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 of Privacy Practices (“Notice”) describes how we may use and disclose your protected health information (“PHI”), as well as  how you can obtain access to such PHI. This Notice also describes your rights with respect to your PHI. We are required by law to  maintain the privacy of your PHI; provide you with notice of our legal duties and privacy practices with respect to your PHI; and to notify  you following a breach of unsecured PHI. A reference to “we” and “our” is defined to include Water Gap Wellness Center, its  employees and workforce members. This Notice does not apply to the care you may separately receive from health care professionals  at their offices. Your health care professional may have his or her own policies and procedures regarding your PHI, and you should  review your health care professional’s notice of privacy practices for information on how your PHI will be handled outside of our  facilities. 

How We May Use and Disclose Your PHI 

We may use and disclose PHI without your prior authorization for purposes of Treatment, Payment or Health Care Operations. To the  extent that there are more strict state requirements or restrictions, we will only use and disclose your PHI as permitted by those stricter  requirements. For example, substance use disorder patient records may be further protected by the federal Confidentiality of  Substance Use Disorder Patient Records, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2 (“Part 2”). Part 2 has more strict requirements on how  we use and disclose PHI that consists of substance use disorder treatment records. To the extent that you have PHI that is protected  under Part 2, we will only use and disclose that information as permitted by Part 2. Specific information about how we may use and  disclose PHI that is governed under Part 2 is provided below. 

Uses and Disclosures Without Your Written Authorization 

  1. For Treatment: We may use and disclose PHI as necessary to treat you or perform services in connection with your treatment  or to allow another covered entity or health care provider to treat you. For example, therapists, staff members and other  personnel may need to know and discuss your PHI to carry out your treatment and to evaluate your response to treatment. We  may disclose your PHI to your other health care providers to help coordinate your care and make sure that everyone who is  involved in your care has the information that they need about you to meet your health care needs. 
  2. For Payment: We may use health information about you so that the treatment and services you receive at Water Gap  Wellness may be billed to you, an insurance company or a third party. For example, our billing department will use your health  information to prepare claims; however, we will obtain your permission before disclosing your PHI to an outside party such as  an insurance company.  
  3. For Healthcare Operations: We may use your PHI for our health care operations, which include internal administration and  planning and various activities that improve the quality and cost effectiveness of the care that we deliver to you. For example,  we may use PHI to evaluate the quality and competence of our physicians, nurses and other health care workers. We may  use PHI for our patient satisfaction survey process. We will limit our use of your PHI to the minimum amount necessary to  achieve a permissible purpose.  
  4. Individuals Involved in Your Care or Payment for Your Care: We may release PHI about you to a friend or family member  who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell  your family, friends or others who ask about you your condition and that you are in the facility unless you opt out of being  included in the directory. We are also permitted to disclose PHI to family or friends of a deceased individual to the extent that  the PHI pertains to their involvement in care or payment for care. We may use or disclose your PHI to notify your family or  friends of your condition, status and location. In addition, we may disclose your PHI to an entity assisting in a disaster relief  effort so that your family can be notified about your condition, status and location. 
  5. Research: Under certain circumstances, we may use and disclose your PHI for research purposes. You will not be the subject  of research without your prior written and informed consent. Unless otherwise described in the consent, your identity and your  health information will remain private during and after the research. All research projects must comply with state and federal  regulations 
  6. As Required By Law: We will disclose your PHI when required to do so by federal, state or local law. For example, we may  disclose PHI about you to the U.S. Department of Health and Human Services if it requests such information to determine that  we are complying with federal privacy law.
  7. To Avert a Serious Threat to Health or Safety: We may use and disclose your PHI when necessary to prevent a serious  threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only  be to someone able to help prevent the threat. 
  8. Organ and Tissue Donation: We may disclose your PHI to organizations that handle organ procurement or organ, eye or  tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation. 
  9. Military and Veterans: If you are a member of the armed forces, we may disclose your PHI as required by military command  authorities. We may also release medical information about foreign military personnel to the appropriate foreign military  authority. 
  10. Workers’ Compensation: We may disclose your PHI as authorized by applicable law to the extent necessary to comply with  workers’ compensation laws or laws related to similar programs. These programs provide benefits for work-related injuries or  illness. 
  11. Public Health Activities: We may disclose PHI about you for public health activities. These activities generally include the  following: (i) to prevent or control disease, injury or disability; (ii) to report births and deaths; (iii) to report child abuse or  neglect; (iv) to report reactions to medications or problems with products; (v) to notify people of recalls of products they may be  using; (vi) to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease  or condition; (vii) to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or  domestic violence. 
  12. Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities authorized by law. These  oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for  the government to monitor the health care system, government programs and compliance with civil rights laws. 
  13. Lawsuits and Disputes: We may disclose your PHI in response to a court or administrative order. We may also disclose your  PHI in response to a subpoena, discovery request or other lawful process, but only if efforts have been made to tell you about  the request or to obtain an order protecting the information requested. 
  14. Law Enforcement: We may disclose your PHI to law enforcement: (i) in response to a court order, subpoena, warrant,  summons or similar process; (ii) to identify or locate a suspect, fugitive, material witness or missing person; (iii) about the  victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (iv) about a death we  believe may be the result of criminal conduct; (v) about criminal conduct at our premises; and (vi) in emergency  circumstances, not occurring on the premises, to report a crime; the location of the crime or victims or the identity, description  or location of the person who committed the crime. 
  15. Coroners, Medical Examiners and Funeral Directors: We may disclose your PHI to a coroner or medical examiner. This  may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release PHI to  funeral directors as necessary to carry out their duties. 
  16. National Security and Intelligence Activities: We may disclose your PHI to authorized federal officials for intelligence,  counterintelligence and other national security activities authorized by law. We may disclose your PHI to authorized federal  officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special  investigations. 
  17. Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose  our PHI to the correctional institution or law enforcement official, if necessary (i) for the institution to provide you with health  care; (ii) to protect your health and safety or the health and safety of others or (iii) for the safety and security of the correctional  institution. 
  18. Third Parties: We may disclose your PHI to third parties with whom we contract to perform services on our behalf. These  third-party service providers, referred to as Business Associates, may need to access your PHI to perform services for us.  They are required by their contracts with us and by law to protect your PHI and only use and disclose it as necessary to  perform their services for us.
  19. Limited Data: We may remove most information that identifies you from a set of data and use and disclose this data set for  research, public health and health care operations, provided the recipients of the data set agree to keep it confidential. 
  20. Health Information Exchanges: We may participate in one or more Health Information Exchanges (HIEs) and may  electronically share your PHI for treatment, payment, healthcare operations and other permitted purposes with other  participants in the HIE, including disclosing your PHI to other providers who treat you. HIEs allow your health care providers to  efficiently access and use your PHI as necessary for treatment and other lawful purposes. 

Other Uses of Medical Information 

Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will be made only with your written  permission, including without limitation (i) most uses and disclosures of psychotherapy notes; (ii) most uses and disclosures of your PHI  for marketing purposes and (iii) disclosures that constitute the sale of your PHI. If you provide us permission to use or disclose your  PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your PHI  for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already  made with your permission and that we are required to retain our records of the care that we provided to you. 

Your Health Information Rights 

If you wish to exercise any of your health information rights described below, we will provide you a form to use to submit your specific  request in writing. All requests will be reviewed and considered within the timeframes required under HIPAA. Under certain  circumstances, we may deny your request. If this occurs, you may have the right to have the denial reviewed. If you have given another  individual a medical power of attorney, if another individual is appointed as your legal guardian or if another individual is authorized by  law to make health care decisions for you (known as a “personal representative”), that individual may exercise any of the following  rights listed below. 

  1. Right to Inspect and Copy: You have the right to inspect and copy the PHI that we maintain about you, with limited  exceptions. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies  associated with your request. If we maintain this information electronically, you have the right to receive a copy of such  information in an electronic format. Additionally, you have the right to ask us to send a copy of your PHI to other individuals  that you designate. To do so, you must provide us your signed written request that clearly identifies the designated person and  where to send the copy of your PHI. In most cases, we will provide this access to you or the person you designate. This right  applies to PHI used to make decisions about you or payment for your care, subject to limited exceptions. 
  2. Right to Request an Amendment: If you feel that PHI maintained about you is incorrect or incomplete, you may request that  we amend it. We are obligated to review any such request but are not obligated to agree to it. Specifically, we may deny your request for an amendment if it 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: (i) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (ii) is not part of the medical information kept by or for the facility;  (iii) is not part of the information that you would be permitted to inspect and copy or (iv) is accurate and complete. If we deny  your request for an amendment, we will provide you with a written explanation of why we denied it. 
  3. Right to Accounting of Disclosures: You have the right to request an accounting of certain disclosures that we have made  of your PHI. This is a list of when, what, to whom and why we disclosed your PHI for certain purposes. To request this list, you  must submit your request in writing on the form described above. Your request must state a time period, within the six (6)  years immediately preceding the request. Your request should indicate in what form you want the list (for example, on paper,  electronically). The first list you request within a 12-month period will be free of charge. For additional requests in the same 12- month period, we may charge you a reasonable cost-based fee for providing you with the list. We will notify you of the cost  involved and you may choose to withdraw or modify your request at that time before any costs are incurred. 
  4. Right to Request Restrictions: You have the right to request a restriction or limitation on our use or disclose of your PHI for  treatment, payment or health care operations. You also have the right to request a limitation on the PHI we disclose about you  to someone who is involved in your care or the payment for your care. If we agree, we will comply with your request unless the  information is needed to provide emergency treatment. We are not required to agree to the restrictions, unless your request is  that we not disclose information to a health plan for payment or health care operations activities, if the disclosure is not  otherwise required by law and the PHI pertains solely to a health care item or service for which you, or a person on your  behalf, has paid in full. 
  5. Right to Request Confidential Communications: You have the right to request that we communicate with you about your  health 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.  Please note if you choose to receive communications from us via e-mail or other electronic means, those may not be a secure  means of communication, and your PHI that may be contained in our e-mails to you will not be encrypted. This means that  there is risk that your PHI in the e-mails may be intercepted and read by, or disclosed to, unauthorized third parties.
  6. Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice even if you have agreed to receive  the Notice electronically. You may ask us to give you a copy of this Notice at any time. You may also obtain a copy of this  Notice on our website. 
  7. Right to Notification of a Breach: You have the right to be notified following a breach of your unsecured PHI, and we will  notify you in accordance with applicable law. 

CHANGES TO THIS NOTICE 

We are required to follow the terms of this Notice or any change to it that is in effect. We reserve the right to change our  practices and this Notice at any time and to make the new Notice effective for all PHI we maintain and that we obtain in the  future. If we make a material change to this Notice, we will post the revised notice at the facility where you receive services  and, on our website, and make the revised notice available upon request. 

COMPLAINTS OR INFORMATION REQUESTS 

If you believe that we have violated your privacy rights, you may file a complaint with the Privacy Officer listed below. You may  also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights (“Office for Civil Rights”).  Complaints to the Office for Civil Rights may be filed in writing by mail, fax, e-mail, or via the OCR Complaint Portal  (https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf). To file a complaint in writing, open up and fill out the “Health Information  Privacy Complaint Form Package” (http://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html) and mail it to the  address below, or email it to OCRComplaint@hhs.gov 

Centralized Case Management Operations 

U.S. Department of Health and Human Services 

200 Independence Avenue, S.W. 

Room 509F HHH Bldg. 

Washington, D.C. 20201 

We will promptly investigate any complaints in an effort to resolve the matter. We will not penalize or retaliate against you for  filing a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights 

If you have questions or would like additional information about our privacy practices, please contact our Privacy Officer at: 

Water Gap Wellness Center 

c/o Legal Department 

805 Scott Street Unit 3 

Stroudsburg, PA 18360 

Phone Number: 570-775-3100 ext 100 

Fax Number: 570- 775 – 3101 

E-mail wgwlegal@watergapwellness.com 

Effective Date 

This Notice is effective as of February 1, 2020

 

NOTICE OF CONFIDENTIALITY OF SUBSTANCE USE DISORDER PATIENT RECORDS 

Applicability Of Part 2 

The confidentiality of substance uses disorder patient records we maintain may also be protected by the federal Confidentiality  of Substance Use Disorder Treatment Records, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2 (“Part 2”). To the extent that Part 2  governs one of our programs, our use and disclosure of any of your PHI that is covered under Part 2 will be done only as permitted by Part 2, as further described below. 

How We May Use or Disclose Your Part 2 PHI: 

No Consent Required 

Federal law permits us to disclose your Part 2 PHI without your prior written consent as follows: 

Pursuant to an agreement (requiring compliance with Part 2) with a qualified service organization/ business associate that  provides services to us: 

  • To qualified personnel for purposes of research, audit or program evaluation; 
  • To report a crime committed by you on our facility’s premises or against our personnel or any threat to commit such a  crime; 
  • To medical personnel in a medical emergency; 
  • To appropriate authorities to report suspected child abuse and/or neglect; and 
  • As allowed by a court order that is in compliance with the Part 2 requirements for court orders. 

Consent Required 

If you are receiving treatment covered by Part 2, we may not say to a person outside the program that you attend the program, nor disclose any information identifying you as having or having had a substance use disorder or disclose any other protected  information except as permitted by Part 2 or with your written consent. In addition, if applicable, Part 2 requires us to obtain  your written consent before we can 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 we can share information for treatment purposes outside the program or for health care  operations. A violation of Part 2 by a program is a crime, and suspected violations may be reported to appropriate authorities  in accordance with Part 2, along with contact information.

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