HIPPA Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

Effective Date: April 14, 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

This notice is available in other languages and alternative formats that meet the guidelines for the Americans with Disabilities Act (ADA). Contact Heavens Peak Behavioral Services HIPPA Privacy Officer at phone 307-645-3384 or fax 307-645-3384.

Esta noticia está disponible en otras idiomas y formativos alternativos que van por los reglamentos del Acto de Americanos con Incapacidades. Llame al Heavens Peak Behavioral Services HIPPA Privacy Officer at phone 307-645-3384 or fax 307-645-3384.

As your health care provider, Heavens Peak Behavioral Services provides behavioral health services and staff must collect, create and maintained information about you to provide these services. Heavens Peak Behavioral Services knows that the information we collect about you and your health is private. Heavens Peak Behavioral Services, Inc is required to protect this information by federal and state law. This information is known as “Protected Health Information” (PHI).

The Notice of Privacy Practices tells you how Heavens Peak Behavioral Services may use or disclose your PHI. This notice may not be all inclusive of all situations. Heavens Peak Behavioral Services is required to give you notice of our privacy practices for the information we collect and keep about you. Heavens Peak Behavioral Services is required to follow the terms of the notice currently in effect.

Heavens Peak Behavioral Services is required by law to maintain the privacy of your PHI, provide you with notice of our legal duties and privacy practices with respect to PHI, and notify you if your PHI is affected in a breach of unsecured PHI.

When Heavens Peak Behavioral Services May Use and Disclose Information Without Your Authorization

  • For Treatment. Heavens Peak Behavioral Services may use or disclose information with health care providers who are involved in your health care. This may include health care providers (doctors, nurses, licensed practitioners) employed by or outside of the health plan. For example, information may be shared to create and carry out a plan for your treatment.
  • For Payment. Heavens Peak Behavioral Services may use or disclose information to get effect payment for the health care services you receive. For example, Heavens Peak Behavioral Services may provide PHI in relation to a bill received for health care services provided to you.
  • For Health Care Operations. Heavens Peak Behavioral Services may use or disclose information in order to manage its programs and activities. These uses and disclosures are necessary to run the health plan and to make sure that people covered by our plan receive quality care. For example, Heavens Peak Behavioral Services may use PHI to review the quality of services you receive or to evaluate a provider’s performance prior to providing payment.
  • Other Disclosures for Plan Operations. Heavens Peak Behavioral Services may use or disclose PHI for the following activities
    Heavens Peak Behavioral Services may disclose PHI to your plan sponsor as required under the plan’s contract,
    Heavens Peak Behavioral Services will use or disclose PHI for underwriting purposes, but Heavens Peak Behavioral Services is prohibited from using or disclosing any genetic information for such purposes
    Heavens Peak Behavioral Services may use or disclose PHI for fundraising purposes. However, you have the right to opt out of any fundraising communications.
  • Appointments and Other Health Information. Heavens Peak Behavioral Services may send you reminders for medical care checkups. Heavens Peak Behavioral Services may send you information about health services that may be of interest to you. You have a right to place restrictions on these communications and request how these communications occur.
  • For Public Health Activities. Heavens Peak Behavioral Services may send PHI to the state or local public health agency that keeps and updates vital records, such as births and deaths, and tracks some diseases. We may disclose medical information to these agencies as required by law.
  • For Health Oversight Activities. Heavens Peak Behavioral Services may use or disclose information to inspect or investigate health care providers. We may disclose medical information to health oversight agencies for activities authorized by law.
  • As Required by Law and For Law Enforcement. Heavens Peak Behavioral Services will use and disclose information when required by federal or state law; by court order, subpoena, warrant, summons, administrative request or similar process; or in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
  • For Abuse Reports and Investigations. Heavens Peak Behavioral Services is required by law to receive and investigate reports of abuse (administrative related to violations of regulation).
  • For Government Programs. Heavens Peak Behavioral Services may use and disclose information for public benefits under other government programs. For example, Heavens Peak Behavioral Services may disclose information for the determination of Supplemental Security Income (SSI) benefits.
  • To Avoid Harm. Heavens Peak Behavioral Services may disclose PHI to law enforcement in order to avoid a serious threat to the health and safety of a person or the public.
  • For Research. Heavens Peak Behavioral Services uses information for studies and to develop reports. These reports do not identify specific people. These types of disclosures may only occur without specific patient authorization when you (the patient) has previously agreed to participate in a research study and the report disclosures are included in participation agreements.
  • Disclosures to Family, Friends and Others Who Are Involved In Your Medical Care. Heavens Peak Behavioral Services may disclose information to your family or other persons who are involved in your medical care. You have the right to object to the sharing of this information. Disclosures may only occur without authorization in instances of emergency or incapacity to effect treatment or care.
  • Other Uses and Disclosures Require Your Written Authorization. For other situations, Heavens Peak Behavioral Services will ask for your written authorization before using or disclosing information. You may cancel this authorization at any time in writing. Heavens Peak Behavioral Services cannot take back any uses or disclosures already made with your authorization, however disclosures made in conjunction with a valid authorization and prior to a written revocation cannot be withdrawn.
  • Other Laws Protect PHI. Many Heavens Peak Behavioral Services programs have other laws for the use and disclosure of information about you. For example, you must give your written authorization for Heavens Peak Behavioral Services will obtain your authorization prior to any such disclosures.

Your PHI Privacy Rights

You have the following rights regarding health information Heavens Peak Behavioral Services maintains about you:

  • Right to Inspect and Receive Copies of Your Records. In most cases, you have the right to inspect or receive copies of your records. You must make the request in writing. You may be charged a fee for the cost of copying your records. Heavens Peak Behavioral Services may deny your request to inspect and copy in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.
  • Right to Request a Correction or Update of Your Records. You may ask Heavens Peak Behavioral Services to amend information you feel to be incorrect or add missing information to your records. You must make the request in writing, and provide a reason for your request. Heavens Peak Behavioral Services may deny your request in certain limited circumstances.
  • Right to Get a List of Disclosures. You have the right to ask Heavens Peak Behavioral Services for a list of disclosures or access report made within the last three years. You must make the request in writing. The list will not include information provided directly to you or your family, or information that was sent with your authorization.
  • Right to Request Limits on Uses or Disclosures of PHI. You have the right to ask that Heavens Peak Behavioral Services limit how your information is used or disclosed. You must make the request in writing to Heavens Peak Behavioral Services 89 RD 8 RA, Powell, WY 82435 and tell Heavens Peak Behavioral Services what information you want to limit and to whom you want the limits to apply. Heavens Peak Behavioral Services is not required to agree to the restriction, unless the restriction is for disclosures to a health plan for carrying out payment or health care operations that are not otherwise required by law, and the PHI pertains solely to a health care item or service for which you personally, and not your plan, have paid in full, You can request that the restrictions be terminated in writing or verbally.
  • Right to Revoke Permission. If you are asked to sign an authorization to use or disclose information, you can cancel that authorization at any time. You must make the request in writing to Heavens Peak Behavioral Services Privacy Officer at 89 RD 8 RA, Powell, WY 82435, this will not affect information that has already been shared.
  • Right to Choose How We Communicate with You. You have the right to request that Heavens Peak Behavioral Services share information with you in a certain way or in a certain place. For example, you may ask Heavens Peak Behavioral Services to send information to your work address instead of your home address. You must make this request in writing. You do not have to explain the basis for your request.
  • Right to File a Complaint. You have the right to file a complaint if you do not agree with how Heavens Peak Behavioral Services has used or disclosed information about you or if you believe your privacy rights have been violated. You will not be penalized for filing a complaint. To file a complaint you may write to us at:Heavens Peak Behavioral Services 64 Safe Haven Rd, Powell, WY 82435, Fax 866-320-1673 You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services Office of Civil Rights.
  • Right to Get a Paper Copy of this Notice. You have the right to ask for a paper copy of this notice any time.

For More Information

If you have any questions about this notice or need more information, please contact the Heavens Peak Behavioral Services Privacy Officer/HIM Director/Designated Official at Phone 844-HEAVEN1, Fax 866-320-1673 Address: 64 Safe Haven Rd, Powell, WY 82435

In the future, Heavens Peak Behavioral Services may change its Notice of Privacy Practices. Any changes will apply to information Heavens Peak Behavioral Services already has, as well as information Heavens Peak Behavioral Services receives in the future. A copy of the new notice will be posted at Heavens Peak Behavioral Services as required by law. You may ask for a copy of the current notice anytime you visit or contact Heavens Peak Behavioral Services