Notice of Privacy Practices

Your 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.

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper 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 a 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 us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say "no" to your request, but we'll 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.

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. We are not required to agree to your request, and we may say "no" if it would affect your care.
• 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 with your health insurer. We will say "yes" unless a law requires us to share that information.

Get a list of those with whom we've shared information

• You can ask for a list (accounting) of the times we've 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'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

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 you 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 at the bottom of this page.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Your Choices

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 go ahead and 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 unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

Our Uses and Disclosures

How do we typically use or share your health information? Because we are a substance use disorder treatment program, federal law (42 CFR Part 2) requires your written consent for most disclosures — including many that other health care providers may make without consent.

Treat you

We can use your health information and, with your written consent where required by 42 CFR Part 2, share it with other professionals who are treating you.

Example: A physician treating you coordinates with our clinical team about your overall treatment plan.

Run our organization

We can use and share your health information to run our program, improve your care, and contact you when necessary — including quality improvement, staff training, licensing, and accreditation activities.

Example: We use health information about our clients to review and improve our treatment services.

Bill for your services

With your written consent where required, we can use and share your health information to bill and get payment from 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 public health and research. We have to meet many conditions in the law before we can share your information for these purposes, and as a Part 2 program, additional federal restrictions apply. For more information see: www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/.

• Help with public health and safety issues — reporting suspected child abuse or neglect as required by state law; preventing or reducing a serious and imminent threat to anyone's health or safety.
• Do research — we can use or share your information for health research when regulatory requirements are met.
• 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're complying with federal privacy law.
• Respond to court orders — for SUD records, only a court order meeting the special requirements of 42 CFR Part 2 permits disclosure.
• Medical emergencies — we may share information with medical personnel to the extent necessary to meet a bona fide medical emergency.
• Audits and evaluations — we may share information with qualified personnel for audit, program evaluation, or oversight of the program.
• Address workers' compensation and other government requests — as authorized by law and consistent with Part 2.

Confidentiality of Substance Use Disorder Records (42 CFR Part 2)

The confidentiality of substance use disorder patient records maintained by Elijah's House is protected by federal law and regulations (42 U.S.C. § 290dd-2; 42 CFR Part 2). Generally, we may not say to a person outside the program that you attend the program, or disclose any information identifying you as having a substance use disorder, unless:

• You consent in writing;
• The disclosure is allowed by a court order; or
• The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.

Violation of the federal law and regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with federal regulations. Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program, or about any threat to commit such a crime. Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.

Our Responsibilities

• 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.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, at our facility, and on our website at elijahshouse.com.

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