NOTICE OF PRIVACY PRACTICES
Health Insurance Portability and Accountability Act
We will not use or disclose your health information without your authorization, except as otherwise described in this Notice of Privacy Practices.
Effective July 24, 2016
Burrell Behavioral Health’s NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY OR MAY NOT BE USED AND DISCLOSED AND ALSO HOW YOU MAY OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Burrell Behavioral Health is required to:
- maintain the privacy and security of your protected health information as required bylaw;
- notify you promptly if a breach occurs that may have compromised the privacy or security of yourinformation.
- abide by the terms of this notice and provide you with a copy ofit;
- notify you if we are unable to agree to a requested restriction on how your information is used ordisclosed;
- accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations;and
- obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted underlaw.
Burrell Behavioral Health reserves the right to change the terms of this notice. The changes will apply to all protected health information it maintains. The most recent version of our Privacy Notice will be available on request, available in all of our office locations and posted on our website. Copies will be made available for you asrequested.
Burrell Behavioral Health uses your health information for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Burrell Behavioral Health.
How Burrell Behavioral Health May use or Disclose Your Health Information
For Treatment. Burrell Behavioral Health may use your health information to provide and coordinate medical treatment or services. For example, your protected health information may be provided to a physician you have been referred by to ensure the referring physician has the necessary information to diagnose or treat you. Sharing of information for treatment purposes is necessary for healthcare providers to determine what treatment you should receive. Healthcare providers will also record actions taken by them in the course of your treatment and note your responses.
For Payment. Burrell Behavioral Health may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis and your course of treatment.
For Health Care Operations. Burrell Behavioral Health may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of our risk or quality assurance staff, and othersto:
- evaluate the performance of ourstaff;
- access the quality of care and outcomes in your cases and similarcases;
- learn how to improve our facilities and services;and
- determine how to continually improve the quality and effectiveness of the health care we provide.
Appointments. Burrell Behavioral Health may use and disclose your information to provide appointment reminders, a referral visit, or to follow-up with you after a visit. We may leave a brief reminder on your answering machine or voicemail system unless you tell us not to do so.
Individuals Involved in your Healthcare. We will only disclose your information to a member of your family, a relative, or any other person you identify and we will limit such information to that which directly relates to that person's involvement in your care. You will be asked to provide the names of these individuals.
In an Emergency. We may use or disclose your medical information in an emergency situation. If this happens, we shall try to obtain your acknowledgement as soon as reasonably practicable after the emergency situation is under control.
Additional Disclosures Required by Law. Burrell Behavioral Health may use and disclose information about you when required by law. For example, Burrell Behavioral Health may disclose information for the following purposes:
- to assist law enforcement officials in their law enforcementduties;
- for national security and intelligence activities for the protection of thePresident;
- to report information related to victims of abuse, neglect or domestic violence;and
- for judicial and legal proceedings pursuant to legal authority such as to a court or administrative order or in response to a subpoena.
- to the Department of Health and Human Services if it wants to see that we are complying with federal privacylaw.
Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.
Emergency or Disaster Events. We may use or disclose your information to a public or private entity authorized by law to assist in disaster relief efforts, for the purpose of coordinating care or services with such entities. This may include, but is not limited to emergency managers, fire officials, law enforcement officers, public health authorities, emergency medical services such as ambulance districts and other public works officials regarding: the numbers and locations of our patients; emergency notification contacts to expedite contact with families, legal guardians, representatives or others regarding the need for evacuation or emergency care; or any other information that is deemed necessary to protect the health, safety and well-being of Burrell clients.
Research. Burrell Behavioral Health may use your health information for research purposes, but only after an institutional review board or privacy board has reviewed the research proposal, has established protocols to ensure the privacy of your health information and has approved the research.
Health and Safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person according to applicable law. We may use or disclose your protected health information in the event of an emergencysituation.
Medical Examiner or Funeral Director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Government Functions. Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services.
Workers’ Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to any Workers’ Compensation claim you may file.
Oversight Activities. Information may be disclosed for the purpose of oversight activities, such as audits, investigations, licensure or disciplinary actions or legal proceedings.
Decedents. Health information may be disclosed to coroners to enable them to carry out their lawful duties.
Military. Information will be released when required by military command authorities if you are a member of the armed forces or to appropriate foreign military authorities if you are foreign military personnel;
Inmates. In the case of a prison inmate, information can be released to the correctional facility in which he or she resides for the following purposes: (1) for the institution to provide the inmate with health care (2) to protect the health and safety of the inmate or the health and safety of others; or (3) for the safety and security of the correctional facility.
Fundraising Activities. We may use or disclose your demographic information to contact you regarding fundraising activities. If you wish to opt out of fundraising activities, you may call or email the Privacy Officer at 417.761.5962 or email@example.com.
Limited Marketing Activities. We may use and disclose protected health information to inform you of treatment alternatives or other health related benefits and services that may be of interest to you;
Other Uses. Other uses and disclosures will be made onlywith your written authorization and you may revoke that authorization regarding future action.
Your Health Information Rights
You have the right to:
- Request a restriction on certain uses and disclosures of your information. However, Burrell Behavioral Health is not required to agree to a requested restriction and we may say “no” if it would affect your care.
- Restrict disclosures of your protected health information to your health plan if you pay for a service out of pocket and in advance. We will honor this request unless a law requires us to share the information.
- Obtain a paper copy of the notice of privacy practices, even if you have agreed to receive the notice electronically, upon request.
- To be notified of a breach of unsecured protected health information if you are affected and obtain an electronic or paper copy of your of your health and/or record, upon written request. You will be provided a copy or a summary of your health information, usually within 30 days or less of your request. We may charge a reasonable, cost-based fee. Please contact the Health Information Management Release of Information Department.
- Amend your health record within the bounds of accuracy as understood by those involved in your care. we may say “no” to your request, but we will tell you why in writing within 60 days.
- Request communications of your health information by alternative means, such as to your home or office phone or to send mail to different or at alternative locations, if we are able to do so.
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken and receive an accounting of disclosures made of your health information for six years prior to the date you ask, who we shared it with and why. We will include all disclosures except those about treatment, payment, and health care operation, and certain disclosures (such as those 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 a 12 month period.
- Choose someone to act for you. If you have given someone power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information. We will make sure the person has the authority and for you before we take anyaction.
You may complain to Burrell Behavioral Health and to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.
If you have any questions, or wish to file a complaint, please contact:
Compliance Hotline at 417.761-5028 or firstname.lastname@example.org
If you believe your privacy rights have been violated, you may contact the privacy officer at 417.761.5962, or email@example.com.
File a complaint with the facility at the above numbers, or with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to them at 200 Independence Avenue SW, Washington, DC 20201 or by calling 877.696.6775, or TTY 886.788.7989.