THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice is effective on January 1, 2020.
Federal laws have restrictive requirements for health information regarding treatment of substance use disorders. In order for us to disclose your substance use disorder health information for a purpose other than those permitted by law, we must have your authorization. The only exception to disclosure of such information, without your authorization, is in limited circumstances as regulated by federal law. For instance, in the case of your medical emergency, we may disclose your patient identifying information without your prior consent. Alcohol and/or drug treatment records are protected under the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 C.F.R. Pts 160 & 164, and cannot be disclosed without written consent from patient unless otherwise provided for in the regulations.
Right to Inspect and Copy Your Health Information: You may request access to your health information in order to review or request copies of such information. In certain situations, we may deny you access to a portion of your health information (for example, mental health records or information gathered for judicial proceedings) as allowed by law. To review or obtain copies of your health information, we require that your request be submitted in writing. We will charge you a reasonable fee for copies of your health information, which may include the cost of copying (including cost of supplies and labor) and postage. You have the right to request that the copy be provided in an electronic form or format. If the form and format are not readily producible, we will work with you to create a reasonable electronic form or format. If you decline the available electronic formats, we will provide you with a paper copy.
When We May Use or Disclose Your Health Information without Your Written Authorization
Payment. We may use and disclose your health information to obtain payment for services that we provide to you. For example, in order for an insurance company to pay for your treatment, we must submit a bill that identifies you, your diagnosis, and the treatment provided to you. As a result, we will provide such health information to an insurer to obtain payment for your medical bills.
Disclosures to Business Associates. In order for us to carry out treatment, payment or health care operations, we may disclose your health information to persons or organizations that perform a service for us, or on our behalf, that requires the use or disclosure of individually identifiable health information. Such persons or organizations are our business associates. For example, we may disclose your health information to an agency that accredits health care organizations or to a collection agency to collect payment of medical bills.
Health or Safety. We may use or disclose your health information to prevent or lessen a serious and imminent threat to the health or safety of a person or the general public.
Judicial and Administrative Proceedings. We may disclose your health information in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
Coroners, Medical Examiners and Funeral Directors. We may disclose your health information to a coroner, medical examiner or funeral director as required or allowed by law.
Right to Cancel Authorization to Use or Disclose Your Health Information. You may cancel an authorization you have provided to us. This must be submitted in writing to: Bruce Decorah, PO BOX 1550, Rhinelander WI, 54508.
Right to Receive a Record of Disclosures of Your Health Information. You may ask for a list of certain disclosures of your health information made by us, in the six years prior to the date of your request. This list must include the date of each disclosure, who received the health information disclosed, a brief description of the health information disclosed, and why the disclosure was made. This list will not include disclosures made to you, or for purposes of treatment, payment, health care operations, or for certain other purposes. To request a list of such disclosures, you must request records from our administrative staff.
Right to Notification of Breach. You have the right to be informed of a breach of your protected health information. We will notify you, within 60 days of our discovery of the incident, if we breach your unsecured protected health information.
If you believe your privacy rights have been violated, you may file a complaint with the federal Department of Health and Human Services and us. We will not retaliate against you for filing such a complaint. To file a complaint, please contact Bruce Decorah at 1-715-362-5745. All complaints must be submitted in writing and sent to PO BOX 1550, Rhinelander WI, 54508.
If you have any questions about your privacy rights or the information in this Notice, you may contact Bruce Decorah at 715-362-5745.