Your Information. Your Rights. Our Responsibilities.
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.
The confidentiality of alcohol and drug abuse patient records maintained by this program is protected by Federal and State regulations. Generally, THS may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as alcohol or other drug involved (i.e., abuse or dependency) unless:
- The patient consents in writing;
- The disclosure is allowed by a court order; or
- The disclosure is made to medical personnel in a medical emergency or to qualified authorized personnel for research, audit, or program evaluation.
There are three important situations in which THS must and will release information about you without your written authorization:
- MEDICAL EMERGENCY: If a physician or hospital calls the clinic and states a need to know information about a patient in order to provide that person emergency medical services, we will release information about the patient, limiting our release to only the information necessary for care. This usually means methadone dose level and date of last dose given, and/or information concerning psychiatric (psychotropic) medications.
- COURT ORDER: If THS is presented with a properly drawn court order, we must obey that order and give all information required by that order.
- CHILD ABUSE/NEGLECT: In a situation where any staff member has reason to believe that a patient is currently abusing or neglecting a child, THS is required by state law to report the situation to Children’s Protective Services (CPS). Our report may have to include information about the patient’s treatment at this agency.
- HOMICIDAL/SUICIDAL: In situations where staff members have reasons to believe that patients may harm themselves or others, THS is required by state and federal laws to report this intent to the local law enforcement or MHP’s.
You have the right to:
- Get a copy of your paper or electronic medical record
- Request correction of your paper or electronic medical record, if needed
- Request confidential communication
- Ask us to limit the information we share
- Get a list (with some exceptions) of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your 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.
Our Uses and Disclosures
We may use and share your information as we:
- Help manage the health care treatment you receive
- Run our organization
- Bill for your services
- Comply with the law
- Respond to lawsuits and legal actions
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy of your health information, usually within 15 business days of your request. We may charge a reasonable, cost-based fee. There are some records we do not need to give you.
Ask us to correct your medical record
- You can ask us, in writing, to correct health information about you that you think is incorrect or incomplete. This applies to certain records, such as those we use to make decisions about you. Ask us how to do this.
- We may say “no” to your request, but we’ll tell you why in writing within 10 business days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment, or our operations.
- We are not required to agree to your request, and we may say “no” if it would affect your care.
Get a list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, 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’ll 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 if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
File a complaint if you feel your rights are violated
- If you believe your privacy rights have been violated you can contact Debbi Bardsley, our Privacy Officer at firstname.lastname@example.org or 206-723-1980, extension 1260.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- 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 office, and on our web site.
This notice effective: 02/24/2023