This notice describes how medical, drug and alcohol related information about you may be used and disclosed. It also includes information on how you can access this information about yourself. Please carefully review.
Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), 42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under these laws, St. Monica's Behavioral Health Services (St. Monica's) may not say to a person outside St. Monica's that you attend any St. Monica's program, nor may St. Monica's disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
St. Monica's must obtain your written consent before it can disclose information about you for payment purposes. For example, St. Monica's must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before St. Monica's can share information for treatment purposes or for health care operations. However, federal law permits St. Monica's to disclose information without your written permission:
1. Pursuant to an agreement with a qualified service organization/business associate;
2. For research, audit or evaluations;
3. To report a crime committed on St. Monica's Behavioral Health Services premises or against St. Monica's personnel;
4. To medical personnel in a medical emergency
5. To appropriate authorities to report suspected child abuse or neglect;
6. As allowed by a court order.
For example, St. Monica's can disclose information without your consent to obtain legal or financial services, or to another medical facility to provide health care to you, as long as there is a qualified service organization/business associate agreement in place.
Before St. Monica's can use or disclose any information about your health in a manner which is not described above, it must first obtain your specific written consent allowing it to make the disclosure. Any such written consent may be revoked by you preferably in writing or verbal communication.
Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. St. Monica's is not required to agree to any restrictions you request, but if it does agree then it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency.
You have the right to request that we communicate with you by alternative means or at an alternative location. St. Monica's will accommodate such requests that are reasonable and will not request an explanation from you. Under HIPAA you also have the right to inspect and copy your own health information maintained by St. Monica's, except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal or administrative proceeding or in other limited circumstances.
Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in St. Monica's records, and to request and receive an accounting of disclosures of your health related information made by St. Monica's during the six years prior to your request. You also have the right to receive a paper copy of this notice.
St. Monica's Duties
St. Monica's is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. St. Monica's is required by law to abide by the terms of this notice. St. Monica's reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. In the event that we do change the terms of the notice of our privacy practices, we will mail you a revised copy and /or will make available the revised copy on our website at stmonicas.com. Current copies of the Notice of Privacy Practices are also available at all St. Monica's facilities.
Complaints & Reporting Violations
You may complain to St. Monica's and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. To file a complaint with St. Monica's Behavioral Health Services, please contact the HIPAA Officer at (402) 437-8448; email your complaint to email@example.com; fax your complaint to (402) 441-3770 attn: HIPAA Officer; or mail your complaint to St. Monica's Behavioral Health Services c/o HIPAA Officer, 120 Wedgewood Drive, Lincoln, NE 68510-2431. You will not be retaliated against for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.
For further information, contact Natalya Young, HIPAA Officer, at 402-437-8448 or firstname.lastname@example.org, or mail inquiries to St. Monica's Behavioral Health Services, attn: Natalya Young, 120 Wedgewood Drive, Lincoln, NE 68510-2431.
March 22, 2004