This Notice Describes How Medical and Psychological Information About You May Be Used and Disclosed and How You Can Get Access to This Information.
Your Rights Regarding Your Protected Health Information (PHI)
Restorative Behavioral Health Services (the "Practice") is committed to maintaining the privacy of your protected health information (PHI). This notice explains how we use and disclose your PHI, and outlines your rights regarding your health information.
In accordance with the Health Insurance Portability and Accountability Act (HIPAA), we are required to:
Maintain the confidentiality of your PHI.
Provide you with a copy of this Notice of Privacy Practices.
Notify you in the event of a breach of your unsecured PHI.
How We May Use and Disclose Your Health Information
We may use and disclose your PHI for the following purposes:
Treatment: We may use and disclose your PHI to provide, coordinate, or manage your treatment and services. For example, we may share your PHI with another healthcare provider who is involved in your treatment.
Payment: We may use and disclose your PHI to obtain payment for services provided to you. This includes billing insurance companies, verifying eligibility, and handling claims.
Healthcare Operations: We may use and disclose your PHI for operational purposes, such as quality assessment, training, and administrative activities necessary to run our practice.
Appointment Reminders and Communications: We may contact you with appointment reminders or other health-related communications.
Required by Law: We may disclose your PHI when required by federal, state, or local law, including compliance with court orders, legal proceedings, or other legal obligations.
Uses and Disclosures of PHI Without Your Authorization
YIn certain circumstances, we may disclose your PHI without your written authorization. These include:
Public Health Activities: For disease control, reporting adverse reactions, or aiding in public health efforts.
Judicial and Administrative Proceedings: If required by law or in response to a court order, subpoena, or other legal request.
Law Enforcement: If necessary for law enforcement purposes, including in cases of criminal activity or to prevent harm.
To Avert a Serious Threat to Health or Safety: To law enforcement or others to prevent a serious and imminent threat to the health or safety of a person or the public.
Workers’ Compensation: If necessary for compliance with workers' compensation laws.
Your Health Information Rights
You have the following rights concerning your PHI:
Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI in a designated record set, with certain exceptions.
Right to Amend: If you believe your PHI is inaccurate or incomplete, you have the right to request an amendment to your records.
Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your PHI made by us for purposes other than treatment, payment, or healthcare operations.
Right to Request Restrictions: You have the right to request restrictions on how we use or disclose your PHI. We are not required to agree to your request, but we will consider it carefully.
Right to Confidential Communications: You have the right to request that we communicate with you about your PHI in a certain way or at a specific location, such as a P.O. Box instead of your home address.
Right to Receive a Copy of This Notice: You have the right to request a paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive it electronically.
How We Protect Your Information
We are committed to safeguarding your PHI. We utilize appropriate physical, administrative, and technical safeguards to prevent unauthorized access, use, or disclosure of your information.
For More Information or Complaints
If you believe your privacy rights have been violated, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-800-368-1019
TDD: 1-800-537-7697
Fax: 1-202-619-3818
Email: OCRComplaint@hhs.gov
Website: https://www.hhs.gov/ocr/complaints/index.html
By signing below, you acknowledge that you have received this Notice of Privacy Practices. If you have any questions about this notice, please contact us at the contact information provided above.
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Effective Date of This Notice is January 2025.