involve the care and recovery of all clients
who use one medication for the same condition.
All research projects are subject to special approval. We will ask for your specific permission if
the researcher will have access to your name, address or other information that
reveals who you are. You may participate
in research or not, as you wish, without jeopardizing your care.
Appointment Reminders: We may use and
disclose information to contact you as a reminder that you have an appointment
for treatment or services.
Health-Related Information or
Resources: We may use and disclose information in order
to tell you about other resources or treatment information that may be of
interest to you, such as new groups or websites.
SUBSTANCE ABUSE HEALTH INFORMATION: The
confidentiality of records related to the diagnosis, treatment, referral for
treatment or prevention of alcohol or drug abuse is protected by federal law
and regulations (42 USC 290dd-3, 42 USC 290ee-3, and 42 CFR part 2). Generally a substance abuse program may not
disclose to anyone outside the program that a client attends the program or
disclose any information identifying a client as an alcohol or drug abuser,
unless:
Violations of the federal law
and regulations by a substance abuse provider are a crime. Suspected violations may be reported to the United
States Attorney in the district where the violations occurs, or to the Center’s
Privacy Officer. State law requires, and
federal law permits, a substance abuse program to report suspected child abuse
or neglect to appropriate authorities.
HIV INFORMATION: All medical information
regarding HIV is kept strictly confidential and released only in accordance
with the requirements of state law (CRS
RIGHTS OF MINORS: A person aged 15 or older may consent to mental health
treatment and authorize disclosure of information as if s/he were an
adult. Parents or legal guardians,
however, may request information about a minor’s mental health treatment and
may receive it without the minor’s permission if a professional person judges
it to be in the minor’s best interests.
A minor of any age may consent to substance abuse treatment. Parents or legal guardians may not have
access to their child’s substance abuse treatment information without written
authorization from the minor. All other
provisions of the privacy notice apply equally to adults and to minors.
SPECIAL CIRCUMSTANCES
Federal
and state laws allow or require the Center and its providers to disclose health
or treatment information about you, other than substance abuse or HIV
information, without your written authorization in certain special
circumstances, if they occur.
Public Health Risks (Health and Safety for You and/or
Others). We may disclose health
information about you for public health activities, when necessary to prevent a
serious threat to your health and safety or to the health and safety of another
person or the general public. These
activities generally include the following:
·
To prevent or control disease, injury, or disability
·
To report child abuse or neglect
·
To report abuse of the elderly or at-risk adults
·
To report reactions to medications
·
To notify people of recalls of medications they may be using
·
To notify a person who may have been exposed to a disease or who may be
at risk for contracting a disease
·
To avert a serious threat to the health or safety of a person or the
public
·
When required by law, to inform the appropriate authorities if we believe
a client has been the victim of abuse, neglect, or domestic violence
Health Oversight Activities. We may disclose health information
about you to a health oversight agency for activities authorized by law. These oversight activities may include
audits, investigations, inspections, and licensure. These activities are necessary for the
government to monitor the behavioral health care system, government-funded
programs, and compliance with civil rights, the Privacy Rule, and other laws.
Lawsuits
and Disputes: If you are involved in a lawsuit or legal
action, we may disclose health information about you in response to a court or
administrative order from a judge. We
may also disclose health information about you in response to a judge’s order
requested by someone else involved in the dispute. If you have filed a complaint or lawsuit
against your therapist or the Center, health information about you may be
disclosed to the agencies responsible for resolving the matter.
Law
Enforcement: We may disclose health
information about you if asked to do so by a law enforcement official for one
of the following reasons:
·
In response to a court order, subpoena, warrant, summons, or similar
lawful process
·
When limited information is needed to identify or locate a suspect,
fugitive, material witness, or missing person
·
About the victim of a crime if, under certain limited circumstances, we are
unable to obtain the person’s authorization
·
About a death we believe may have been the result of criminal conduct
·
About criminal conduct at any Center office, in any Center program, or
against a
·
In emergency circumstances to report a crime, the location of the crime
or victims, or the identity, description, or location of the person believed to
have committed the crime
·
For disaster relief purposes if you are incapacitated or unable to give
consent
Coroners,
Medical Examiners, and Funeral Directors: We
may disclose information to a coroner or medical examiner. This may be necessary to identify a deceased
person or determine the cause of death.
We may also release health information about clients to funeral directors
when necessary to carry out their duties.
National
Security and Intelligence Activities: We
may disclose health information about you to authorized federal officials for
intelligence, counterintelligence, and other national security activities authorized
by law.
Protective
Services for the President and Others: We
may disclose health information about you to authorized federal officials so
they may provide protection to the President, other authorized persons, or
foreign heads of state.
Inmates:
If you
are an inmate of a correctional institution or under the custody of a law
enforcement official, we may disclose health information about you to the
institution or to the official.
As
Required By Law: We will disclose health
information about you when required to do so by federal, state or local law.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU:
Right to Inspect and Copy: You have the
right to inspect and copy health information that may be used to make decisions
about your care. This may include
evaluations/assessments, treatment plans, progress notes, and billing
information. To inspect or copy your
health information, you must submit a request in writing to the Privacy
Officer. You may be charged a reasonable
fee for the costs of copying your records.
Your
request to inspect and copy your information may be denied in certain limited
circumstances. The Center retains the right to withhold information which may
be detrimental to your health or safety or to the health or safety of others. If you are denied access to any part of your
health information, you may request, in some cases, that the denial be
reviewed. Instructions on how to
initiate that review process will be provided in writing at the time on any
denial of your access to information.
Right to Amend: If you believe
there is a mistake or missing information in your records, you may ask us to
amend the record. You have the right to
request an amendment for as long as your health information is kept by the
Center. To request an amendment, submit
the request in writing to the Privacy Officer.
You must provide a reason that supports your request. We may deny your request if you ask us to
amend information that
·
Is accurate and
correct
·
Is not part of
the health information kept by the Center or its providers
·
Is not part of
the health information which you would be permitted to inspect or copy
·
Was not created
by us, unless the person/entity that created the information is no longer
available to make the amendment
Right to an Accounting of
Disclosures: You have the right to request a list of some disclosures
of health information made about you. The
list does not include information disclosed for the purposes of treatment,
payment or health care operations, and it does not include information
disclosed to those when you or your representative authorized it in writing. To request this accounting, you must make
your request in writing to the Privacy Officer.
Your request must state a period of time for the accounting that may not
be longer than six years and may not include dates before
Right to Request Restrictions: You have the
right to request a restriction or limitation on the health information we use
or disclose about you. The Center will
consider your request, but we do not have to agree. If we do agree, we will comply with the
request unless the information is needed to provide you emergency
treatment. To request restrictions, you
must make your request in writing to the Privacy Officer. In your request, you must tell us what
information you want to limit, and to whom you want the limit to apply. We cannot agree to limit uses or disclosures
required by law.
Right to Request Confidential
Communications: You have the right to request that we
communicate with you about health matters in a certain way or at a certain
location. For example, you can ask that
we only contact you at a certain telephone number or address. To request confidential communications, you
must submit your request in writing to the Privacy Officer. We will accommodate all reasonable
requests. Your request must specify how
or where you wish to be contacted.
Right to Paper Copy of this Notice: You have the
right to receive a paper copy of this Notice.
You may ask for one at any time.
OTHER USES
Other uses and disclosures of
health information not covered by this notice or the laws that apply to mental
health and substance abuse providers will be made only with your written
authorization for release of information.
If you provide us with such a written authorization, you may revoke it
in writing at any time. The Center will
no longer use or disclose information for the reasons covered in your
authorization(s). However, the Center is
unable to take back any disclosure that was already made in reliance on your
authorization.
CHANGES TO THIS
NOTICE
The San Luis Valley
Comprehensive Community Mental Health Center may change this notice at any time. We reserve the right to make the updated
notice effective for health information we already have about you as well as
any information we receive in the future.
The notice will contain the effective date. SLVCCMHC will make you aware of any revisions
by posting a revised notice in each office location and on the website at www.slvmhc.org.
COMPLAINTS AND
ASSISTANCE
If you need any assistance to
understand this notice or your rights, and if you need assistance in filing
requests, you may ask your clinician, the consumer advocate, or the privacy
officer. If you believe your privacy
rights have been violated, you may contact the Privacy Officer for the San Luis
Valley Comprehensive Community Mental Health Center. Rhonda Borders may be reached by mail at 8745
CR 9 South,