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 applies to Endless Mountain.
We are required by law to maintain the privacy of your health information and
to give you notices of our legal duties and privacy practices with respect to
your protected health information. This Notice summarizes our duties and
your rights concerning your protected health information and substance abuse
disorder records. Our duties and your rights are set forth more fully in the
Health Insurance Portability and Accountability Act (45 C.F.R. part 164)
(“HIPAA”) and the federal law and regulations governing the confidentiality of
substance abuse disorder records (42 U.S.C. § 290dd-2, 42 C.F.R. Part 2).
We are required to abide by the terms of our Notice that is currently in effect.
Uses and Disclosures of Information That
We May Make Without Your Written
Authorization
We may use or disclose your protected health information for the following
purposes without your written authorization:
Internal Program Communications
Our personnel may disclose your health information between or among
themselves if they have a need for the information in connection with their
duties that arise out of the provision of diagnosis, treatment, or referral for
treatment of patients with substance use disorders.
Crimes on Program Premises or
Against Program Personnel
We may disclose your health information to law enforcement officers to the
extent the disclosure is directly related to crimes and threats to commit crimes
on our premises or against our personnel.
Child Abuse Reporting
We may disclose your health information as required by state law to report
suspected child abuse and neglect to appropriate state or local governmental
authorities.
Medical Emergencies
We may disclose your health information to medical personnel to the extent
necessary to meet a bona fide medical emergency in which your prior
informed consent for the disclosure cannot be obtained.
Court Orders
We may disclose your health information in response to a valid court order.
Audit and Evaluation Activities
We may disclose your health information to qualified persons who are
conducting an audit or evaluation of our program.
Medical Research
We may disclose your health information for medical research purposes,
subject to your authorization or approval by an institutional review board.
Qualified Service Organizations and/or
Business Associates
We may disclose your health information under contracts for services with
qualified service organizations and/or business associates outside of our
program, which assist our program in providing health care.
Appointments and Services
We may use or disclose your health information to send you appointment
reminders, or to provide you with information about treatment alternatives or
other health-related benefits and services that may be of interest to you.
Please advise us if you do not wish to receive such communications, and we
will not use or disclose your information for such purposes. If you wish not to
receive this kind of communication, you must advise us in writing at our
contact address given above.
Uses and Disclosures of Information That
We May Make With Your Written
Authorization
We may use and disclose protected health information in the following
instances only with your written authorization:
Treatment
With your written authorization, we may disclose your protected health
information to healthcare providers outside our program so that they may help
treat you.
Payment
With your written authorization, we may use or disclose your protected health
information so that we, or other healthcare providers, may obtain payment for
treatment provided to you. For example, we may disclose information from
your medical records to your health insurance company to obtain pre-
authorization for treatment or submit a claim for payment.
Healthcare Operations
With your written authorization, we may use or disclose your protected health
information for certain healthcare operations that are necessary to run our
program and ensure that our patients receive quality care. For example, we
may use information from your medical records to review the performance or
qualifications of physicians and staff; train staff; or make business decisions
affecting the program.
Therapy Notes
Notes recorded by your behavioral health professional documenting the
contents of a counseling session with you, which are known as “therapy
notes,” will be used only by your provider and will not otherwise be used or
disclosed without your written authorization unless otherwise required by law.
Marketing Communications
We will not use your health information for marketing communications without
your written authorization.
Sale of Protected Health Information
We must obtain your written authorization prior to selling your protected health
information, consistent with the related definitions and exceptions set forth in
HIPAA.
Other Uses and Disclosures
Other uses and disclosures will be made only with your written authorization.
You may revoke your authorization by submitting a written notice to the CEO
identified below. However, the authorization will not be effective to the extent
we have already taken action in reliance on the authorization.
Your Rights Concerning Your Protected Health
Information
You have the following rights concerning your protected health information. To
exercise any of these rights, you must submit a written request to the CEO
identified below.
Right to Request Additional Restrictions
You may request additional restrictions on the use or disclosure of your
protected health information for treatment, payment or healthcare operations.
We are not required to agree to a requested restriction except if your request
is to restrict disclosing protected health information to a health plan for the
purpose of carrying out payment or health care operations, the disclosure is
not otherwise required by law, and the protected health information pertains
solely to a health care item or service which has been paid in full by you or
another person or entity on your behalf. If we agree to a restriction, we will
comply with the restriction unless an emergency or the law prevents us from
complying with the restriction, or until the restriction is terminated.
Right to Receive Communications by Alternative
Means
We normally contact you by telephone or mail at your home address. You may
request that we contact you by some other method or at some other location.
We will not ask you to explain the reason for your request. We will
accommodate reasonable requests. We may require that you explain how
payment will be handled if an alternative means of communication is used.
Right to Inspect and Copy Records
You may inspect and obtain a copy of protected health information that is used
to make decisions about your care or payment for your care. We may charge
you a reasonable cost-based fee for providing the records. We may deny your
request under limited circumstances, e.g., information prepared and used
solely for legal proceedings or if disclosure may endanger the life or safety of
you or another individual.
Right to Request Amendment to Record
You may request that your protected health information be amended. You
must explain the reason for your request in writing. We may deny your request
if we did not create the record unless the originator is no longer available; if
you do not have a right to access the record; or if we determine that the
record is accurate and complete. If we deny your request, you have the right
to submit a statement disagreeing with our decision and to have the statement
attached to the record.
Right to an Accounting of Certain Disclosures
You may receive an accounting of certain disclosures we have made of your
protected health information within the last six years. We are not required to
account for disclosures for treatment, payment, or healthcare operations; to
family members or others involved in your healthcare or payment; for
notification purposes; or pursuant to our facility directory or your written
authorization. You may receive the first accounting within a 12-month period
free of charge. We may charge a reasonable cost-based fee for all
subsequent requests during that 12-month period.
Right to Receive Notification of a Breach
In accordance with HIPAA, we are required to notify you if we discover a
breach of your unsecured protected health information.
Right to Receive a Copy of This Notice
You have the right to obtain a paper copy of this Notice upon request. You
have this right even if you have agreed to receive the Notice electronically.
Changes to This Notice
We reserve the right to change the terms of our Notice of Privacy Practices at
any time, and to make the new Notice provisions effective for all protected
health information that we maintain. If we materially change our privacy
practices, we will prepare a new Notice of Privacy Practices, which shall be
effective for all protected health information that we maintain. We will post a
copy of the current Notice in our reception area and on our website. You may
obtain a copy of the current Notice in our reception area, or by contacting the
CEO identified below.
Complaints
You may complain to us, the Joint Commission or to the Department of Drug
and Alcohol Programs if you believe your privacy rights have been violated.
You may file a complaint with us by notifying our CEO identified below. All
complaints must be in writing. We will not retaliate against you for filing a
complaint.
Violation of the federal law and regulations governing the confidentiality of
substance abuse disorder treatment records is a crime, and you may report
suspected violations to the U.S. Attorney for the judicial district in which the
violation occurs. Contact information for the U.S. Attorney Office is below:
U.S. Attorney for the Eastern District of Pennsylvania
615 Chestnut Street, Suite 1250
Philadelphia, PA 19106
Phone: 215-861-8200
CEO
If you have any questions about this Notice, or if you want to object to or
complain about any use or disclosure or exercise any right as explained
above, please contact our CEO, Terry Drake (570) 964-8001.
Effective Date
This Notice is effective on 4/9/2024.