Notice of Privacy Practices
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.
Our Obligation To You
We, at Northside Mental 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” (PHI) 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 individually identifiable health information about you.
Our Uses and Disclosures
We typically use or share your health information in the following ways:
|Treat You||We can use your health information and share it with other professionals who are treating you.||Example: A doctor treating you asks another doctor about your overall health condition.|
|Run Our Organization||We can use and share your health information to run our practice, improve your care, and contact you when necessary.||Example: We use health information about you to manage your treatment and services.|
|Bill For Your Services||We can use and share your health information to bill and get payment from your health plans or other entities.||Example: We give information about you to your health insurance plan, so it will pay for your services.|
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/.
|Help with Public Health and Safety Issues||We can share health information about you for certain situations such as:
|Do Research||We can use or share your information for health research.|
|Comply With The Law||We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.|
|Respond To Organ and Tissue Donation Requests||We can share health information about with organ procurement organizations.|
|Work With a Medical Examiner or Funeral Director||We can share health information with a coroner, medical examiner, or funeral director when an individual dies.|
|Respond to Lawsuits and Legal Actions||We can share health information about you in response to a court or administrative order, or in response to a subpoena.|
Your Legal Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
|Address Workers’ Compensation, Law Enforcement, and Other Government Requests||We can use or share health information about you:
|Get A Copy of Your Medical Record||You can ask to see or get a copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.|
|Ask Us to Correct Your Medical Record||You can ask to see or get a copy of your medical record and other health information we have about you. Ask us how to do this. We may say “no” to your request, but we will tell you why in writing within 60 days.|
|Request Confidential Communications||You can ask us to contact you in a specific way (for example home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.|
|Get A List of Those With Whom We Have Shared Information||You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.|
|Ask Us to Limit What We Use or Share||You can ask us not to use or share certain health information for treatment, payment, or our operations.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations to your health insurer.
|Get A Copy Of This Privacy Notice||You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.|
|Choose Someone To Act For You||If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for your before we take any action.|
|File A Complaint If You Feel Your Rights Are Violated||You can complain if you feel we have violated your rights by contacting us using the information for the Main Campus on our Contact Us page.You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:
We will never retaliate against you for filing a complaint. We will never ask you to waive or give up your rights to Protected Health Information as a condition of treatment or eligibility.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care.
- Share information in a disaster relief situation if you are not able to tell us your preference. For example, if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information without written permission:
- Most sharing of psychotherapy notes.
- We will never sell your information.
- We will never include your information in a hospital directory.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here, unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be available upon request, in our office, and on our website.