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We understand that information about your health is personal and should remain private.  This information is called Protected Health InformationPHI” and is protected by federal and state law.

12&12 employees, student interns, volunteers and independent contractors must follow legal regulations with respect to your PHI.

USING OR DISCLOSING YOUR PHI

FOR TREATMENT

During the course of your treatment we use and disclose your PHI to provide you with quality care and to comply with certain legal requirements.  We may disclose PHI about you to doctors, nurses, clinicians, or other medical professionals and business associates and 12&12 personnel who are involved in taking care of you at 12&12.  For example, a doctor prescribing medicine for you would need to know other medications that you are taking and the reason for taking these medicines to help prevent any medication interaction problems.  Different areas of 12&12 may also share PHI about you in order to coordinate your treatment.

FOR PAYMENT

We may use and disclose Protected Health Information about you so that the treatment and services you receive at 12&12 may be billed and payment may be collected from you, an insurance company, or a third party.  We may disclose PHI to your health plan, insurance company, or their utilization review contractor to obtain prior approval or to determine whether your plan will cover a particular treatment.  We may also disclose information about you to a collection agency for collecting a bill that you have not paid.

HEALTHCARE OPERATIONS

We may use and disclose PHI about you for healthcare operations necessary to run 12&12 and to ensure that all of our clients receive quality care.  For example we may use PHI to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also combine PHI about many 12&12 clients to decide what additional services we should offer, what services are not needed, and whether treatment services are effective.

APPOINTMENT REMINDERS

We may use and disclose PHI to contact you as a reminder that you have an appointment for services at 12&12.

AS REQUIRED BY LAW

We may use and disclose PHI about you when required to do so by federal, state or local law.  In Oklahoma 12&12 is required to disclose records and information as necessary and appropriate to individuals and agencies that hold a contract with the Department of Mental Health and Substance Abuse Services and other situations dictated by law.

TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY

We may use and disclose PHI 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. Any disclosure, however, would only be to someone able to help prevent the threat.   We may also disclose PHI to federal, state, or local agencies engaged in disaster relief as well as to private disaster relief or disaster assistance agencies to allow such entities to carry out their responsibilities in specific disaster situations.

AUTHORIZATION FOR RELEASE

We may release your PHI when you provide a valid written consent to release information to another person or organization.  You may revoke your authorization if you change your mind later.

SPECIAL USES

ACCREDITING ORGANIZATIONS

We may disclose PHI to an organization that 12&12 has contracted with for purposes of accreditation such as CARF, DOC, ODMHSAS, and the Oklahoma Health Care Authority.

LAW ENFORCEMENT

We may release PHI in response to a court order or about criminal conduct or threats of criminal conduct at the facility or against program personnel.

REPORT CHILD ABUSE

We are required by law to report child abuse and may release your PHI in making a child abuse report.

RESEARCH

We may use or disclose your PHI for research if we receive certain assurances which protect your privacy.

QUALIFIED SERVICE ORGANIZATION/BUSINESS ASSOCIATES AGREEMENT

We may release PHI to a QSO or BAA with which 12&12 has a business relationship and who renders a service to qualify it as such.  This disclosure is limited to the minimal amount necessary for service provision.

MYHEALTH ACCESS NETWORK

12&12 may share your PHI on the MyHealth Access Network, Oklahoma’s online information exchange, with other health care professionals involved in your care and their approved staff members that belong to the MyHealth Network.  Their access is limited to accessing only the information as their jobs require. MyHealth is a health information network that gives authorized medical personnel secure, online access to their patient’s community-wide medical data.   MyHealth keeps track of every person who views medical records.  Your privacy is protected through regular audits.

WHAT ARE MY RIGHTS?

You have the right to share or not to share your health information through MyHealth Access Network.  In addition you have the right to change your decision at any time.  Organizations which are included in the MyHealth Access Network include doctors, hospitals, labs, pharmacies, clinics, tribal and Indian Health Service clinics, Emergency response, and the Health Department.

HOW CAN MYHEALTH ACCESS NETWORK IMPROVE MY HEALTH?

Time is important when addressing your health needs.  Some examples of when and how your personal health information is used to help you include:

  • When you see a medical specialist, your doctor and the specialist need to share your information to help coordinate effective care.  The quicker this happens, the quicker you receive the care you need.
  • In a medical emergency such as a car accident, ambulance and emergency room doctors can have access to important health information that might save your life or that of a loved one like a medication list, drug and food allergies, presence of a pacemaker, etc.

WHERE CAN I FIND MORE INFORMATION ABOUT MYHEALTH?

Visit their website at:  www.myhealthaccess.net or call 918-236-3434 or write to MyHealth Access Network; PO # 14176, Tulsa, OK  74159-1176.

YOUR PRIVACY RIGHTS AND HOW TO EXERCISE THEM

Under the federally required privacy program, clients have specific rights.

YOUR RIGHT TO REQUEST LIMITED USE OR DISCLOSURE

You have the right to request that we do not use or disclose your PHI in a particular way; however, we are not required to abide by your request.  If we do agree to your request, we must abide by the agreement.

YOUR RIGHT TO REVOKE YOUR AUTHORIZATION

You may revoke, in writing, the authorization you granted us for use or disclosure of your PHI.  However, if we have relied on your consent or authorization, we may use or disclose your PHI up to the time you revoke your consent.

YOUR RIGHT TO INSPECT AND COPY

You have the right to inspect and copy your PHI.  We may refuse to give you access to your PHI if we think it may cause you harm, but we must explain why and provide you with someone to contact for a review of our refusal.

YOUR RIGHT TO AMEND YOUR PHI

If you disagree with your PHI within our records, you have the right to request, in writing, that we amend your PHI when it is a record that we created or have maintained.  We may refuse to make the amendment and you have a right to disagree in writing.  If we still disagree, we may prepare a counter-statement.  Your statement and our counter-statement must be made part of our record about you.

YOUR RIGHT TO KNOW WHO ELSE SEES YOUR PHI

You have the right to request an accounting of certain disclosures we have made of your PHI, but not before April 14, 2003.  We are not required to account for all disclosures, including those made to you, authorized by you or those involving treatment, payment and healthcare operations as described above. We will inform you if there is a charge and you have the right to withdraw your request, or pay to proceed.

WHAT IF I HAVE A COMPLAINT?

If you believe that your privacy has been violated you may file a complaint with us or with the Office of Civil Rights.  We will not retaliate or penalize you for filing a complaint with the facility or with the Office of Civil Rights.

To file a complaint with us please call 918-664-4224 for a complaint form.  Your complaint should provide specific details to help us in investigating a potential problem.

To file a complaint with the Office of Civil Rights, contact information is 1301 Young Street, Suite 1169, Dallas, TX  75202   (214) 767-4056; (214) 767-8940 (TDD) or (214) 767-0432 FAX

If we change our Notice of Privacy Practices, we will provide our revised notice to you when you next seek treatment from us.

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