PATIENT NOTICE OF CONFIDENTIALITY LAWS
THIS NOTICE DESCRIBES HOW MEDICAL AND DRUG AND ALCOHOL-RELATED INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
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. Your health care information is also protected by state laws. Under these laws, Willingway may not say to a person outside Willingway that you are or have been a patient or that you have had an evaluation, nor may Willingway disclose any information identifying you as an alcohol or drug abuser or disclose any other protected information except as permitted by federal and state laws.
Willingway must obtain your written consent before we disclose information about you for payment purposes. For example, we must obtain your written consent before we can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before Willingway can share information for treatment purposes or for health care operations. However, federal and state laws permit Willingway to use or 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 Willingway premises or against Willingway 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;
7. As required by law.
For example, Willingway can disclose information without your consent to obtain legal or financial services or can disclose information 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 Willingway can use or disclose any information about your health in a manner which is not described above, we must first obtain your specific written consent allowing the disclosure. Any such written consent may be revoked by you except when action has been taken in reliance on it. Your revocation must be in writing.
Willingway will not use your health information for marketing purposes without your written authorization.
Under HIPAA, you have the right to receive a paper copy of this notice. You have the right to request restrictions on certain uses and disclosures of your health information. Willingway is not required to agree to any restrictions you request, but if we do agree then we are 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. You must make such requests in writing. Willingway 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 Willingway, except to the extent that the information contains information compiled in reasonable anticipation of, or for use in a civil, criminal or administrative action or proceeding and except in other limited circumstances.
Under HIPAA you also have the right, with some exceptions, to amend or correct health care information maintained in Willingway’s records. Your request to amend or correct your protected health information must be made in writing and must state the reason for the requested amendment/correction. Willingway may deny your request under certain circumstances.
You have the right to request and receive an accounting of disclosures of your health related information made by Willingway during the six years prior to your request. Your request must be made in writing.
You have the right to request that we place additional restrictions on our use or disclosure of your health information.
Willingway is required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to your health information. Willingway is required by law to abide by the terms of this notice. Willingway is required to notify you of any breach of your unsecured health information.
Willingway reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information we maintain. The method for notification of changes to the terms of this notice will be to post it on Willingway’s web site and to post it in visible locations throughout the facility. You have the right to receive a paper copy of a revised notice upon request.
COMPLAINTS AND REPORTING VIOLATIONS
You may complain to Willingway 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. Contact Willingway’s Privacy Officer or Chief Executive Officer at 311 Jones Mill Road, Statesboro, Georgia 30458, (912) 764-6236 to file a complaint with Willingway. You will not be retaliated against for filing such a complaint.
Violation of the Confidentiality Law 42 C.F.R. Part 2 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 Willingway’s Privacy Officer or Chief Executive Officer at 311 Jones Mill Road, Statesboro, Georgia 30458, (912) 764-6236.
This Notice shall be effective as of September 23, 2013, and will remain in effect until Willingway replaces it.
Willingway reserves the right to change its privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. Willingway reserves the right to make changes in its privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information created or received before Willingway made the changes. Before Willingway makes a significant change to its privacy practices, it will change this Notice and make the new Notice available upon request.
Version Date: September 23, 2013
Call us 24 hours a day at (800)242-9455, or complete this confidential form to have one of our staff members contact you.