This notice is effective as of March 30, 2017
USES AND DISCLOSURE OF HEALTH INFORMATION TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
Unity Behavioral Health uses and discloses your protected health information for treatment, payment, and health care operations. Some examples of when our office may use or disclose your health care information for these purposes include:
- Sharing test results with other health care providers for confirmation of a diagnosis
- Providing your diagnosis or other information about your health to your insurance provider or our billing service to obtain payment for the health care services we provide
- Reviewing information as part of our quality improvement program
OTHER USES AND DISCLOSURES
Unity Behavioral Health may also use or disclose your protected health information, in compliance with guidelines outlined by law, for the following purposes:
- Providing you with information related to your health
- Contacting you regarding appointments, information about Unity Behavioral Health or other health related services
- Incidental uses or disclosures (e.g., listing your name on a sign-in sheet, etc.)
- Compliance with all laws (including reports of suspected abuse, neglect or violence)
- Providing certain specified information to law enforcement or correctional institutions
- Providing information to a coroner, medical examiner, funeral director or organ procurement organization
- Public health activities when requested by a public health authority or the FDA. Responding to health oversight agencies
- Responding to court or administrative tribunal orders, subpoenas, discovery requests, or other lawful process
- Research activities
- When necessary to avert a serious threat to health or safety
- Military affairs, veterans affairs, national security, intelligence, Department of State, or presidential protective service activities
- Providing information regarding your location, general condition, or death, to public or private disaster relief agencies
- Providing information to a family member, other relative, or close personal friend, relative to your location, general condition, or death
- To assist in your health care (e.g. pick-up prescriptions or other documents, note follow-up care instructions, etc.)
AUTHORIZATION FOR OTHER USES
Unity Behavioral Health will make other uses and disclosure of your protected health information only after obtaining your written authorization. If you authorize a use not contained in this notice, you may revoke your authorization at any time by notifying us in writing that you wish to revoke your authorization.
YOUR RIGHTS REGARDING THE PRIVACY OF YOUR HEALTH INFORMATION
Subject to limitations outlined by law, you have certain rights related to use and disclosure of your protected health information, including the right to:
- Request restrictions on certain uses and disclosures. However, Unity Behavioral Health is not obligated to agree to requested restrictions.
- Receive confidential communications (e.g., home phone, work phone, etc.) or protected health information. We will comply with reasonable requests.
- Request to see or receive an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or summary of your health information, in most instances, within 30 days. If we are unable to provide the requested information within 30 days, we will give you an explanation as to why not.
- Inspect and copy your protected health information, with some limited exceptions.
- Request that we amend or correct your private health information. We may deny your request, but we will notify you why within sixty (60) days.
- Receive an accounting of disclosures of your health information, for a period of six (6) years after your discharge, except for disclosures made at your request, or relative to your treatment, payment, or our company operations.
- Request that someone act on your behalf, for example, by giving someone medical power of attorney, or by appointing someone as your legal guardian.
- Obtain a copy of this notice. We will provide you with a paper copy of the notice promptly upon your request.
UNITY BEHAVIORAL HEALTH’S DUTIES REGARDING THE PRIVACY OF YOUR HEALTH INFORMATION
Subject to limitations outlined by law, Unity Behavioral Health has certain duties related to your protected health information, including:
- Unity Behavioral Health is required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information.
- Unity Behavioral Health is required to abide by the terms of the privacy notice that is currently in effect.
- Unity Behavioral Health reserves the right to change a privacy practice described in this notice and to make such change effective for all protected health information. Revised notices will be posted in our offices, on our website, and available upon request.
- Unity Behavioral Health is required by law to let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
If you believe your privacy rights have been violated, you may make a complaint by contacting:
Timothy Noonan, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Sam Nunn Atlanta Federal Center
Suite 16T70 61 Forsyth Street, S.W. Atlanta, GA 30303-8909
Voice Phone (800) 368-1019
FAX (404) 562-7881
TDD (800) 537-7697
No individual will be retaliated against for filing a complaint.