This notice describes how medical and drug and alcohols related information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
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 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under these laws, Pacific Ridge treatment center may not say to a person outside of these facilities that you attend the program, nor may Pacific Ridge disclose any identifying information that identifies you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
Pacific Ridge must obtain your written consent before it can disclose information about you for payment purposes. For example, Pacific Ridge must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before Pacific Ridge can share information for treatment purposes or for health care operations. However, federal law permits Pacific Ridge to disclose information without your written permission:
For example, Pacific Ridge can disclose information without your consent to obtain legal or financial services, or to another medical facility to provide health care to you, as long as there is a business associate agreement in place.
Before Pacific Ridge can use or disclose any information about your health in a manner which is not described above, it must obtain your specific written consent allowing it to make the disclosure. Any such written consent may be revoked by you in writing.
Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. Pacific Ridge is not required to agree to any restrictions you request, but if they do agree then they are 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. Pacific Ridge 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 Pacific Ridge, 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 Pacific Ridge’s records, and to request and receive an accounting of disclosures of your health related information made by Pacific Ridge during the prior six years of your request. You also have the right to receive a paper copy of this notice.
Pacific Ridge is required by law to maintain the privacy of your health information, provide you with notice of its legal duties and privacy practices with respect to your health information, and to notify you if you are affected by any breach of your unsecured health information. Pacific Ridge is required by law to abide by the terms of this notice. Pacific Ridge reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. We reserve the right to change our practices and to make the new provisions effective for all individually identifiable health information that we maintain. If we change our information practices, we will mail a revised notice to the address that you have given us.
You may complain to Pacific Ridge and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. To file a complaint with Pacific Ridge a written note describing the complaint and how to contact the complainant needs to be given to the Executive Director. You will not be retaliated against for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.
For further information, contact Pacific Recovery at
February 1, 2003