PATIENT NOTICE AND RIGHTS “HIPAA” 45 CFR Pts. 160-164

THIS NOTICE DESCRIBES HOW MEDICAL AND DRUG AND ALCOHOL RELATED INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

General Information

Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 V.S.C. § 1320d et seq., 45 CFR Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 CFR Part 2. Under these laws, ANNANDALE BEHAVIORAL HEALTH, LLC may not say to a person outside ANNANDALE BEHAVIORAL HEALTH, LLC that you attend the program, nor may ANNANDALE BEHAVIORAL HEALTH, LLC disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.

  • Pursuant to an agreement with a business associate;
  • For research, audit or evaluations;
  • To report a crime committed on ANNANDALE BEHAVIORAL HEALTH, LLC premises or against ANNANDALE BEHAVIORAL HEALTH, LLC personnel;
  • To medical personnel in a medical emergency;
  • To appropriate authorities to report suspected child abuse or neglect;
  • As allowed by a court order

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

Your Rights

Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. ANNANDALE BEHAVIORAL HEALTH, LLC is not required to agree to any restrictions you request, but if it does agree then it is bound by that agreement and may not use or 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 location. ANNANDALE BEHAVIORAL HEALTH, LLC will accommodate such requests that are reasonable and will not request an explanation from you. Under HIPAA you also have the right to inspect and copy your own health information maintained by ANNANDALE BEHAVIORAL HEALTH, LLC , except to the extent that the information contains psychotherapy notes or information compiled for 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 ANNANDALE BEHAVIORAL HEALTH, LLC records, and to request and receive an accounting of disclosures of your health related information made by ANNANDALE BEHAVIORAL HEALTH, LLC during the six years prior to your request. You also have the right to receive a paper copy of this notice.

STATEMENT OF PERSONAL RIGHTS

As an individual receiving services, all participants have the following rights:

  1. The right to be free from discrimination based on ethnic group identification, religion, age, gender, race, disability, or sexual orientation.
  2. The right to considerate and respectful care.
  3. The right to be accorded access to his or her record.
  4. The right to confidential treatment of all communications and records pertaining to your care and participation in our program. Written permission shall be obtained before records can be made available to anyone not directly connected with participants care. This right to confidentiality is provided for in the Code of Federal regulations, Title 42, Section 2.1 through 2.67-1.
  5. The right to leave the program at any time, this right does not prohibit us from setting rules for participants protection.
  6. The right to examine and receive an explanation of all participant fees, regardless of source of payment.
  7. The right to know program rules and policies, which apply to your services.
  8. The right to be accorded dignity in all personal relationships with program staff and other participants.
  9. The right to be safe, healthful, and comfortable accommodations, and equipment to meet your needs.
  10. The right to be free from intellectual, emotional, and/or physical abuse. This includes freedom from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.
  11. The right to be informed of the provisions of law regarding grievances and our policy including the address and telephone number of the government agencies, which have administrative responsibilities over the program of which you are participating in.
  12. The right to be personally advised of these rights and to receive a copy during admission.
  13. The right to receive or reject medical care or health-related services.
  14. The right to receive medically assisted treatment services.

Although these rights will not be denied by any participant, some of these rights may not be applicable to all participants.

PERSONAL RIGHTS – CALIFORNIA ADMINISTRATIVE CODE TITLE 9

  1. To the right to confidentiality as provided for in Title 42, Sections 2.1 though 2.76, code of Federal Regulations, effective August 1, 1975.
  2. To be accorded dignity in personal relationships with staff and other persons.
  3. To be accorded safe, healthful and comfortable accommodations to meet his or her needs.
  4. To be free from verbal, intellectual, emotional, physical abuse and/or inappropriate sexual behavior.
  5. The right to be informed of the provisions of law regarding grievances and our policy including the address and telephone number of the government agencies, which have administrative responsibilities over the program of which you are participating in.
  6. The right to be free from discrimination based on ethnic group identification, religion, age, gender, race, disability, or sexual orientation.
  7. The right to be accorded access to his or her record.