When it comes to your health information, you have certain rights and choices. Please review carefully.

Get a copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record. We will provide a copy of your health information usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request, but we’ll tell you why in writing within 60 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.

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.

• If you pay for a service out of pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
• SUD Treatment Information. If we receive or maintain any information about you from a substance use disorder treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the Part 2 Program record for purposes of treatment, payment or health care operations, we may use and disclose your Part 2 Program record for treatment, payment and health care operations purposes as described in this Notice and it is subject to redisclosure by the recipient without further protection. If we receive or maintain your Part 2 Program record through specific consent you provide to us or another third party, we will use and disclose your Part 2 Program record only as expressly permitted by you in your consent as provided to us.
• In no event will we use or disclose your Part 2 Program record, or testimony that describes the information contained in your Part 2 Program record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.
• You will be notified if you would like to have your likeness and/or other information used in any SPBHS fundraising activities. You have the right to deny any use of your image, name, or other information, related to fundraising activities.

Get a list of those with whom we have shared information

You can ask for a list of the times we have shared your information, who we shared it with, and why.

• We will include all 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 free in a year, but will charge a reasonable cost-based fee if you ask for another one within 12 months.

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 care.

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

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting us. We will not retaliate against you for filing a complaint.

• You can contact the Privacy Officer Carla Meitler, 907-235-9233
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, by contacting:
  • 200 Independence Avenue SW,  Room 509F HHH Building, Washington DC 20201
  • Call 1-800-368-1019
  • Visit www.hhs.gov/hipaa
• We will not retaliate against you for filing a complaint.

You have both the right and the choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• If you are not able to tell us your preference, for example if 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 family and safety

In these cases, we may never share your information unless you give us written permission:

• Marketing Purposes
• Most sharing of psychotherapy notes