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 applies to Northpoint Colorado, LLC and its adolescent treatment program Imagine Fort Collins.
We are required by law to maintain the privacy of your health information and to give you notices of our legal duties and privacy practices with respect to your protected health information. This Notice summarizes our duties and your rights concerning your protected health information and substance abuse disorder records. Our duties and your rights are set forth more fully in the Health Insurance Portability and Accountability Act (45 C.F.R. part 164) (“HIPAA”) and the federal law and regulations governing the confidentiality of substance abuse disorder records (42 U.S.C. § 290dd-2, 42 C.F.R. Part 2). We are required to abide by the terms of our Notice that is currently in effect.
Uses and Disclosures of Information That We May Make Without Your Written Authorization
We may use or disclose your protected health information for the following purposes without your written authorization:
Internal Program Communications
Our personnel may disclose your health information between or among themselves if they have a need for the information in connection with their duties that arise out of the provision of diagnosis, treatment, or referral for treatment of patients with substance use disorders.
Crimes on Program Premises or Against Program Personnel
We may disclose your health information to law enforcement officers to the extent the disclosure is directly related to crimes and threats to commit crimes on our premises or against our personnel.
Child Abuse Reporting
We may disclose your health information as required by state law to report suspected child abuse and neglect to appropriate state or local governmental authorities.
We may disclose your health information to medical personnel to the extent necessary to meet a bona fide medical emergency in which your prior informed consent for the disclosure cannot be obtained.
We may disclose your health information in response to a valid court order.
Audit and Evaluation Activities
We may disclose your health information to qualified persons who are conducting an audit or evaluation of our program.
We may disclose your health information for medical research purposes, subject to your authorization or approval by an institutional review board.
Qualified Service Organizations and/or Business Associates
We may disclose your health information under contracts for services with qualified service organizations and/or business associates outside of our program, which assist our program in providing health care.
Appointments and Services
We may use or disclose your health information to send you appointment reminders, or to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. Please advise us if you do not wish to receive such communications, and we will not use or disclose your information for such purposes. If you wish not to receive this kind of communication, you must advise us in writing at our contact address given above.
Uses and Disclosures of Information That We May Make With Your Written Authorization
We may use and disclose protected health information in the following instances only with your written authorization:
With your written authorization, we may disclose your protected health information to healthcare providers outside our program so that they may help treat you.
With your written authorization, we may use or disclose your protected health information so that we, or other healthcare providers, may obtain payment for treatment provided to you. For example, we may disclose information from your medical records to your health insurance company to obtain pre-authorization for treatment or submit a claim for payment.
With your written authorization, we may use or disclose your protected health information for certain healthcare operations that are necessary to run our program and ensure that our patients receive quality care. For example, we may use information from your medical records to review the performance or qualifications of physicians and staff; train staff; or make business decisions affecting the program.
Notes recorded by your mental health professional documenting the contents of a counseling session with you, which are known as “psychotherapy notes,” will be used only by your provider and will not otherwise be used or disclosed without your written authorization unless otherwise required by law.
We will not use your health information for marketing communications without your written authorization.
Sale of Protected Health Information.
We must obtain your written authorization prior to selling your protected health information, consistent with the related definitions and exceptions set forth in HIPAA.
Other Uses and Disclosures
Other uses and disclosures will be made only with your written authorization. You may revoke your authorization by submitting a written notice to the Privacy Officer identified below. However, the authorization will not be effective to the extent we have already taken action in reliance on the authorization.
Your Rights Concerning Your Protected Health Information
You have the following rights concerning your protected health information. To exercise any of these rights, you must submit a written request to the Privacy Officer identified below.
Right to Request Additional Restrictions
You may request additional restrictions on the use or disclosure of your protected health information for treatment, payment or healthcare operations. We are not required to agree to a requested restriction except if your request is to restrict disclosing protected health information to a health plan for the purpose of carrying out payment or health care operations, the disclosure is not otherwise required by law, and the protected health information pertains solely to a health care item or service which has been paid in full by you or another person or entity on your behalf. If we agree to a restriction, we will comply with the restriction unless an emergency or the law prevents us from complying with the restriction, or until the restriction is terminated.
Right to Receive Communications by Alternative Means
We normally contact you by telephone or mail at your home address. You may request that we contact you by some other method or at some other location. We will not ask you to explain the reason for your request. We will accommodate reasonable requests. We may require that you explain how payment will be handled if an alternative means of communication is used.
Right to Inspect and Copy Records
You may inspect and obtain a copy of protected health information that is used to make decisions about your care or payment for your care. We may charge you a reasonable cost-based fee for providing the records. We may deny your request under limited circumstances, e.g., information prepared and used solely for legal proceedings or if disclosure may endanger the life or safety of you or another individual.
Right to Request Amendment to Record
You may request that your protected health information be amended. You must explain the reason for your request in writing. We may deny your request if we did not create the record unless the originator is no longer available; if you do not have a right to access the record; or if we determine that the record is accurate and complete. If we deny your request, you have the right to submit a statement disagreeing with our decision and to have the statement attached to the record.
Right to an Accounting of Certain Disclosures
You may receive an accounting of certain disclosures we have made of your protected health information within the last six years. We are not required to account for disclosures for treatment, payment, or healthcare operations; to family members or others involved in your healthcare or payment; for notification purposes; or pursuant to our facility directory or your written authorization. You may receive the first accounting within a 12-month period free of charge. We may charge a reasonable cost-based fee for all subsequent requests during that 12-month period.
Right to Receive Notification of a Breach
In accordance with HIPAA, we are required to notify you if we discover a breach of your unsecured protected health information.
Right to Receive a Copy of This Notice
You have the right to obtain a paper copy of this Notice upon request. You have this right even if you have agreed to receive the Notice electronically.
Changes to This Notice
We reserve the right to change the terms of our Notice of Privacy Practices at any time, and to make the new Notice provisions effective for all protected health information that we maintain. If we materially change our privacy practices, we will prepare a new Notice of Privacy Practices, which shall be effective for all protected health information that we maintain. We will post a copy of the current Notice in our reception area and on our website. You may obtain a copy of the current Notice in our reception area, or by contacting the Privacy Officer identified below.
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our Privacy Officer identified below. All complaints must be in writing. We will not retaliate against you for filing a complaint.
Violation of the federal law and regulations governing the confidentiality of substance abuse disorder treatment records is a crime, and you may report suspected violations to the U.S. Attorney for the judicial district in which the violation occurs. Contact information for the U.S. Attorney Office where we operate is below:
U.S. Attorney for the District of Colorado
1801 California Street, Suite 1600
Denver, Colorado 80202
Suspected violations by an opioid treatment program may be reported to the Substance Use and Mental Health Services Administration (SAMHSA), Opioid Treatment Program Compliance Office by phone at 204-276-2700 or online at OTPemail@example.com.
If you have any questions about this Notice, or if you want to object to or complain about any use or disclosure or exercise any right as explained above, please contact our Privacy Officer, Stacey Shaw (208) 370-2866.
This Notice is effective on 12/22/2022