NOTICE OF PRIVACY PRACTICES
Effective Date: 03/17/2021
This notice describes how medical and health information about you may be used and disclosed, and how you can get access to this information. Please review this notice carefully.
You have the right to:
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 or a summary 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. Ask us how to do this.
- 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 or health care item 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.
Get a list of our disclosures of your health information
- You can ask for a list (accounting) of the times we’ve shared your health information for up to six (6) years prior to the date you ask, who we shared it with, and why.
- We will include all of the disclosures we are required by law to include in an accounting. Except in certain circumstances, federal law generally does not require us to provide an accounting of disclosures made for treatment, payment, and health care operations purposes, or for certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but, if permitted by the laws that apply to us, we will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this Notice of Privacy Practices
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.
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 based on that person’s directions.
File a complaint if you feel your rights are violated
If you believe we have violated your privacy rights, you have the right to:
- Complain to us. Kyle@granitemountainbhc.com
- 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/.
- A violation of the of federal Part 2 law and regulations is a crime. You may report a suspect violation of Part 2 to the United States Attorney at:
United States Attorney’s Office
District of Arizona
Two Renaissance Square
40 N. Central Avenue,
Phoenix, AZ 85004-4449
Phone: (602) 514-7500
- If the violation involves an opioid treatment program, the violation may also be reported to:
SAMHSA Center for Substance Abuse Treatment
5600 Fishers Lane
Rockville, MD 20857
Phone: 240-276-1660 ‖ Fax: 301-480-6596
We will not retaliate against you for filing a complaint.
Your Choices regarding Your Health Information
Information about health care you receive from Summit Behavioral Health of AZ DBA Granite Mountain Behavioral Healthcare is protected by two federal laws:
- The Health Insurance Portability and Accountability Act of 1996, known as “HIPAA.” (42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 and 164) HIPAA covers protected health information, known as “PHI.”
- The federal law on the confidentiality of substance use disorder patient records, known as “Part 2.” (42 U.S.C. § 290dd-2, 42 C.F.R. Part 2)
The Part 2 law and regulations are more restrictive than HIPAA. When Part 2 applies, we follow Part 2’s more restrictive privacy protections.
For certain health information, you can tell us your choices about what we share. Because we comply with the Part 2 law and regulations, there are very limited circumstances in which we may share your health information without your written consent to do so. In most circumstances we will ask you for your written permission before sharing health information.
However, as explained below, there might be circumstances where your health information is not protected by Part 2 but is protected by HIPAA. In these circumstances, we may use and disclosure such health information as permitted by HIPAA. However, 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.
You have both the right and choice under HIPAA to give us permission to:
- Share information with your family, close friends, or others involved in your care; and
- 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 and, if applicable, permitted by Part 2. We may also share your information when needed to lessen a serious and imminent threat to health or safety and, if applicable, will do so in compliance with Part 2 requirements.
Unless you give us written permission, we will never:
- Use or disclose your information for marketing purposes;
- Sell your information;
We may contact you for fundraising efforts, but you can tell us not to contact you again.
Unless you give us written permission, we generally will not share any psychotherapy notes relating to you (that is, your mental health professional’s impressions from your individual or group therapy sessions that are kept separate from the rest of your medical record).
How We Typically Use Your Health Information
We typically use your health information (including substance use disorder information) in the following ways:
To treat you
We can use your health information for purposes of providing treatment to you.
Example: Sharing information with your Primary Care Physician
To run our organization
We can use your health information to run our business, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
How We Disclose Your Health Information
A Part 2 program may not say whether you are receiving services from the Part 2 program (or have received services) if doing so would reveal your substance use disorder. We will not disclose any information that identifies you as a patient of Summit Behavioral Health of AZ DBA Granite Mountain Behavioral Healthcare, as someone who has (or had in the past) a substance use disorder unless:
- You consent to the disclosure in writing. Or your guardian (or other individual legally authorized to act on your behalf) consents to the disclosure.
- The disclosure is allowed by court order.
- The disclosure is to medical personnel in a medical emergency where your prior consent cannot be obtained.
- The disclosure is to medical personnel of the Food and Drug Administration (FDA) for product recalls.
- The disclosure is to medical personnel when there is a temporary state of emergency declared as the result of a natural or major disaster (such as a wildfire or hurricane) and the Part 2 program is closed and unable to provide services or obtain your prior consent due to the emergency.
- The disclosure is to a third-party payor (like your health plan) for payment purposes in circumstances where the Part 2 program director has consented on your behalf because your condition prevents you from knowing or taking effective action on your own behalf.
- The disclosure is to the Part 2 program’s contractors who provide services to the Part 2 program and who agree to be bound by the privacy protections for substance use disorder information.
- The disclosure is to organization(s) that have direct administrative control over the Part 2 program.
- The disclosure is to qualified personnel for research, audit or program evaluation purposes.
- The disclosure is for cause of death reporting or investigations permitted by state law.
- The disclosure is for another purpose permitted by the Part 2 law or regulations (42 U.S.C. § 290dd-2 and 42 C.F.R. Part 2).
Federal law and regulations do NOT protect any information about:
- A crime committed by a patient on the premises of the Part 2 program, against Part 2 program personnel, or about any threat to commit such a crime.
- Suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.
If Part 2 does not apply to your health information, we may share that non-Part 2 information without your written consent in the following ways:
- To treat you. We may share your health information with other professionals who are treating you.
- For normal health care operations activities. We may share your health information to run our business and to the improve the care that is provided to patients.
- To bill for your services. We may share your health information to bill and get payment from health plans or other entities.
Other Ways We Use or Share Your Health Information
If Part 2 does not apply, we may be 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 provide a summary of those other purposes below. But we have to meet many conditions in the law before we can share your information for these purposes. However, if Part 2 applies, we may not be allowed to share your health information in these ways unless we get your written consent.
Public health and safety issues
If Part 2 does not apply, we may share health information about you for certain public health situations (and if certain conditions are met), such as:
- Preventing disease;
- Reporting adverse reactions to medications;
- Reporting suspected partner or elder abuse, neglect, or domestic violence; and
- Preventing or reducing a serious threat to anyone’s health or safety.
We can use or share your information for health research if certain conditions are met.
Complying with the law
Unless Part 2 prevents us from making the disclosure, 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 HIPAA.
Respond to organ and tissue donation requests
If Part 2 does not apply, we may share health information about you with organ procurement organizations (and if certain conditions are met).
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 (and if certain conditions are met).
Address workers’ compensation, law enforcement, and other government requests
If Part 2 does not apply, we may use or share health information about you (if certain conditions are met):
- For workers’ compensation claims;
- For law enforcement purposes or with a law enforcement official;
- With health oversight agencies for activities authorized by law; and
- For special government functions such as military, national security, and presidential protective services.
Respond to lawsuits and legal actions
If Part 2 does not apply, we may share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Additional Responsibilities
We are required by law to maintain the privacy and security of your protected health information and substance use disorder records.
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 the Notice.
We will not use or share your information other than as described in this Notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. If you change your mind, please let us know in writing.
Changes to this Notice
- Upon request;
- On our website; and
- Posted in our place of business.
For More Information
If you have any questions about this Notice, or how we handle your health information, please contact Kyle Schwartz email@example.com
For more information about your privacy rights, please go to www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
 For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.