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.

When it comes to your health information you have certain rights

You have the right to

Request to review/receive copy your electronic medical record
Request in writing to make corrections to your electronic medical record
Request in writing to change how your information is communicated
Request us to limit how we share your information
Request in writing a list of those with whom we’ve shared your information
Request a copy of your Notice of Privacy Practices at any time
Choose someone to act for you through ah health care power of attorney
File a complaint if you believe your privacy rights have been violated

Your Choices on how we share certain information about you

We may use and share your information without your consent so we can:

Tell family or friends about your condition
Request in writing that we send your health information to your designee or third party
Share information in a disaster relief situation
Provide mental health care
Market our services
Raise Funds

Our Uses and Disclosures:

We may use and share your information without your consent so we can:

Treat you
Run our organization
Bill for your services
Help with public health and safety issues
Do research
Work with medical examiner or funeral director
Address workers’ compensation, law enforcement, and other government requests
Respond to lawsuits and legal court actions
Comply with Federal and State Law

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Request an electronic or paper copy of your medical record

You can request to see or get an electronic and/or paper copy of your medical record.
We will provide a copy of your record or with your permission a summary of your health information within 30 days of your request. We may charge a reasonable, cost-based fee for copying your records

Ask us to correct your medical record

You can request in writing to correct your health information that you think is incorrect or incomplete. Your correction will be written and added to your medical record.
We may so “no” to your request, but we will tell you why via writing within 60 days.

Get a list of those with whom we’ve shared information

You can ask for a list (accounting of disclosure) of the times we’ve shared your health information for six years prior to the date you ask, and who we shared it with and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).
We will provide one accounting a year for free, but will charge a reasonable , cost based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even though you have agreed to receive the notice electronically.

Choose someone to act for you

If you have a court appointed legal guardian, that person can exercise your rights and make choices about your health information.

We will make sure the person has this authority and can act for you before we take any action.

You have the right to file a complaint if you believe your privacy rights have been violated. We will not retaliate against your for filing a complaint.

You can make a complaint to any Different MHP, PC staff by calling 844-325-4647

You can also file a complaint with the U.S Department of Health and Human Services Office for Civil rights:

Centralized Case management Operations
US Department of Health and Human Services
200 Independence Ave, SW
Room 509F HHH Bldg.
Washington, DC 20201

Your Choices

For certain health information, you can tell us your choice about how we share. If you have a clear preference for how we share your information with your consent in the situations described below, let us know. Tell us what you want us to do and we will follow your instructions.

In these cases you have both the right and choice to tell us to

Share information with your family, close friends, or others involved in your care
Share information in a diaster relief situation

In the following cases we never share your information unless you give us written permission

Sale of your information
Marketing purposes
Fundraising purposes
Sharing of psychotherapy notes

If you are not able to tell us your preference, for example, you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways without your consent To Treat you – we can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

Bill for your services: We can use and share your health information to bill and get paid by health plans or other entities. Example: we give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

For more information see:

https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

Help with public health and safety issues

We can share health information about you for certain situations such as:

Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety

Do research- We can use or share your information for health research.

Work with a medical examiner or funeral director- We can share health information with a coroner,medical examiner, or funeral director when an individual dies.

We can use or share health information about you

For workers’ compensation claims
For certain types of law enforcement purposes
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions – We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Comply with the law – We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Sometimes state law requires greater limits on disclosures. North Carolina law generally requires that we obtain your written consent before we may disclose health information related to your mental health,developmental disabilities, or substance abuse services.

There are some exceptions to this requirement; we can disclose this health information to members of our workforce, our professional advisors, and to agencies or individuals that oversee our operations or that help us carry out our responsibilities in serving you. We also may disclose information to the following people: (i) a health care provider who is providing emergency medical services to you and (ii) to other mental health, developmental disabilities, and substance abuse facilities or professionals when necessary to coordinate your services. We also will disclose information about you if the law requires us to do so, for example, when a court orders disclosure or when we suspect abuse or neglect of a child or disabled adult.

If you apply for or receive substance abuse services from us, federal law generally requires that we obtain your written consent before we may disclose information that would identify you as a substance abuser or a patient of substance abuse services. There are some exceptions to this requirement. We can disclose this information within our program to members of our workforce as needed to coordinate your care and to agencies or individuals that help us carry out our responsibilities in serving you. We may disclose information to medical personnel in a medical emergency and as may otherwise be required by law.

Under North Carolina law, minors, with or without the consent of a parent or guardian, have the right to consent to services for the prevention, diagnosis and treatment of certain illnesses including: venereal disease and other diseases that must be reported to the State; pregnancy; abuse of controlled substances or alcohol; and emotional disturbance. If you are a minor and you consent to one of these services, you have all the authority and rights included in this Notice. In addition, the law permits certain minors (such as those emancipated by law) to be treated as adults for all purposes. These minors have all rights and authority included in this Notice for all services.

If you have one of several specific communicable diseases (for example, tuberculosis, syphilis orHIV/AIDS), information about your disease will be treated as confidential, and will be disclosed without your written permission only in limited circumstances. We may not need to obtain your permission to report information about your communicable disease to State and local officials or to otherwise use or disclose information in order to protect against the spread of the disease.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.
We will let you know within 60 days if we determine a breach has occurred that may have compromised the privacy or security of your information.
We must follow the privacy practices described in this notice and make the notice available to you.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice- We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our service sites and on our web site at www.differentmhp.com

I agree that I have read and understood the above and this notice is available is available for you online.

Conditions

Medications

Interventions