Behavioral Health Services in Northwest Arkansas

PRIVACY PRACTICES NOTICE

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.  If you have questions about this notice please contact our Privacy Officer.  This notice is required by the Privacy Regulations created as a result of the Health Information Portability and Accountability Act of 1996 (HIPAA).  We realize that these laws are complicated, but we must provide you with the following important information:

USE AND DISCLOSURE OF YOUR HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES:

The following circumstances may require us to use or disclose your health information.  These circumstances do not require written permission from you as the patient or your guardian: 

1.  Public Health authorities and health oversight agencies that are authorized by law to collect information. 

2. Lawsuits and similar proceedings in response to a court administrative order or valid subpoena.

3. If required to do so by law enforcement officials in investigative process.

4. When necessary to reduce or prevent a serious threat to your health and safety when we believe that it is in your best interest, the health and safety of another individual or the public.  We will only make disclosures to a person or organization able to prevent the threat. 

5. To federal officials for intelligence and national security activities as authorized by law

6. To correctional institution or law enforcement officials if you are an inmate or under the custody of a law enforcement official

7. For worker’s compensation and similar programs.

8. To support continued healthcare on your behalf.

9. To share information in a disaster relief situation. 

10. Work with a medical examiner; coroner;  or funeral director regarding death certificates.

11. To share information for the public health and research such as: mandatory reporting and disease prevention; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect, or domestic violence; or preventing or reducing a serious threat to anyone’s health or safety. 

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION: 

1. Right To Request Alternative Communications – you can request that we communicate with you about your health and related issues in a particular manner or a certain location.  For instance, you may ask that we contact you at home rather than work.  We will do as much as we can to accommodate reasonable requests.  We are not required to approve all requests.  Perspectives Behavioral Health does not text protected health information.  

2. Right to Request Restrictions to Use or Disclosure – You can request a restriction in our use or disclosure of your health information for treatment, payment, or health care operations.  Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or the payment of your care, such as family members or friends. We are not required to agree to your request.  However, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.   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 of our operations with your health insurer. 

3. Right to Access Information.  You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patienet medical records and billing records.  You must submit your request in writing to our Health Information Department at 1340 South Waldron Road, Fort Smith, Arkansas, 72903. 

4. Right to Request Amendments.  You may ask to amend or correct your health record if you believe it is incorrect or incomplete and as long as the information is kept for our use.  To request an amendment to the record, your request must be in writing and submitted to our Health Information Department Manager at 1340 South Waldron Road, Fort Smith, Arkansas 72903.   You must present clear reason that supports your request for an amendment.

5. Right to A Notice of Privacy Practices.  You are entitled to receive a copy of this notice of privacy practices.  You may ask us to give you a 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.  To obtain a copy of this notice, contact the Health Information Management Department at 1340 South Waldron Road, Fort Smith, Arkansas, 72903. 

6. Right to Complain About Our Privacy Practices.  You have the right to file a privacy complaint if you believe your privacy rights have been violated.  You may file a complaint with us or the Secretary of the Department of Health and Human Services 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 or penalize you for filing a complaint.   To file a complaint with us, contact our Privacy Officer at 1340 South Waldron Road, Fort Smith, Arkansas 72903.  All complaints must be in writing.

7. Right to Choose Disclosures for Other Uses.  You have the right to provide an authorization for other uses and disclosures.  Perspectives Behavioral Health Management will obtain your written authorization for use and disclosures that are not identified by this notice or permitted under applicable laws.  You can later revoke these authorizations if you so desire.  

8. Right to an Accounting.  You may 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.  Some restrictions do apply.  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 will provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

9. Right to 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.

ADDITIONAL RESTRICTED DISCLOSURE:

We will never share your information unless you give us written permission for:

  • Marketing purposes 
  • Sale of your information
  • Psychotherapy Notes as defined below. 

PSYCHOTHERAPY NOTES:  

Psychotherapy notes: “notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the content of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record”.  The provider must give prior approval for release of these types of notes to the patient for patient and provider safety and we do not have to release if felt that significant harm to the individual patient could occur.

BREACH NOTIFICATION REQUIREMENTS: 

Covered entities must promptly notify affected individuals following the discovery of a breach of   Unsecured Protected health information.  A breach is generally, an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of an individuals Protected Health Information.  A thorough investigation and Risk Assessment will be done prior to the notification of an individual concerning a breach of Protected Health Information. 


REQUIREMENT TO ABIDE:  

Perspectives Behavioral Health is required to abide by the terms of this notice.



Copyright (c) 2017 Perspectives Behavioral Health Management, LLC

P.O. Box 23070, Barling, AR 72923  |  1340 South Waldron Road, Fort Smith, AR 72903
Main Phone: 479-452-5040  |  Toll Free: 888-505-5040  |  Fax: 479-452-5047