Participant
Notice and Rights "HIPAA" & 45
CFR Pts. 160-164
Participant Notice
THIS NOTICE DESCRIBES HOW MEDICAL AND DRUG AND
ALCOHOL RELATED INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
General Information
Information regarding your health care, including
payment for health care, is protected by two federal
laws: the Health Insurance Portability and Accountability
Act of 1996 (“HIPAA”), 42 U.S.C. § 1320d et seq.,
45 C.F.R. Parts 160 & 164, and the Confidentiality
Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under
these laws, Mid Valley Recovery Services may not
say to a person outside Mid Valley Recovery Services
that you attend the program, nor may Mid Valley
Recovery Services disclose any information identifying
you as an alcohol or drug abuser, or disclose any
other protected information except as permitted
by federal law.
Mid Valley Recovery Services must obtain your written
consent before it can disclose information about
you for payment purposes. For example, Mid Valley
Recovery Services must obtain your written consent
before it can disclose information to your health
insurer in order to be paid for services. Generally,
you must also sign a written consent before Mid
Valley Recovery Services can share information for
treatment purposes or for health care operations.
However, federal law permits Mid Valley Recovery
Services to disclose information without your written
permission:
- Pursuant to an agreement with a qualified service
organization/ business associate;
-
For research, audit or evaluations;
- To report a crime committed on Mid Valley Recovery
Servicesf premises or against Mid Valley Recovery
Services personnel;
- To medical personnel in a medical emergency;
- To appropriate authorities to report suspected child
abuse or neglect;
- As allowed by a court order.
For example, Mid Valley Recovery Services can disclose
information without your consent to obtain legal
or financial services, or to another medical facility
to provide health care to you, as long as there
is a qualified service organization / business associate
agreement in place.
Before Mid Valley Recovery Services can use or
disclose any information about your health in a
manner which is not described above; it must first
obtain your specific written consent allowing it
to make the disclosure. Any such written consent
may be revoked by you in writing.
Your Rights
Under HIPAA you have the right to request restrictions
on certain uses and disclosures of your health information.
Mid Valley Recovery Services is not required to
agree to any restrictions you request, but if it
does agree then it is bound by that agreement and
may not use or disclose any information which you
have restricted except as necessary in a medical
emergency.
You have the right to request that we communicate
with you by alternative means or at an alternative
location. Mid Valley Recovery Services will accommodate
such requests that are reasonable and will not request
an explanation from you. Under HIPAA you also have
the right to inspect and copy your own health information
maintained by Mid Valley Recovery Services except
to the extent that the information contains psychotherapy
notes or information compiled for use in a civil,
criminal or administrative proceeding or in other
limited circumstances.
Under HIPAA you also have the right, with some
exceptions, to amend health care information maintained
in Mid Valley Recovery Services' records, and to
request and receive an accounting of disclosures
of your health related information made by Mid Valley
Recovery Services during the six years prior to
your request. You also have the right to receive
a paper copy of this notice.
Mid Valley Recovery Services' Duties
Mid Valley Recovery Services is required by law
to maintain the privacy of your health information
and to provide you with notice of its legal duties
and privacy practices with respect to your health
information. Mid Valley Recovery Services is required
by law to abide by the terms of this notice. Mid
Valley Recovery Services reserves the right to change
the terms of this notice and to make new notice
provisions effective for all protected health information
it maintains. In the event that changes occur, revised
notices will be provided by the Program Director
to all currently enrolled participants and shall
be considered effective only for all currently enrolled
participants, exempting participants who have been
discharged from new and/or revised provisions.
Complaints and Reporting Violations
You may complain to Mid Valley Recovery Services
and the Secretary of the United States Department
of Health and Human Services if you believe that
your privacy rights have been violated under HIPAA.
Complaints must be filed within one hundred eighty
(180) days of the date the individual knows or should
have known that the wrongdoing occurred (which time
period may be waived for good cause shown). A complaint
form may be requested from the Program Director,
from the Privacy Officer, or from your Primary Counselor.
You will not be retaliated against for filing such
a complaint.
Violation of the Confidentiality Law by a program
is a crime. Suspected violations of the Confidentiality
Law may be reported to the United States Attorney
in the district where the violation occurs.
Contact
For further information, contact the Executive Director at 626 453-3417.
Effective Date
This notice is in effect as of January 1, 2007.
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