HIPAA Notice of Privacy Practices

Please review carefully.

This notice outlines your protected health information (PHI), how it may be used, and what your rights are. Questions about this notice can be directed to Real Psychiatric Services.

Our Pledge Regarding Protected Health Information

We, Real Psychiatric Services, understand that protected health information about you and your health is personal. We are committed to protecting health information about you. This Notice applies to all of the records of your care generated by Real Psychiatric Services, whether made by Real Psychiatric Services personnel or your personal doctor or other health care provider.

This Notice will tell you about the ways in which we may use and disclose protected health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of protected health information. The law requires us to:

• Make sure that protected health information that identifies you is kept private.
• Notify you about how we protect protected health information about you.
• Explain how, when and why we use and disclose protected health information.
• Follow the terms of the Notice that is currently in effect.

We are required to follow the procedures in this Notice. We reserve the right to change the terms of this Notice and to make new notice provisions effective for all protected health information that we maintain by:

• Posting the revised Notice in our office.
• Making copies of the revised Notice available upon request.
• Posting the revised Notice on our website.

How We May Use and Disclose Protected Health Information About You

The following categories describe different ways that we use and disclose protected health information without your written authorization.

• For Treatment: We may use protected health information about you to provide, coordinate, or manage your medical treatment or services. We may disclose protected health information to doctors, nurses, technicians, medical students, or other personnel involved in your care.
• For Payment for Services: We may use and disclose protected health information so treatment and services you receive may be billed to and payment collected from you, an insurance company, or a third party.
• For Health Care Operations: We may use and disclose protected health information for Real Psychiatric Services operations such as quality assessment and improvement, case management, coordination of care, business planning, customer services, and other activities.
• As Required By Law: We will disclose protected health information when required by federal, state, or local law.
• Research: We may disclose PHI to researchers when their research is approved by an institutional review board or privacy board.
• Health Risks: We may disclose PHI if we believe you are a victim of abuse, neglect, or domestic violence.
• Judicial and Administrative Proceedings: We may disclose information in response to a court or administrative order.
• Business Associates: We may disclose information to business associates who perform services on our behalf.
• Public Health: As required by law for preventing or controlling disease, injury, or disability.
• To Avert a Serious Threat to Health or Safety: We may use and disclose PHI when necessary to prevent a serious threat to health or safety.
• Health Oversight Activities: For audits, investigations, inspections, licensure, and compliance activities.
• Law Enforcement: In response to court orders, warrants, or subpoenas.
• Organ and Tissue Donation: To organizations that handle organ procurement.
• Special Government Functions: Military, veterans’ activities, national security, etc.
• Coroners, Medical Examiners, and Funeral Directors: To identify a deceased person or determine cause of death.
• Correctional Institutions: If you are an inmate or under custody.
• Worker’s Compensation: To comply with worker’s compensation laws.
• Food and Drug Administration: Regarding adverse events, product defects, etc.

You Can Object to Certain Uses and Disclosures

Unless you object or request a limited amount/type of information be shared, we may use or disclose PHI in these circumstances:

• We may share with a family member, relative, friend, or other person identified by you PHI directly relevant to that person’s involvement in your care or payment for your care.
• We may share information with a public or private agency (e.g., the American Red Cross) for disaster relief purposes.

Your Rights Regarding Protected Health Information About You

You have the following rights regarding PHI we maintain about you:

• Right to Inspect and Copy: Usually medical and billing records. Submit your request in writing.
• Right to Amend: If you believe PHI is incorrect or incomplete. Request must be in writing.
• Right to an Accounting of Disclosures: A list of disclosures we made of PHI up to six years before your request.
• Right to Request Restrictions: You may request restrictions on PHI use or disclosure. We are not required to agree.
• Right to Request Confidential Communications: You may request we communicate with you in a certain way or at a certain location.
• Right to a Paper Copy of This Notice: You may obtain a paper copy at any time.

Other Uses and Disclosures

We will obtain your written authorization before using or disclosing PHI for purposes not described above. You may revoke an authorization in writing at any time.

You May File a Complaint About Our Privacy Practices

If you believe your privacy rights have been violated, you may file a complaint with Real Psychiatric Services or with the Secretary of the Department of Health and Human Services. Filing a complaint will not affect your treatment or result in retaliation.

---