NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact Serenity Lane’s Privacy Officer at: (541) 687-1110
Coburg Campus and Administrative Offices
Physical Address 1 Serenity Lane, Coburg, OR 97408
Mailing Address PO Box 8549, Coburg, OR 97408
WHO WILL FOLLOW THIS NOTICE: This notice describes the information privacy practices followed by Serenity Lane’s staff members.
YOUR HEALTH INFORMATION: This notice applies to the information and records we have about your health, health status, and the health care and services you receive at Serenity Lane. Your health information may include information created and received by Serenity Lane and may be in the form of written or electronic records or spoken words, and may include information about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, and similar types of health-related information.
We are required by law to give you this notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The confidentiality of our patients’ records is protected by federal law and regulations. Generally, we may not say to persons outside our facilities that a patient attends our facilities, or disclose any information identifying a patient as a person with a substance use disorder unless the patient agrees to the disclosure in writing, the disclosure is allowed by subpoena and court order, or the disclosure is made to medical personnel in a medical emergency or, under certain circumstances, to qualified personnel for research, audit or program evaluation. In other words, we will not disclose drug and alcohol health records in most circumstances without having your written Authorization.
We may use and disclose health information with your Authorization for the following purposes:
For Treatment: We may use health information about you to provide you with clinical treatment or services. We may disclose health information about you to Serenity Lane’s doctors, nurses, technicians, office staff or other personnel who are involved in taking care of you and your health.
For example, your doctor may be treating you for chemical dependency and may need to know if you have other health problems that could complicate your treatment. The doctor may use your clinical history to decide what treatment is best for you. With a written authorization the doctor may also tell another doctor about your condition so that doctor can help determine the most appropriate care for you.
Different personnel in our office may share information about you and disclose information to people who do not work in our office in order to coordinate your care, such as phoning in prescriptions to your pharmacy, scheduling lab work and ordering x-rays. Family members and other health care providers may be part of your clinical care outside Serenity Lane and may require information about you. This information may be shared with them only with your written authorization.
For payment: We may use and disclose health information about you so that the treatment and services you receive at Serenity Lane may be billed to and payment may be collected from your insurance company, a third party or from you.
For example, we will need to contact your insurance company to determine your eligibility and estimated benefits. We may tell your health plan about a treatment you are going to receive in order to obtain prior approval. Your insurance company may require treatment updates and clinical records to determine whether your plan will pay for treatment.
For Health Care Operations. We may use and disclose health information about you in order to perform business functions and provide quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about you to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.
We may also disclose your health information to health plans that provide you insurance coverage for the purpose of helping these providers and plans provide improved quality of care and improve services, reduce cost, coordinate and manage health care and services, train staff and comply with the legal requirements and accrediting organizations.
We may use your protected health information for purposes of treatment, payment and health care operations to communicate between or among our own staff, facilities, and certain organizations which have a need for the information in connection with their duties or functions related to diagnosing, treating, or referring you for treatment. In these instances, we do not need your written Authorization to make such communications. If, however, we disclose your protected health information for treatment, payment or health care operations to other persons or organizations, we will first need your written Authorization to make such a disclosure.
Appointment Reminders. We may contact you as a reminder that you have an appointment for assessment, treatment or admission at Serenity Lane. For example, we may telephone you at the telephone number you provide or send you a text message reminder. You have the right to opt out of these communications at any time, either by contacting Serenity Lane staff directly or by replying “STOP” to a text message reminder.
Treatment Alternatives. We may tell you about or recommend possible treatment options or alternatives that may be of interest to you. For example, you may have a condition that requires special care. We may recommend a specialist or treatment facility appropriate for your condition.
Health-Related Products and Services. We may tell you about health-related products or services that may be of interest to you. Please notify us if you do not wish to be contacted for appointment reminders, or if you do not wish to receive communications about treatment alternatives or health-related products and services. If you advise us in writing (at the address listed at the top of this Notice) that you do not wish to receive such communications, we will not use or disclose your information for these purposes.
We may use or disclose your health information for the following purposes, subject to all applicable legal requirements, including the requirement, where applicable, to obtain your written Authorization:
To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. For example, Serenity Lane will take appropriate actions, including notifying authorities and/or family members, regarding a situation that may place you or someone else in physical danger.
Required by Law. We will disclose health information about you when required to do so by federal, state or local law.
Business Associates. We may disclose your health information to “business associates” with which we contract to perform services on our behalf.
Research. We may use and disclose health information about you for research after determining that the researcher 1) is qualified, 2) has a protocol with appropriate safeguards; and 3) has had independent review by an IRB or similar review board. A limited data set may also be created and used without authorization under specified conditions. For example, we may use your treatment information to determine the effectiveness of a procedure or treatment. We will obtain your authorization if the researcher will have access to your name, address or other information that reveals who you are or the researcher will be involved in your care at Serenity Lane.
Military, Veterans, National Security and Intelligence. If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you. We may disclose your health information to authorized federal officials for intelligence, counterintelligence, special investigations, and other national security activities authorized by law or to protect the President or other authorized persons.
Workers’ Compensation. We may release health information about you for worker’s compensation or similar disability programs with your written Authorization.
Incidental Disclosures. Certain incidental disclosures of your health information may occur as a by-product of permitted uses and disclosures. For example, a roommate may inadvertently overhear a discussion about your care if you share a room.
Public Health Risks. We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products. Reports of suspected child abuse and neglect made under state law to appropriate state or local authorities are not protected by federal substance abuse information confidentiality laws. Medical information may be disclosed to personnel from the Food and Drug Administration (FDA) who believe that your health may be threatened by a product under FDA jurisdiction.
Health Oversight Activities. We may disclose health information to a health oversight agency for audits, investigations, inspections or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws. For example, the State of Oregon will audit select records to determine Serenity Lane’s compliance for licensure.
Fundraising. We may use or disclose to a “business associate” limited information about you to raise money for Serenity Lane. You may opt-out of receiving future communication or materials relating to fundraising.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose treatment information about you with a subpoena and a proper court order or with your written Authorization. Information may be released if you commit a crime on Serenity Lane’s premises. Should Serenity Lane feel it necessary to take court action to receive payment for any amount owing, you give permission for your name to be published in any forum legally necessary to proceed with such actions. This means if Serenity Lane, or you, file a court action, your relationship with Serenity Lane may become public record.
Law Enforcement. We may release treatment information if asked to do so by a law enforcement official in response to an appropriate court order and subpoena. Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime.
Coroners, Medical Examiners and Funeral Directors. We may release health information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine a cause of death.
Victims of Abuse, Neglect or Domestic Violence. As allowed or required by law, we may disclose health information about an individual we reasonably believe to be the victim of abuse, neglect, or domestic violence to a government authority authorized to receive such reports.
Information Not Personally Identifiable. We may use or disclose treatment information about you in a way that does not personally identify you or reveal who you are.
Family and Friends. We may disclose treatment information about you to your family members or friends if we obtain your written Authorization to do so.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION. We may use or disclose your health information for purposes other than those identified in the previous sections with your specific, written Authorization. If you give us Authorization to use or disclose health information about you, you may revoke that Authorization, in writing, at any time unless it is a non-revocable criminal justice authorization to release protected health information. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission. In some circumstances, we may need specific, written authorization from you in order to disclose certain types of specially–protected information such as HIV, substance use disorder, mental health, and genetic testing information.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU. You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy your treatment information, such as clinical and billing records, that we keep and use to make decisions about your care. You must submit a written request to the Medical Records Department for Hospital/Residential/Eugene Outpatient Program located downtown Eugene. For Outpatient treatment at other sites, submit request to the Program Manager in order to inspect or to receive copies of your treatment information. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other associated supplies.
We may deny your request to inspect and/or copy in certain limited circumstances. If you are denied copies of or access to health information that we keep about you, you may ask that our denial be reviewed. If the law gives you a right to have our denial reviewed, we will select a licensed health care professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.
Right to Amend. If you believe treatment 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 as long as the information is kept by or for Serenity Lane. To request an amendment, complete and submit a TREATMENT RECORD AMMENDMENT CORRECTION FORM to the Program Manager.
We may deny your request for an amendment if your request is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that we did not create, the information is not part of the treatment information that Serenity Lane keeps; if it is information that you would not be permitted to inspect and copy; or if it is determined that the information is accurate and complete.
Right To An Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of clinical information about you for purposes other than treatment, payment, health care operations, and a limited number of special circumstances involving national security, correctional institutions and law enforcement. The list will also exclude any disclosures we have made to you or based on your written authorization.
To obtain this list, you must submit your request in writing to Program Manager. It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate your mailing address. This first list you request within a 12-month period will be free. For additional lists, we may charge you the normal copy fee of $25.00 per request.
Right to Request Restrictions. You have the right to request a restriction or limitation on the treatment information we use or disclose about you for treatment, payment or health care operations by making selective choices on the written authorization to release such information. You also have the right to request a limit on the treatment information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had.
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 emergency treatment. To request restrictions, you may complete and submit the REQUEST FOR RESTRICTION ON USE/DISCLOSURE OF CLINICAL INFORMATION to the Program Manager.
Right to Request Confidential Communications. You have the right to request that we communicate with you about clinical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you may complete and submit the REQUEST FOR RESTRICTION OF USE/DISCLOSURE OF CLINICAL INFORMATION AND/OR CONFIDENTIAL COMMUNICATION form to the Program Manager. 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.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy. To obtain such a copy, contact Program Manager.
COMPLAINTS. If you believe your privacy rights have been violated, you may file a complaint with Serenity Lane’s Privacy Officer, at the address located at the beginning of this form. You may file a complaint to the Secretary of The Department of Health and Human Services, Office of Civil Rights,
Hubert H. Humphrey Building, Room 425A, 200 Independence Avenue, SW, Washington, DC 20201. You will not be penalized for filing a complaint.
See 42 U.S.C. 290dd-3 and 42 U.S.C.290ee-3 for federal laws and 42 CFR part 2 for federal regulations protecting the confidentiality of substance abuse information. Violation of these federal laws and regulations by a covered program is a crime. Suspected violations may be reported to appropriate authorities in accordance with federal regulations. Other applicable regulations are found at 45 CFR parts 160 and 164.
CHANGES TO THIS NOTICE. We reserve the right to change this notice, and to make the revised or changed notice effective for clinical information we already have about you, as well as any information we receive in the future. We will post a summary of the current notice in the office with its effective date. You are entitled to a copy of the notice currently in effect.