Notice of Privacy Practices

Effective Date: April 14, 2003

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

We are required by the privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to maintain the privacy of our patients? health information and to provide patients with this Notice of Information and Privacy Practices. These privacy regulations extend to all officers, employees, volunteers, and agents of High Plains Mental Health Center who have access to or obtain knowledge of treatment information.

Your Rights under the Federal Privacy Standard

As a patient at High Plains Mental Health Center, you have the right to the confidentiality of your records, and information regarding whether you currently are, or have ever been a patient. Although your mental health records are the physical property of the High Plains Mental Health Center, you have the following rights with regard to the information contained therein:

• Request restriction on uses and disclosures of your health information for treatment, payment, and healthcare operations. The right to request restriction does not extend to uses or disclosures permitted or required under federal privacy regulations. Your request must be in writing mailed to the contact identified at the end of this Notice. Your request must describe in detail the restriction you are requesting. We do not, however, have to agree to the restriction. If we do, we will adhere to it unless you request otherwise, or we give you advance notice.
• You have the right to receive a paper copy of this Notice of Information and Privacy Practices upon request. We also have posted this notice in prominent locations throughout the agency and on our website.
• You have the right to receive confidential communication. For example, you may ask us to communicate with you by alternate means, and if the method of communication is reasonable, we must grant the alternate communication request.
• You have the right to inspect and copy your health information upon request; however, in certain situations, we can deny access. You do not have a right of access to the following: 1) information compiled in reasonable anticipation of or for use in civil, criminal, or administration actions or proceedings; 2) information that was obtained from another healthcare provider; or 3) information that was obtained from someone other than a healthcare provider under a promise of confidentiality and the requested access would be reasonably likely to reveal the source of the information. There are also instances where we can deny access, but must provide you a review of our decision to deny such access. These reviewable grounds for denial include the following: 1) a licensed healthcare professional has determined that the access is reasonably likely to endanger the life or physical safety or yourself or another person; 2) the information makes reference to another person (other than a healthcare provider) and a licensed professional has determined that access is likely to cause substantial harm to such other person; or 3) the request is made by your personal representative and a licensed profession has determined that giving access to the personal representative is reasonably likely to cause substantial harm to you or another person. For these reviewable grounds, another licensed professional must review the decision to deny access within 60 days. If we deny you access, we will explain why and what your rights are, including how to seek review. If we grant access, we will tell you what, if anything, you have to do to get access. We reserve the right to charge a reasonable fee for making copies that may be requested following review.
• You have the right to request an amendment or correction of your health information. We do not have to grant the request if the following conditions exist: 1) we did not create the record; 2) the records are not available to you as discussed above; 3) the record is already accurate and complete. If we deny your request for amendment or correction, we will notify you why, how you can attach a statement of disagreement to your records (which we may rebut), and how you can complain. If we grant the request, we will make the correction and distribute the correction as allowed.
• You have the right to obtain an accounting of nonroutine uses and disclosures, those other than for treatment, payment, and healthcare operations. We do not need to provide an accounting for the following disclosures: 1) to you for disclosures of protected health information to you; 2) for uses and disclosures that you authorized; 3) to persons involved in your care or for other notification purposes as allowed in the federal privacy regulations; 4) for national security or intelligence purposes as allowed under the federal privacy regulations; 5) to correctional institutions or law enforcement officials as allowed under the federal privacy regulations; 6) that occurred before April 14, 2003.
  
  We must provide the accounting within 60 days, and the accounting must include the following information: 1) date of each disclosure; 2) name and address of the organization or person who received the information; 3) brief description of the information disclosed; 4) brief statement of the purpose of the disclosure that reasonably informs you of the basis for the disclosure or, a copy of your written authorization or written request for the disclosure.
• You have the right to revoke your consent or authorization to use or disclose health information except to the extent that we have taken action in reliance on the consent or authorization.
• You have the right to file a complaint with High Plains Mental Health Center or Health and Human Services if you believe High Plains Mental Health Center is not in compliance with the regulations.