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 DESCRIBES:
- HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
- YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
- HOW TO FILE A COMPLAINT CONCERNING A VIOLATON OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR YOUR RIGHTS CONCERNING YOUR INFORMATION
YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH OUR PRIVACY OFFICER AT 833-7777-228 OR [email protected] IF YOU HAVE ANY QUESTIONS.
THE EFFECTIVE DATE OF THIS NOTICE IS June 17, 2024.
Who Presents This Notice
The references to “Facility”, “Health Professionals”, “We”, “Us”, and/or “Our” in this notice refer to the members of the Bradford Health Services, LLC Affiliated Covered Entity. An Affiliated Covered Entity (ACE) is a group of organizations under common ownership or control who designate themselves as a single Affiliated Covered Entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). The Facility, its employees, workforce members and members of the ACE who are involved in providing and coordinating health care are all bound to follow the terms of this Notice of Privacy Practices (“Notice”). The members of the ACE will share Protected Health Information with each other for the treatment, payment and health care operations of the ACE and as permitted by HIPAA, 42 C.F.R. Part 2, and this Notice. For a complete list of the members of the ACE, please contact the Privacy Officer.
Privacy Obligations
Each Facility is required by law to maintain the privacy and security of your Protected Health Information and records and to provide you with this Notice of legal duties and privacy practices with respect to your Protected Health Information and records. When the Facility uses or discloses your Protected Health Information, we are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure). The Facility will make uses and disclosures not described in this Notice only with the patient’s written authorization/consent. The Facility is required by law to protect the privacy of your Protected Health Information, distribute this Notice to you, and follow the terms of this Notice. The Facility is also required to notify you if there is a breach of your unsecured Protected Health Information or unsecured records.
Uses and Disclosures Requiring Your Authorization
Use or Disclosure with Your Authorization. In certain situations, your Protected Health Information may be used or disclosed only when you provide your written authorization/consent on a written or electronic form (“Your Authorization”). The Facility will request and/or obtain Your Authorization when it is required by applicable privacy laws as described within this Notice. You may provide a single authorization/consent for all future uses or disclosures for treatment, payment, and health care operations purposes. Records that are disclosed to a part 2 program, covered entity, or business associate pursuant to the patient’s written authorization/consent for treatment, payment, and health care operations may be further disclosed by that part 2 program, covered entity, or business associate, without the patient’s written consent, to the extent the HIPAA regulations permit such disclosure.
Treatment. We will request your general authorization/consent for all future uses and disclosures we need to carry out for treatment purposes. Your Protected Health Information may be disclosed to other providers involved in your treatment. For example, we may disclose your Protected Health Information to your primary health care provider, other healthcare personnel, or third parties who have a need for such information for your care and treatment such as coordination or management of your care and treatment. Your Protected Health Information may be disclosed to a family member, other relative, a close personal friend or any other person identified by you who is involved in your care or helps pay for your care. If information is disclosed to a family member, other relative, close personal friend, or other person involved in your care or payment for your care, the Facility and/or Health Professionals would disclose only information believed to be directly relevant to the person’s involvement with your care or payment for your care; this may include disclosing your Protected Health Information to secure your presence in treatment, verify your wellbeing, and/or lessen a serious and imminent threat to your health or safety. We may disclosure your Protected Health Information to other treatment providers or individuals not employed by Facility to arrange, coordinate, or provide notice regarding the progress of your consultation, assessment, evaluation, admission, treatment planning, transfer, and/or discharge planning or discharge. We may disclose your Protected Health Information to any of the aforementioned individuals in the exercise of professional judgment that the patient does not object to the disclosure and/or the disclosure is in the best interests of the patient.
Payment. We will request your general authorization/consent for all future uses and disclosures we need to carry out for payment purposes. For example, we disclose your Protected Health Information to your insurance company to obtain reimbursement or work with others to verify your health insurance benefits. Your Protected Health Information may be disclosed to a family member, other relative, a close personal friend, or any other person identified by you who helps pay for your care. If information is disclosed to a family member, other relative, close personal friend, or other person involved in payment for your care, the Facility and/or Health Professionals would disclose only information believed to be directly relevant to payment for your care. We may disclosure your Protected Health Information to other treatment providers or individuals not employed by Facility to arrange, coordinate, or provide notice regarding the progress of your consultation, assessment, evaluation, admission, treatment planning, transfer, and/or discharge planning or discharge.
Health Care Operations. We will request your general authorization/consent for all future uses and disclosures we need to carry out for health care operations purposes. Health care operations includes certain administrative, legal and quality improvement activities that are necessary for us to operate the Facility and to support its functions of treatment and payment. For example, your Protected Health Information may be used to evaluate the quality and competence of staff. Your Protected Health Information may be provided to various governmental, oversight, and/or accreditation entities (i.e., the Joint Commission on Accreditation of Healthcare Organizations, Office of Inspector General, Office for Civil Rights, etc.) for ensuring compliance with applicable laws, to maintain our license and accreditation, or in the course of audits or evaluations mandated by statute or regulation. In addition, Protected Health Information may be shared with business associates who perform services on behalf of the Facility and Health Professionals related to treatment, payment and health care operations.
Civil, Administrative, Criminal, or Legislative Proceedings. We will request or you must provide Your Authorization for us to disclose your Protected Health Information for purposes of a civil, administrative, criminal, or legislative proceeding, unless the disclosure is mandatory (as described in this Notice). For example, disclosing your Protected Health Information to a probation office, court official, or attorney representing you in a criminal or civil matter requires a specific written authorization/consent. Disclosing your Protected Health Information to an employer or organization for the purpose of demonstrating the reason for an absence from employment or obtaining a disability benefit requires a specific written authorization/consent. Disclosing your Protected Health Information to a professional board or association related to licensure or other credentials or affiliation requires a specific written authorization/consent.
Psychotherapy and/or Substance Use Disorder Counseling Notes. Pursuant to Your Authorization, Facility may disclose psychotherapy and/or substance use disordering counseling notes (as defined by 45 C.F.R. § 164.501 and 42 C.F.R. § 2.11), except Your Authorization is not necessary to carry out the following treatment, payment, or health care operations: use by the originator of the psychotherapy and/or substance use disorder counseling notes for treatment; use or disclosure by Facility for its own training programs in which students, trainees, or practitioners learn under supervision to practice or improve their skills in group, joint, family or individual counseling; or use or disclosure by Facility to defend a legal action or proceeding brought by the patient.
Marketing and/or Sale of Protected Health Information. Pursuant to Your Authorization, Facility may disclose your Protected Health Information to third parties for marketing purposes. If the marketing involves direct or indirect payment, the written authorization/consent you provide will include notice that such payment is involved. However, marketing materials can be provided to you in a face-to-face encounter, and Facility, Health Professionals, and/or other staff or vendors may communicate with you about products or services relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings without obtaining your written authorization/consent.
Public Health Activities. Pursuant to Your Authorization, we may disclose your Protected Health Information for public health reporting, including, but not limited to, reporting communicable diseases or notifying person(s) who may have been exposed to a disease or are at risk of contracting or spreading a disease or condition.
Permissible Uses and Disclosures Without Your Authorization
As described in this Notice, in certain situations your written authorization/consent must be obtained in order to use and/or disclose your Protected Health Information. Facility will make uses and disclosures of Protected Health Information not described in this Notice only with the patient’s written authorization/consent. However, the Facility and Health Professionals do not need any type of consent/authorization from you for the following uses and disclosures:
Uses and Disclosures Among Internal Sites/Facilities. Facility and Health Professionals may share your Protected Health Information with other facilities owned/operated by Bradford (that are part of the ACE), or the staff of these facilities, without Your Authorization, as necessary, to carry out treatment, payment, and health care operations.
Care Coordination and Information About Our Services. We may use your Protected Health Information to provide you appointment or refill reminders or for the purpose of management or coordination of your care. We may use your Protected Health Information to contact you about treatment alternatives or other health-related benefits and services that may be of interest to you (or payment for such product or service).
Medical Emergencies. Your Protected Health Information may be disclosed to medical or other appropriate personnel to the extent necessary to respond to a bona fide medical emergency.
Food and Drug Administration (FDA). Your Protected Health Information may be disclosed to medical personnel of the Food and Drug Administration (FDA) who assert a reason to believe that the health of any individual may be threatened by an error in the manufacture, labeling, or sale of a product under FDA jurisdiction, and that the information will be used for the exclusive purpose of notifying patients or their physicians of potential dangers.
Response to Legal Requests Involving Court Orders. Your Protected Health Information may be disclosed in the course of a judicial and/or administrative proceeding or in response to a legal order that requires the disclosure and satisfies applicable privacy laws. Records, or testimony relaying the content of such records, shall not be used or disclosed in any civil, administrative, criminal, or legislative proceedings against the patient unless based on specific written consent/authorization or a court order. Records shall only be used or disclosed based on a court order after notice and an opportunity to be heard is provided to the patient or the holder of the record, where required by 42 U.S.C. 290dd-2 and 42 C.F.R. Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other similar legal mandate compelling disclosure before the record is used or disclosed.
Reporting of Crimes. Your Protected Health Information may be disclosed to alert law enforcement (or another appropriate agency) to the commission of a crime on our premises or against our personnel.
Disclosures for Public Health. Your Protected Health Information may be disclosed to a public health authority, provided any records disclosed have been de-identified in accordance with the requirements of 45 CFR 164.514(b).
Business Associates/Qualified Services Organizations. Your Protected Health Information may be disclosed to vendors (known as business associates/qualified services organizations) who provide services to us if necessary for the vendor to provide services to the Facility.
Reports of Suspected Child Abuse and/or Neglect. Your Protected Health Information may be disclosed to a local, state, or federal government authority, including social services or a protective services agency authorized by law to receive such reports, if Facility has a reasonable belief of child abuse and/or neglect.
Vital Statistics. Your Protected Health Information may be disclosed under laws requiring the collection of death or other vital statistics or permitting inquiry into the cause of death. For example, your Protected Health Information may be disclosed to a coroner or medical examiner to determine a cause of death.
Research. Your Protected Health Information may be disclosed for the purpose of conducting scientific research if the recipient of the information is a covered entity or business associate (which are required to comply with HIPAA) that has obtained and documented a waiver or alteration of authorization, consistent with the requirements of the HIPAA Privacy Rule at 45 C.F.R. § 164.512(i).
Audits and Evaluations Mandated by Statute or Regulation. Your Protected Health Information may be disclosed to federal, state, or local government agencies, and the contractors, subcontractors, and legal representatives of such agencies, in the course of conducting audits or evaluations mandated by statute or regulation, if those audits or evaluations cannot be carried out using deidentified information.
Fundraising. Your Protected Health Information may be used for fundraising efforts if the patient is first provided a clear and conspicuous opportunity to elect not to receive fundraising communications (unless or until you elect not to receive this type of communication).
Your Rights Regarding Your Protected Health Information
Right to Request Additional Restrictions. You may request restrictions on the use and disclosure of your Protected Health Information for treatment, payment, and health care operations or to individuals (such as a family member, other relative, close personal friend, or any other person identified by you) involved with your care or with payment related to your care. While all requests for additional restrictions will be carefully considered, the Facility and Health Professionals are not required to agree to these requested restrictions, to the extent the restriction would limit a disclosure necessary for treatment, payment, or health care operations purposes (and the patient provided written authorization/consent for all future uses disclosures related to such purposes). If Facility does agree to the requested restriction, we may not use or disclose your Protected Health Information in violation of that restriction, unless it is needed to provide emergency treatment.
You may also request to restrict disclosures of your Protected Health Information to your health plan for payment and healthcare operations purposes if the disclosure pertains to a healthcare item or service for which you paid out-of-pocket in full. The Facility and Health Professionals must agree to abide by the restriction to your health plan except when the disclosure is required by law.
If you wish to request additional restrictions, please obtain a restriction request form from the personnel at Facility. A written response will be provided to you if you submit a restriction request form.
Right to Receive Confidential Communications. You may request, and the Facility and Health Professionals will accommodate, any reasonable written request for you to receive your Protected Health Information by alternative means of communication or at alternative locations (subject to receiving information regarding the handling of payment for services).
Right to Revoke Your Authorization. You may revoke Your Authorization, including any written authorization/consent obtained in connection with your Protected Health Information, except to the extent that the Facility and/or Health Professionals have taken action in reliance upon it, by requesting, completing, and/or delivering a written revocation statement to the personnel at the Facility. A written authorization/consent related to treatment required as part of a criminal proceeding may become revoked as of a specified amount of time or the occurrence of a specified event (i.e., final court hearing).
Right to Inspect and Copy Your Health Information. You may request access to your medical and/or billing records maintained by the Facility and Health Professionals in order to inspect and request copies of the records. Under limited circumstances, you may be denied access to a portion of your records. If you desire access to your records, please obtain a record request form from the Facility at which you received services and submit the completed form to the personnel of the same Facility. You may request your medical and/or billing records in physical or electronic form. If you request physical copies of your records, you may be charged a fee based on the costs of the supplies, labor and/or postage necessary to fulfill the request.
Right to Amend Your Records. You have the right to request that Protected Health Information maintained in your medical or billing records be amended. If you desire to amend your records, please obtain an amendment request form from the Facility at which you received services and submit the completed form to the personnel of the same Facility. Your request will be accommodated unless the Facility and/or Health Professionals believe that the information that would be amended is accurate and complete or other special circumstances apply.
Right to Receive an Accounting of Disclosures. Upon request, you may obtain an accounting of certain disclosures of your Protected Health Information made during any period of time prior to the date of your request provided such period does not exceed six years and does not apply to disclosures that occurred prior to April 14, 2003. Upon request, you may obtain an accounting of certain disclosures of your Protected Health Information made pursuant to your written authorization/consent in the three years prior to the date of the request (or a shorter time period chosen by the patient), however, this does not include all disclosures made for purposes of treatment, payment, and/or health care operations. Upon request, you may obtain an accounting of disclosures of your Protected Health Information made for treatment, payment, and/or health care operations in the three years prior to the date of the request, if the disclosure(s) is made through an electronic health record. If you request an accounting more than once during a twelve-month period, you may be charged for the accounting statement.
Right to a List of Disclosures by an Intermediary. Upon request, you may obtain a list of disclosures of your Protected Health Information and a list of persons to which your records have been disclosed by an Intermediary. Such requests should be submitted in writing to the Intermediary. Facility will assist you in identifying Intermediaries that may have your information as result of disclosures carried out by Facility.
Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Notice, even if you have agreed to receive such notice electronically.
Right to Discuss this Notice. Upon request, you have the right to discuss or request further information about this Notice from the Privacy Officer.
Right to File a Complaint. If you want to exercise any of these rights, have any questions, or feel that your privacy rights have been violated, please contact the Privacy Officer. If you believe that your privacy rights have been violated or Facility has violated its own privacy practices, you may file a complaint with the Privacy Officer. Requests or complaints may be submitted in writing or by telephone per the information in this Notice. Facility and/or Health Professionals will not retaliate against you in any way should you file a complaint. You may also file a complaint with the Department of Health and Human Services Office for Civil Rights; complaints may be submitted via mail to: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F HHH Building, Washington, D.C. 20201.
Effective Date and Duration of This Notice. This Notice is effective on June 1, 2024 and remains effective until revised.
Right to Change Terms of This Notice. The terms of this Notice may be changed at any time. If this Notice is changed, the new notice terms may be made effective for all Protected Health Information and records that the Facility and Health Professionals maintain, including any information created or received prior to issuing the new notice. If this Notice is changed, the new notice will be posted in areas around the Facility and on our websites. You also may obtain any new notice by contacting the Privacy Officer.
Facility Contacts:
Bradford Health Services, LLC
Attn: Privacy Officer
2101 Magnolia Avenue, Suite 518
Birmingham, Alabama 35205
Telephone: 833-7777-228
You may also file a complaint with the Department of Health and Human Services Office for Civil Rights; complaints may be submitted via mail to: Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Room 509F HHH Building, Washington, D.C. 20201. Violation of 42 C.F.R. Part 2 by a Part 2 program is a crime and suspected violations may be directed to United States Attorney for the judicial district in which the violation occurs as well as to the Substance Abuse and Mental Health Services Administration (SAMHSA) office responsible for opioid treatment program oversight. A directory for the Offices of the United States Attorneys may be located online at https://www.justice.gov/usao/find-your-united-states-attorney.