NOTICE OF PRIVACY PRACTICES

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.

A HEALING PLACE COMMITMENT TO YOU

We at A Healing Place understand that your health information is private. Maintaining the privacy of your personal health information is one of our most important responsibilities. We are committed to protecting your personal health information and abiding by all state and federal laws regarding the protection of your personal health information. The Notice also tells you about your rights and A Healing Places requirements concerning the use and disclosure of your personal health information.

YOUR INFORMATION RIGHTS

You have the following rights regarding the health information that A Healing Place has about you:

Right to inspect and Copy: You have the right to inspect and obtain a copy of your health information.You may request that the copy be provided in electronic format. This request may include your medical information and billing information. Request must be in writing. It does not include information that is needed for civil, criminal or administrative actions or proceedings or psychotherapy notes. Psychotherapy notes may be requested but we have the right to restrict access if you are an active client. We may charge a reasonable fee for the costs of copying, mailing and other supplies associated with your request.

Right to amend: If you feel that the health information that A Healing Place has created about you is incorrect or incomplete, you may ask to amend that information. A Healing Place may deny your request if you ask to amend information that: 1) was not created by A Healing Place 2) is not part of the information kept by A Healing Place 3) is not part of the information which you would be permitted to inspect or copy; or 4) the information is determined to be accurate and complete. Should we deny your request to amend, you may submit a statement of your point of view that will be added to the case file. Right to an Accounting of Health Information Releases: You have the right to request a list of information release that A Healing Places has made of your health information. This list will not include: 1) health information releases made for the purpose of providing treatment to you, obtaining payment for services or releases made for administrative or operational purposes; 2)health information releases made for national security; 3)health information made to correctional institutions and other law enforcement custodial situations; 4)health information release A Healing Place has made based on your written authorizations; 5)health information releases to the person involved in your care. We must comply with your request within 60 days.

Right to Request Restrictions: You have the right to request a restriction on limitation of how your healthcare information is used or released for treatment payment or operational purposes. A Healing Place is not legally requested under all circumstances to agree with the requested restriction or limitation.

 Right to Request Confidential Communications: You have the right to request that we communicate with you about your health care matters in a certain way or a certain location. For example, you can request that we only contact you at work or only by email. A Healing Place will accommodate all reasonable requests. To request confidential communications, you must do so in writing and specify how or where you wish to be contacted.

Right to a Paper Copy of this Notice: You have the right to request a paper copy of this notice from A Healing Place at any time.

Right to File Complaint: If you believe your privacy rights have been violated, you have the right to file a complaint with A Healing Place or may send a written complaint to the Secretary of the U. S. Department of Health and Human Services.

All requests for inspecting, copying, amending making restriction, or obtaining an

accounting of your health information must be in writing. 

Requests may be made to A Healing Place, 145 W. Wisconsin Avenue Neenah, WI 54956  Email requests may be sent to Info@healingplaceccc.org

HOW A HEALING PLACE USES AND RELEASE HEALTH CARE INFORMATION

Your health information may be used and released by A Healing Place for the purpose of providing treatment to you, obtaining payment for services, for administrative and operational purposes, and to evaluate the quality of the services that you receive. A Healing Place provides a range of services and for this reason not all types of uses and releases can be described in this document. WE have listed some of the common examples of permitted uses and releases below.

For Treatment: Service providers, such as social workers, nurses, psychologists, therapists and doctors may use your health information to determine your plan of care. Individuals within A Healing Place may share health information about you to coordinate the services you may need, such as court ordered services, mental health services, medications, hospitalizations or follow-up services. We may also use your health information to ensure that proper treatment or  services are provided. We may also use your information with an agency with whom we contract for services on your behalf to ensure proper services. One example may be a group living facility if they are to assist you in managing your medications.

For Payment: A Healing Place may release information about you to your health plan or health

  insurance carrier to obtain payment of our services. For example, we may need to give your health plan information about the type of treatment you are going to receive in order to obtain prior approval or to determine where your plan will cover the treatment.

For Operations: A Healing Place may use and release information about you to ensure that the services treatment or services are useful. Our therapists may share your prescription information with your pharmacist so that he/she can ensure that you are receiving the proper type and dosage, and that your medicines will not interact with each other provided to you are appropriate and are high quality. We may combine health information about many individuals to research health trends, to determine what services should be offered, or whether new

To Other Agencies Providing Benefits of Services: A Healing Place may release your health

information to other agencies that are providing you with benefits or services when information is necessary for you to receive those benefits and services.

To Keep You Informed: A Healing Place may contact you about reminders for treatment, medical care, etc. We may also contact you to tell you about your health-related benefits or services that may be able to assist you.

For Public Health: A Healing Place may release your health information to public health agencies

subject to the provisions of applicable state and federal law for the following kinds of activities:

a. To prevent or control disease, injury or disability or to keep vital statistics records such  as deaths.

b. To notify social service agencies that are authorized by law to receive reports of abuse, neglect of domestic violence.

c. To report reactions to medications or problems with products to the Food and Drug    Administration.For Health Oversight Activities: A Healing Place may share your health information with other agencies for oversight activities requested by law. Examples of these activities include audits, inspections, certification and licensure and investigations.

For Law Enforcement: A Healing Place may release health information to a law enforcement individual, subject to applicable federal and state laws and regulations, for the purposes that are required by law or in response to a court order or subpoena.

For Research: A Healing Place may release your health information for research projects that have been reviewed and approved by an institutional review board or a privacy board to ensure the continued privacy and protection of health information. This is very rarely done at A Healing Place.

Lawsuits and disputes: If you are involved in a lawsuit or dispute, A Healing Place may release health information about you in response to a court or administrative order. WE may also release 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 information requested.

To Avert a Serious Threat to Health and Safety: A Healing Place may release your health information if it is necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person.

To the Military: If you are a veteran or current member of the armed forces, A Healing Place may release your health information as requested by military command or veteran administration authorities.