Notice of Privacy Practices

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.

This Notice of Privacy Practices describes how we may use and disclose your protected health information once you have signed our Consent to Use and Disclose Health Information. New federal legislation requires that we issue this official notice of our privacy practices. You have the right to the confidentiality of your medical information, and this practice is required by law to maintain the privacy of that protected health information. “Protected health information” means health information (including identifying information) we have collected from you or received from your health care providers, health plans, your employer or healthcare clearinghouse. It may include information about your past, present or future mental health condition. This agency is required to abide by the terms of the Notice of Privacy Practices currently in effect, and to provide notice of its legal duties and privacy practices with respect to protected health information. If you have any questions about this Notice, please contact the Privacy Officer at P.O. Box 30, Paris, TN 38242.

Who Will Follow This Notice

Any health care professional authorized to enter information into your medical record, all employees, staff and other personnel at this agency who may need access to your information must abide by this Notice. All subsidiaries, business associates (e.g. a billing service), sites and locations of this agency may share medical information with each other for treatment, payment purposes or health care operations described in this Notice. Except where treatment is involved, only the minimum necessary information needed to accomplish the task will be shared.

How We May Use and Disclose Medical Information About You

The following categories describe different ways that we may use and disclose medical information without your specific consent or authorization. Examples are provided for each category of uses or disclosures. Not every possible use or disclosure in a category is listed.

For Your Treatment and Care Coordination
We may use medical information about you to provide you with medical treatment or services. Example: In treating you for a specific condition, we may need to know if you have allergies that could influence which medications we prescribe for the treatment process. We will also use and disclose information to CAREY staff who are part of your treatment team, or who may need information for billing purposes, or for quality improvement purposes. We may use and disclose information to outside organizations for coordinating care for you, such as your Primary Care Physician, your pharmacy, or a hospital. Unless you require emergency care, we will only disclose your information to these outside organizations with your written permission.

For Payment
We may use and disclose medical information about you so that the treatment and services you receive from us may be billed and payment may be collected from you, an insurance company or a third party. Example: We may need to send your protected health information, such as your name, address, office visit date, and codes identifying your diagnosis and treatment to your insurance company for payment.

For Health Care Operations
We may use and disclose medical information about you for health care operations to assure that you receive quality care. Example: We may use medical information to review our treatment and services and evaluate the performance of our staff in caring for you and in determining possible treatment options for you.

Other Uses or Disclosures That Can Be Made Without Consent or Authorization
• As required by law during an investigation by law enforcement agencies
• To avert a serious threat to public health or safety
• In response to a legal proceeding, such as a court order
• If an inmate, to the correctional institution or law enforcement official, if they pay for your services
• As required by the US Food and Drug Administration (FDA), such as problems with medications
• In an emergency treatment situation
• Uses and disclosures required by law
•For research purposes when the research has been approved by an institutional Review Board and has protocols to ensure the privacy of your health information
• For health oversight activities authorized by law

Uses and Disclosures of Protected Health Information Requiring Your Written Authorization
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you give us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will thereafter no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care we have provided you.

Your Individual Rights Regarding Your Medical Information

Right to Request Restrictions
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations or to someone who is involved in your care or the payment for your care. To request a restriction you must either include it (with our approval) in the Consent for Use or Disclosure Form or make your request in writing to the Privacy Officer at P.O. Box 30, Paris, TN 38242. You will be asked to sign a new consent form which includes the restrictions. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Right to Request Confidential Communications
You have the right to request how we should send communications to you about medical matters, and where you would like those communications sent. To request confidential communications, you must make your request to the Privacy Officer at P.O. Box 30, Paris, TN 38242. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. We reserve the right to deny a request if it imposes an unreasonable burden on the agency.

Right to Inspect and Copy
You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually this includes medical and billing records but does not include psychotherapy notes, information compiled for use in a civil, criminal, or administrative action or proceeding, and protected health information to which access is prohibited by law. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Privacy Officer at P.O. Box 30, Paris, TN 38242. If you request a copy of the information, we reserve the right to charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by this practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Amend
If you feel that medical information we have about 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 the information is kept. Usually, this would include clinical and billing records, but not psychotherapy notes. To request an amendment, your request must be made in writing and submitted to the Privacy Officer at P.O. Box 30, Paris, TN 38242. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if the information was not created by us, is not part of the medical information kept at this agency, is not part of the information which you would be permitted to inspect and copy, or which we deem to be accurate and complete. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Statements of disagreement and any corresponding rebuttals will be kept on file and sent out with any future authorized requests for information pertaining to the appropriate portion of your record.

Right to an Accounting of Non‐Standard Disclosures
You have the right to request a list of the disclosures we made of medical information about you. To request this list, you must submit your request to the Privacy Officer at P.O. Box 30, Paris, TN 38242. Your request must state the time period for which you want to receive a list of disclosures that is no longer than six years, and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (example: on paper or electronically). The first list you request within a 12‐month period will be free. For additional lists, we reserve the right to charge you for the cost of providing the list.

Right to a Paper Copy of This Notice
You have the right to a paper copy of this the Privacy Notice at any time, in addition to the written Notice you received at your initial appointment. To obtain an additional paper copy of the current Privacy Notice, ask your service provider or the Office Manager at the location you receive services.

Right to File Complaints
If you believe your information was used or shared in a way that is not allowed under the privacy law, or if you were not able to exercise your rights, you can file a complaint with your provider or health insurer. To file a complaint, your request must be made in writing and submitted to the Privacy Officer at P O Box 30, Paris, TN 38242.

Changes To This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice, with the effective date in the upper right corner of the first page.

Confidentiality of Substance Abuse Records. 42 U.S.C §290dd-2 or 42 CFR part 2 for federal laws and regulations
For individuals who have received treatment, diagnosis or referral from our drug or alcohol abuse programs, the confidentiality of drug or alcohol abuse records is protected by federal laws and regulations. We may not report or disclose information concerning your alcohol or drug use unless:
*you authorize in writing
*the disclosure is permitted by law, which includes suspected child abuse or neglect issues
*the disclosure is made to medical personnel in emergency situations
*the disclosure is made to personnel for research, audit or program evaluation
*or you threaten to commit a crime either at this agency or against agency personnel

A violation by us of this federal law is a crime reportable to the United States Attorney in the district in which the violation occurs.