NOTICE OF PRIVACY PRACTICES
Effective Date: August 26, 2005
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THIS NOTICE IS COMPLIANT WITH 42 CFR, PART 2.
A copy of this may be found in the Administrative Office of 12&12, Inc. If you have any questions about this notice, please contact the Client Advocate at (918) 664-4224.
I. Who Will Follow This Notice
This notice describes our organization’s practices and that of:
- Any health care professional authorized to enter information into your medical record
- All departments and units of 12&12, Inc.
- All employees, staff and other 12&12, Inc. personnel, including physicians, psychologists, and therapists who are contractors of 12&12, Inc.
II. Our Pledge Regarding Protected Health Information
We understand that Protected Health Information about you and your health is personal and we are committed to protecting your Protected Health Information. We create a record of the care and services you receive at 12&12, Inc. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by 12&12, Inc.
12&12, Inc. has begun obtaining data through the MyHealth Access Network, Oklahoma’s online health information exchange. MyHealth is a health information network that gives authorized medical personnel secure, online access to their patient’s community-wide medical MyHealth medical data. Connecting to MyHealth will allow us to improve patient care, make more informed health care decisions and improve our performance. At this time we will not be sharing information on the MyHealth Access Network.
This notice will tell you about the ways in which we may use and disclose Protected Health Information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of Protected Health Information.
We are required by law to:
- Make sure that Protected Health Information that identifies you is kept private.
- Give you notice of our current legal duties and privacy practices with respect to Protected Health Information about you.
- Follow the terms of the notice that is currently in effect.
III. How We May Use and Disclose Protected Health Information About You
The following categories describe different ways that we use and disclose Protected Health Information. For each category of uses or disclosures we will explain what we mean and try to give an example. Not every use of disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
- Routine Uses
- For Treatment. We may use Protected Health Information about you to provide you with medical treatment or services. We may disclose Protected Health Information about you to doctors, nurses, clinicians, or other medical professionals and business associates, and 12&12, Inc. personnel who are involved in taking care of you at 12&12, Inc. 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, Inc. also may share Protected Health Information about you in order to coordinate the different things you need, such as lab work, prescriptions and other testing. This would also include the sharing of information among students of a professional training program that 12&12, Inc. may sponsor. 12&12, Inc. will securely obtain client personal health information from the MyHealth health information system as of September 1, 2013, however we will not begin sharing PHI at this time.
- For Payment. We may use and disclose Protected Health Information about you so that the treatment and services you receive at 12&12, Inc. may be billed and payment may be collected from you, an insurance company, or a third party. We may disclose Protected Health Information to your health plan, insurance company, HMO, or their utilization review contractor to obtain prior approval or to determine whether your plan will cover a particular treatment.
- For Healthcare Operations. We may use and disclose Protected Health Information about you for healthcare operations. These uses and disclosures are necessary to run 12&12, Inc. and ensure that all of our clients receive quality care. For example, we may use Protected Health Information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine Protected Health Information about many 12&12, Inc. clients to decide what additional services 12&12, Inc. should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, clinicians and other 12&12, Inc. personnel for review, research, and learning purposes. We may also combine the Protected Health Information we have with Protected Health Information from other healthcare organizations to compare how we are doing and see whether we can make improvements in the care and services we offer. We will remove information that identifies you from this set of Protected Health Information so others may use it to study health care and health care delivery without learning who the specific clients are.
- Appointment Reminders. We may use and disclose Protected Health Information to contact you as a reminder that you have an appointment for services at 12&12, Inc.
- Treatment Alternatives. We may use and disclose Protected Health Information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-Related Benefits and Services. We may use and disclose Protected Health Information to tell you about health-related benefits or services that may be of interest to you.
- As Required By Law. We will disclose Protected Health Information about you when required to do so by federal, state or local law. In Oklahoma, 12&12, Inc. 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, described elsewhere in this notice.
- To Avert a Serious Threat to Health or Safety. We may use and disclose Protected 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. Any disclosure, however, would only be to someone able to help prevent the threat. We may also disclose Personal Health Information 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.
- When you provide 12&12, Inc. with written authorization for the release of Protected Health Information to the criminal justice system and your services at 12&12, Inc. are a condition of your legal status, you may revoke your written authorization prior to the expiration date or event stated on the signed consent.
- Special Situations
- Public Health Risks. We may disclose Protected Health Information about you for public health activities. These activities generally include the following:
- To prevent or control disease, injury or disability
- To report deaths
- To report suspected child abuse or neglect
- To report reactions to medications or problems with products
- To notify people of recalls of products they may be using
- 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
- Health Oversight Activities. We may disclose Protected Health Information 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.
- Accrediting Organizations. We may disclose Protected Health Information to an organization that 12 & 12, Inc. has contracted with for purposes of accreditation such as CARF, DOC, DMHSAS, and the Oklahoma Health Care Authority, etc.
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Protected Health Information about you in response to a court order. We may also disclose Personal Health Information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the Personal Health Information requested or with your consent. We may disclose Personal Health Information to any governmental agency or regulator with whom you have filed a complaint or as part of a regulatory agency examination.
- Law Enforcement. We may release Protected Health Information if asked to do so by a law enforcement official:
- In response to a court order, or a warrant, summons or similar process with your consent.
- About criminal conduct or threats of criminal conduct at the facility
- National Security and Intelligence Activities. We may release Protected Health Information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
- Protective Services for the President and Others. We may disclose Protected Health Information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
IV. Your Rights Regarding Protected Health Information About You
You have the following rights regarding Protected Health Information we maintain about you:
Right to Inspect and Copy. In most cases, you have the right to request to inspect and copy Protected Health Information that may be used to make decisions about your care. This request must be made in writing to 12&12, Inc. If you request a copy of the information, we may charge a fee for the cost of copying, mailing, or other supplies associated with your request. The fee would be at the Oklahoma statutory rate of .25 per copied page plus postage. If the Clinical Director or Primary Counselor denies your request, you will receive a written explanation for the denial. If we deny your request, you may ask that the denial be reviewed. The review will be conducted by an individual chosen by us, but who was not involved in the original decision to deny your request. We will comply with the outcome of that review.
Right to Amend. If you feel that Protected Health Information we have about you is incorrect or incomplete, you may ask 12&12, Inc. to amend the information. You have the right to request an amendment for as long as the information is kept by or for 12&12, Inc.
To request an amendment, your request must be made in writing and submitted to the Clinical Director for 12&12, Inc. In addition, you must provide a reason that supports your request.
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 12&12, Inc. to amend information that:
- Was not created by 12&12, Inc. unless the person or entity that created the information is no longer available to make the amendment
- Is not part of the Protected Health Information kept by or for 12&12, Inc.
- Is not part of the information which you would be permitted to inspect and copy
- 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 Protected Health Information about you. This list will not include disclosures made for treatment, payment, health care operations, for purposes of national security, made to law enforcement or to corrections personnel or made pursuant to your authorization or made directly to you.
To request this list or accounting of disclosures, you must submit your request in writing to 12&12, Inc. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the cost of providing 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.
Right to Request Restrictions. You have the right to request a restriction of limitation on the Protected Health Information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the Protected Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we do agree, we will comply with your request at our convenience unless the information is needed to provide you emergency treatment. We will not agree to restrictions on Personal Health Information uses or disclosures that are legally required, or which are necessary to administer our business.
To request restrictions, you must make your request in writing to 12&12, Inc. In your request, you must tell 12&12, Inc.:
- What information you want to limit
- Whether you want to limit our use, disclosure, or both
- To whom you want the limits to apply, for example, disclosures to your spouse
Right to Request Confidential Communications. You have the right to request that we communicate with you about Protected Health Information 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 communication, you must make your request in writing to 12&12, Inc. 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 12&12, Inc. to give you a copy of this notice at any time. To obtain a paper copy of this notice, please contact the administrative office of any 12&12, Inc. facility.
- Changes to This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for Protected Health Information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the administrative office of each facility. The notice will contain on the first page, the effective date. In addition, each time you are admitted to 12&12, Inc. for treatment or health care services, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with 12&12, Inc. or with the Secretary of the Department of Health and Human Services. To file a complaint with 12&12 Inc., contact the Privacy Officer at (918) 664-4224. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
VII. Other Uses of Protected Health Information
Other uses and disclosures of Protected Health Information not covered by this notice or the laws that apply to its use will be made only with your written permission. If you provide 12&12, Inc. permission to use or disclose Protected Health Information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose Protected Health Information about you 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 provide to you.
VIII. Contacting 12&12, Inc.
You may contact 12&12, Inc. with questions and/or requests by contacting the Privacy Officer at (918) 664-4224 or by mail at: Privacy Officer, 12&12, Inc., 6333 E Skelly Drive, Tulsa, OK, 74135.