CEDAR VALLEY RECOVERY SERVICES

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBED HOW THE MEDICAL AND DRUG/ALCOHOL RELATED INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED.  THE FOLLOWING WILL ASSSIT YOU IN HOW YOU CAN OBTIAN THAT INFORMATION.  PLEASE READ CAREFULLY.

General Information:

Information regarding your health care, including payment for health care services, in 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.  Under these laws, Cedar Valley Recovery Services (CVRS) may not disclose to an individual outside of CVRS that you attend treatment, nor may CVRS disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.

CVRS must obtain your written consent before it can disclose any information about you for payment purposes.  CVRS must obtain your written consent before it can disclose information to your health insurer in order to be paid of services.  Generally, you must also sign a written consent before CVRS can share information for treatment purposes or for health care operations.  However, federal law permits CVRS to disclose information without your written permission in the following instances:

  1. Pursuant to an agreement with a business associate;
  2. For research, audit or evaluations;
  3. To report a crime committed on CVRS premises or against CVRS staff;
  4. To medical personnel in a medical emergency;
  5. To appropriate authorities in a medical emergency;
  6. As allowed by court order;
  7. To report mandatory child abuse or dependent adult abuse.

Before CVRS can use or disclose any information about your health in a manner which is not described above, CVRS must first obtain your specific written consent allowing it to make the disclosure.  Any such written consent may be revoked by the patient in writing.

CVRS can disclose information without the patient’s consent to obtain legal or financial services, to another medical facility to provide health care to the patient, as a business associate agreement is in place.

 

 

Patient Rights:

Under HIPAA, you have the right to request restrictions on certain uses and disclosures of your health information.  CVRS is not required to agree to any restrictions you request, but if the entity does agree- it is bound by that agreement and may not 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 CVRS location.  CVRS will accommodate such requests that are reasonable and will not request an explanation from you.  Under HIPAA you have the right to inspect and copy your own health care information maintained by CVRS, except to the extent that the information contains psychotherapy notes or information complied to use in a civil, criminal or administrative proceeding or in other limited circumstances.  Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in CVRS’ records, and to request and receive an accounting of disclosures of your health related information made by CVRS during the six years prior to your request.  In most instances, your copies must be given to you within 30 days.  You also have the right to receive a paper copy of this notice.

Cedar Valley Recovery Services Duties:

Cedar Valley Recovery Services is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information.  CVRS is required by law to abide by the terms of this notice.  CVRS reserves the right to change the terms of this notice and to make new notice provisions effective for all protected heath information it maintains.  Upon new HIPAA revisions, you will be notified and provided with a copy of those revisions.

Complaints and Reporting Violations:

You may file a complaint with CVRS, in the form of a written grievance, 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.  To register a complaint or grievance with CVRS, contact eh Executive Director.  For information on how to file a grievance, refer to accompanying hand out.  CVRS ensures that you will not be retaliated against for filing such as complaint.

Violation of the Confidentiality Law 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.

Contact: For further information, contact CVRS’ Office Manager or Executive Director.

I hereby acknowledge receiving a copy of this notice.

 

Patient Signature:________________________________________________  Date:_______________