Effective Date: June 3, 2020
St. John’s Recovery Place (SJRP) is required by law to maintain the privacy of your health information in accordance with federal and state law. In particular, we protect the privacy and security of your substance use disorder patient records in accordance with 42 U.S.C. § 290dd–2 and 42 C.F.R. Part 2, the Confidentiality of Substance Use Disorder Patient Records (“Part 2”), in addition to HIPAA and applicable state law. This Notice of Privacy Practices (“Notice”) outlines the legal duties and privacy practices for SJRP with respect to the appropriate collection and secure storage of health information. We are required by law to provide you with a copy of this Notice and to notify you following a breach of your unsecured health information. SJRP may provide health care through health care providers who are contracted with SJRP. All such health care providers have agreed to be bound by this Notice.
SJRP will abide by the terms of the Notice. We reserve the right to make changes to this Notice as permitted by law. We reserve the right to make new Notice provisions effective for all health information we currently maintain, as well as any health information we receive in the future. If important changes are made to the material or data contained in our privacy practices, we will promptly update our Notice. Each version of the Notice will maintain an effective date listed on the first page. You may access the revised Notice on our website at SJRP.com or from the receptionist at any SJRP facility.
If you believe your privacy rights have been violated, you have the right to file a complaint. You can file a complaint by sending a letter outlining your concerns to: St. John’s Recovery Place, ATTN: Compliance, 1125 N. Summit St., Crescent City, FL 32112 or by email at email@example.com You also have the right to complain to the Secretary of the United States Department of Health and Human Services, the United States Attorney for the judicial district in which the violation occurs, and the Substance Abuse and Mental Health Services Administration (SAMHSA) office responsible for treatment program oversight. You will not be penalized or otherwise retaliated against for filing a complaint.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION:
We will obtain your written authorization to use and disclose your health information unless we are permitted to use or disclose your information without your authorization under applicable law. The following categories describe the way that we may use and disclose your health information without your written authorization under Part 2. To the extent applicable, state law is even more restrictive than Part 2 on how we use and disclose any of your health information, we comply with more restrictive state law.
Within our Facilities. SJRP personnel who have a need for your information in connection with their duties that arise out of the provision of diagnosis, treatment, or referral for treatment may use and share your information.
Emergency Treatment. In the event of a bona fide medical emergency in which your prior authorization cannot be obtained, we may disclose your identifying information to medical personnel. We will obtain your authorization prior to disclosing your information for all non-emergent treatment.
Business Associates/Qualified Service Organizations. We may disclose your information to third party, “Business associates” and “qualified service organizations” that perform various services on our behalf, such as transcription, billing, or collection services, and who agree to protect the privacy of your health information.
Audits. We may disclose your health information to entities who are legally permitted to perform audits of our facilities. Those entities are required to maintain the privacy of your information.
Legal Proceedings. We may disclose your health information pursuant to court orders that meet the requirements of applicable law.
Reporting Crimes on Our Premises or Against Our Personnel. We may disclose the commission or threatened commission of a crime on our premises or against our personnel to a law enforcement agency or official. In such an incident, we are permitted to disclose information regarding the circumstances, including the suspect’s name, address, last known whereabouts, and status as a patient in our program.
Reporting Child Abuse or Neglect. We may report incidents of suspected child abuse and neglect to the appropriate state or local authorities.
Deceased Persons. We may disclose information related to the cause of death of a patient under laws requiring the collection of death or other vital statistics or permitting inquiry into the cause of death.
Research. Under certain circumstances, we may disclose your health information to researchers who are conducting a specific research project. In such cases, your identifying information will never be published without your written authorization.
FDA Reporting. We may disclose patient identifying information to medical personnel of the Food and Drug Administration (“FDA”) who assert a reason to believe that the health of any individual may be threatened by an error in the manufacture, labeling, or sale of a product under FDA jurisdiction and that the information will be used for the exclusive purpose of notifying patients or their physicians of potential dangers.
Additional Uses & Disclosures:
Disclosure or use of your health information for any purpose other than those listed above requires your explicit authorization in writing. Some examples of such use or disclosures include:
- Marketing: We will not use or disclose your health information for marketing purposes without your written authorization except as otherwise permitted by law.
- Sale of Your Health Information: We will not sell your health information without your written authorization except as otherwise permitted by law.
- Release of Your Presences in Our Facility: We will not disclose your presence in treatment to individuals who may call the facility or present in person at the facility unless you have provided your written authorization permitting the release of such information.
- Psychotherapy Notes: We will not use or disclose your psychotherapy notes without your written authorization except as otherwise permitted by law.
If, after authorizing a use or disclosure of your health information, you change your mind, you may withdraw your permission by revoking the authorization. Your decision to revoke authorization will not affect or undo any use or disclosure of your health information that occurred prior to your notification to us of your decision not to allow such use or disclosure of information. Any prior actions that we have taken based upon your authorization are not affected by your decision to withdraw permissible authorization.
To revoke an authorization, please notify us by mail at St. John’s Recovery Place, ATTN: Compliance, 1125 N. Summit St., Crescent City, Fl 32112 or by contacting our office at 904-990-1200 or by email at firstname.lastname@example.org
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION:
The following section describes your rights regarding the health information we maintain about you. All requests or communications to exercise your rights discussed below must be submitted in writing to St. John’s Recovery Place, ATTN: Compliance, 1125 N. Summit St., Crescent City, Fl 32112 or by email at email@example.com
Right to Inspect and Copy. You have the right to inspect and receive a copy of your health information, excluding your psychotherapy notes. We may, as authorized by law, charge a fee to meet your request. You have the right to request access to your health information, if readily producible, in a certain electronic form and format, or if not readily producible, in a mutually agreeable electronic form and format. You also may request, in writing, that we transmit such a copy to any person or entity you designate. Your signed, written request must clearly identify the designated person or entity and where you would like us to send the copy. In limited circumstances, we may deny your request to inspect and copy. You may request that the denial be reviewed by a licensed health care professional chosen by us if your access to health information is denied. The individual conducting the review will not be the individual that denied your request. We will fully comply with the outcome of the review.
Right to Request Confidential Communications. You have the right to request that we communicate your health information to you in a certain manner or at a certain location. For example, you may wish to receive your information through a written letter sent to a specific private address. We will grant reasonable requests. We will not ask you to specify the reason for your request.
Right to Amend. You have the right to request a correction or amendment to your health information if you believe it is incorrect or incomplete. For example, if your date or birth is inaccurate, you may request that the information be corrected. Request for a correction or amendment to your health information must be made in writing and should include a reason for your request. You have a right to request an amendment for as long as the health information is kept by or for us. We may, under certain circumstances, deny your request. If we deny your request, we will provide you with information about the denial and how you can file a written statement of disagreement with us that will become part of your medical record.
Right to Accounting of Disclosures. You have the right to request an accounting of disclosures we make of your health information. Certain disclosures need not be included in the accounting that we provide to you, including most disclosures we make pursuant to your authorization. To request accounting disclosures you must state a time period which may not go back further than six years. You will not be charged for a single accounting per year. Future accounting may result in a charge for the reasonable cost-based fee for providing such additional accountings in a year. We will notify you of the costs involved and allow you the opportunity to withdraw or modify your request before any costs have been incurred.
Right to Request Restrictions. You have the right to request restrictions on how your health information is used or disclosed for treatment, payment, or health care operations activities under HIPAA but we are not required to agree to your requested restriction unless that restriction is regarding disclosure of health information to your health insurance company and: (1) the purpose of the disclosure is to carry out payment or health care operations and is not otherwise required by law; and (2) the health information pertains solely to a health care item or service for which you or another person (other than your health insurance company) paid for in full. Note, however, that Part 2 requires that we obtain your written authorization for most disclosures, except as expressly outlined above.
Right to a Paper Copy of This Notice. You have the right to receive a full paper copy of this Notice at any time, even if you previously agreed to receive this Notice electronically. You may obtain a paper copy of this Notice from our website at SJRP.
If you have questions or concerns about your privacy rights, or the information contained in this Notice, please contact St. John’s Recovery Place by mail at SJRP, ATTN: Compliance, 1125 N. Summit St., Crescent City, Fl 32112, by telephone at 904-990-1200 or by email at firstname.lastname@example.org