NOTICE OF PRIVACY PRACTICES
This notice describes how medical, health, and
behavioral health information about you may be used and disclosed, and how you
can get access to this information.
Please review it carefully.
West Central Mental Health
Center is committed to protecting health and personal information about
you. The Center and its providers
collect information about you and create a record of the care and services you
receive. We need this record to provide
you with quality care and to comply with certain legal requirements. This Notice of Privacy Practices applies to
all of the records of your care generated or maintained by the Center and its
providers, including the following people and organizations:
This notice tells you about
the ways in which we may use and disclose health and treatment information
about you. It also describes your
rights and certain obligations we have regarding the use and disclosure of
health and treatment information.
West Central Mental Health
Center is required by law to:
The following information
describes different ways we use and disclose health and treatment information
For Treatment: We may use
health and treatment information about you to provide you with behavioral
health treatment or services. We may
disclose information about you to psychiatrists, therapists, case managers,
your primary care physician, and other behavioral health professionals involved
in your care. For example, a
psychiatrist treating you may need to know if you have allergies to certain
medications. Your primary care
physician may need to know what psychiatric medications you are using to
coordinate care, or we may need to speak to the pharmacist about your
prescriptions. Different departments or
groups within our Center may also share information in order to coordinate the
services you need, such as medications, individual therapy, group therapy, and
case management. We may ask for you to
authorize a release of information for some treatment disclosures even though
it is not required as a way to inform and involve you with the course of your
treatment.
For Payment: We may use
and disclose health and treatment information about you so we may bill for the
services you receive and collect from appropriate payers, such as Colorado
Mental Health Services (CMHS), Medicaid, an insurance company, or other third
parties. For example, we may need to
give the agency paying for your care information about the treatment you
received in order for them to pay. We
may also need to request prior approval or authorization to determine whether
your insurance or the responsible payer will cover services.
For Health Care Operations: We may use
and disclose health and treatment information about you for the business
activities of the Mental Health Center and its providers. These uses and disclosures are necessary for
administrative functions and to ensure our clients receive quality care. For example, we may use health and treatment
information about you to review the performance of clinical staff, to complete
audits by our licensing agencies, or to develop additional clinical
services. We may call you or send you a
survey to ask about your satisfaction with services provided by our agency.
Individuals Involved in Your Care: We may
release health or treatment information about you to a family member actively
involved in your care or treatment as allowed by Colorado law (CRS 27-10-120
and 27-10-120.5). This information is
limited and may only be released when it is determined to be in your best
interests.
Research: Under certain
limited circumstances, we may use and disclose health or treatment information
about you for research purposes. For example,
a research project may involve the care and recovery of all clients who use one
medication for the same condition. All
research projects are subject to special approval. We will ask for your specific permission if the researcher will
have access to your name, address or other information that reveals who you
are. You may participate in research or
not, as you wish, without jeopardizing your care.
Appointment Reminders: We may use
and disclose information to contact you as a reminder that you have an
appointment for treatment or services.
Health-Related Information or
Resources: We may use and disclose information in order
to tell you about other resources or treatment information that may be of
interest to you, such as new groups or websites.
HIV INFORMATION: All medical information
regarding HIV is kept strictly confidential and released only in accordance
with the requirements of state law (CRS 25-4-1 and CRS 25-4-14). Disclosure of any health information
referring to a client’s HIV status may only be made with the specific written
authorization of the client. A general
authorization for the release of health information is not sufficient for this
purpose.
RIGHTS OF MINORS: A person aged
15 or older may consent to mental health treatment and authorize disclosure of
information as if s/he were an adult. Parents or legal guardians, however, are
legally entitled to request and receive information about a minor’s mental
health treatment without the minor’s permission. All other provisions of the
privacy notice apply equally to adults and to minors.
Federal
and state laws allow or require the Center and its providers to disclose health
or treatment information about you, other than HIV information, without your
written authorization in certain special circumstances, if they occur.
Public
Health Risks (Health and Safety for You and/or Others). We may disclose health information about you for public health
activities, when necessary to prevent a serious threat to your health and
safety or to the health and safety of another person or the general
public. These activities generally
include the following:
·
To prevent or control disease, injury, or disability
·
To report births or deaths
·
To report child abuse or neglect
·
To report abuse of the elderly or at-risk adults
·
To report reactions to medications
·
To notify people of recalls of medications they may be using
·
To notify a person who may have been exposed to a disease or who may be
at risk for contracting a disease
·
To avert a serious threat to the health or safety of a person or the
public
·
When required by law, to inform the appropriate authorities if we believe
a client has been the victim of abuse, neglect, or domestic violence
Health
Oversight Activities. We may disclose health information about you to a
health oversight agency for activities authorized by law. These oversight activities may include
audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the
behavioral health care system, government-funded programs, and compliance with
civil rights and other laws.
Lawsuits
and Disputes: If you are involved in a lawsuit or legal
action, we may disclose health information about you in response to a court or
administrative order from a judge. We
may also disclose health information about you in response to a subpoena,
discovery request or other lawful process initiated by someone else involved in
the dispute. If you have filed a
complaint or lawsuit against your therapist or the Center, health information
about you may be disclosed to resolve the matter.
Law
Enforcement: We may disclose health
information about you if asked to do so by law enforcement for one of the
following reasons:
·
In response to a court order, subpoena, warrant, summons, or similar
lawful process
·
When limited information is needed to identify or locate a suspect,
fugitive, material witness, or missing person
·
About the victim of a crime if, under certain limited circumstances, we
are unable to obtain the person’s authorization
·
About a death we believe may have been the result of criminal conduct
·
About criminal conduct at any Center office, in any Center program, or
against a staff member, visitor, or another client
·
In emergency circumstances to report a crime, the location of the crime
or victims, or the identity, description, or location of the person believed to
have committed the crime
Coroners,
Health Examiners, and Funeral Directors: We
may disclose information to a coroner or health examiner. This may be necessary to identify a deceased
person or determine the cause of death.
We may also release health information about clients to funeral
directors when necessary to carry out their duties.
National
Security and Intelligence Activities: We may
disclose health information about you to authorized federal officials for
intelligence, counterintelligence, and other national security activities
authorized by law.
Protective
services for the President and Others: We
may disclose health information about you to authorized federal officials so
they may provide protection to the President, other authorized persons, or
foreign heads of state.
As
Required By Law: We will disclose health information about you when required to do so by
federal, state or local law.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU:
Right to Inspect and Copy: You have the
right to inspect and copy health information that may be used to make decisions
about your care. This may include
evaluations/assessments, treatment plans, progress notes, and billing
information. To inspect or copy your
health information, you must submit a request in writing to the Privacy
Officer. You may be charged a reasonable
fee for the costs of copying your records.
Your
request to inspect and copy your information may be denied in certain very
limited circumstances. In those
circumstances, the Center retains the right to withhold information that may be
detrimental to your health or safety or to the health or safety of others. If you are denied access to any part of your
health information, you may request that the denial be reviewed. Instructions on how to initiate that review
process will be provided in writing at the time on any denial of your access to
information.
Right to Amend: If you feel
any health information we have abut you is incorrect or incomplete, you may ask
us to amend the information. You have
the right to request an amendment for as long as your health information is
kept by the Center. To request an
amendment, submit the request in writing to the Privacy Officer. You must provide a reason that supports your
request. We may deny your request if
you ask us to amend information that
·
Is accurate and correct
·
Is not part of the
health information kept by the Center or its providers
·
Is not part of the
health information which you would be permitted to inspect or copy
·
Was not created by us,
unless the person/entity that created the information is no longer available to
make the amendment
Right to an Accounting of Disclosures: You have the
right to request an accounting or list of disclosures of health information
made about you. The list does not
include information disclosed for the purposes of treatment, payment or health
care operations, and it does not include information disclosed on the basis of
a written authorization for release of information signed by you or someone
authorized to act for you. To request
this accounting, you must make your request in writing to the Privacy
Officer. Your request must state a period
of time for the accounting that may not be longer than six years and may not
include dates before April 14, 2003.
Right to Request Restrictions: You have the
right to request a restriction or limitation on the health information we use
or disclose about you. The Center is
not required to agree to your request.
If we do agree, we will comply with the request unless the information
is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to the
Privacy Officer. In your request, you
must tell us what information you want to limit, and to whom you want the limit
to apply.
Right to Request Confidential
Communications: You have the right to request that we
communicate with you about health matters in a certain way or at a certain
location. For example, you can ask that
we only contact you at a certain telephone number or address. To request confidential communications, you
must submit your request in writing to the Privacy Officer. We will accommodate all reasonable
requests. Your request must specify how
or where you wish to be contacted.
Right to Paper Copy of this Notice: You have the
right to receive a paper copy of this Notice.
You may ask for one at any time.
Other uses and disclosures of
health information not covered by this notice or the laws that apply to mental
health and substance abuse providers will be made only with your written
authorization for release of information.
If you provide us with such a written authorization, you may revoke it
in writing at any time. The Center will
no longer use or disclose information for the reasons covered in your
authorization(s). However, the Center
is unable to take back any disclosure that was already made in reliance on your
authorization.
West Central Mental Health
Center reserves the right to change this notice. We reserve the right to make the updated notice effective for
health information we already have about you, as well as for any information we
receive in the future. The Center will
post a copy of the current notice in each office location and on its
website. The notice will contain the
effective date. The Center will make
you aware of any revisions by posting a revised notice in the above locations.
If you need any assistance to
understand this notice or your rights, and if you need assistance in filing
requests, you may ask your clinician, the consumer advocate, or the privacy
officer. If you believe your privacy
rights have been violated, you may contact the Privacy Officer for West Central
Mental Health Center. Steve Samsel may
be reached by mail at 3225 Independence Road, Canon City, CO 81212, or by
calling 719-275-2351. If we cannot resolve your concern, you also have the
right to file a written complaint with the United States Secretary of the
Department of Health and Human Services.
You may also refer to the Clients Rights form for additional sources of
information or assistance. The services
you receive will not be jeopardized nor will you be penalized for filing a
complaint.