HIPAA and Privacy Information   Woodland Centers Notice of Privacy Practices THIS NOTICE DESCRIBES HOW INFORMATION WE COLLECT ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR INFORMATION.   PLEASE REVIEW THIS NOTICE CAREFULLY.   WOODLAND CENTERS RESERVES THE RIGHT TO MAKE CHANGES IN ITS PRIVACY PRACTICES. If you have questions about this Notice, please contact: Richard Lee, Ph.D., L.P. - Privacy Officer 320-235-4613 This Notice describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, and healthcare operations, and other purposes that are permitted or required by law. Also described are your rights to access and control your information. PHI is information about you that may identify you and that relates to your past, present, and future physical or mental health and related services you have received. We are required by law to abide by the terms of this Notice. We may change the terms of this Notice at any time. The new Notice will be effective for all PHI that we maintain at the time. You will be requested to verify, by signature, that you have read this Notice. You may request a copy of this Notice at any time. You may also find this Notice on our web site: woodlandcenters.com You are not required to provide us with information about yourself. However, without it we may not be able to provide you with appropriate treatment. If you are here because of a Court order and you refuse to provide information, the Court may be informed of your refusal. Minnesota law allows certain minor children the right to request that private data about them be kept from their parents. Uses and Disclosures of PHI Uses and disclosures based on your written consent. Without your consent, Woodland Centers cannot provide services to you. You will be asked to sign a consent for any services you receive from us. That consent allows us to disclose PHI for healthcare operations. Healthcare Operations: We may use or disclose your PHI to support our business activities as a community mental health center. These activities may include, but are not limited to, quality reviews, employee supervision and reviews, training of students and interns, licensing, and credentialling activities. We are required by Minnesota law to report mental health data with social security numbers to the Mental Health Division of the Department of Human Services. This is done to obtain an accurate reflection of mental health services statewide and will not be used for monitoring individuals. We also may use or disclose your PHI to provide you with information about alternative treatments and treatment reminders. Treatment: With your authorization, we will use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that has already obtained your permission to have access to your PHI. Also, with your authorization we may disclose your PHI to another healthcare provider who becomes involved in your care. Payment: With your authorization, your PHI may be used to obtain payment for the services we provide to you. This may include activities that your health insurance plan, social services, medical assistance, Medicare, etc. may undertake prior to approval or payment of services we recommend to you. Your authorization is not required for us to disclose PHI to a collections agency or small claims court if other efforts have failed to address a delinquency in your account. Uses and disclosures based on your written authorization. Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described in this Notice. You may revoke your authorization, in writing, at any time. Any use or disclosure of your PHI already made based on your authorization cannot be undone. Other permitted and required uses and disclosures that may be made with your consent, authorization, and opportunity to object. We may use and disclose your PHI to an authorized public or private entity to assist in disaster relief efforts, or in the case of emergency which is considered life threatening or may cause physical harm to you. In these situations, you have the right to agree or object to the use or disclosure of all or part of your PHI. If you are not present or otherwise unable to agree or object, then your case manager, doctor, or therapist may, using professional judgment, determine whether the use or disclosure is in your best interest. In this case, only the PHI that is relevant to your healthcare will be disclosed. Other permitted and required uses and disclosures that may be made without your consent, authorization, or opportunity to object. As Required By Law: The use and disclosure will be made in compliance with the law and limited to the relevant requirement of the law. You will be notified as required of any such uses or disclosures. Public Health: The use and disclosure will be made to a public health authority that is permitted by law to collect or receive information for the purposes of disease control, injury or disability. Communicable Diseases: The use and disclosure will be made to a person who may have been exposed or may otherwise be at risk of contracting or spreading a disease or condition. Health Oversight: We may disclose to a health oversight agency for activities authorized by law such as audits, investigations, inspections, or licensing boards. Abuse or Neglect: We may disclose if we believe that you have been a victim of abuse or neglect to a governmental agency authorized to oversee the healthcare system, government benefits programs or other government regulatory programs and civil rights laws. Such disclosures include but are not limited to child protection investigations. Food and Drug Administration: We may disclose to report adverse events, product defects or problems, biologic product deviation, or to make repairs or replacement as required. Legal Proceedings: We may disclose in the course of any judicial or administrative proceeding, in response to a Court order, to a county social service agency for pre-petition screening under the Minnesota Commitment Act or administrative tribunal (to the extent that such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful purpose. NOTE: A SUBPOENA OR SUMMONS IS NOT A COURT ORDER. Law Enforcement: We may disclose so long as legal requirements are met. These enforcement purposes include, but are not limited to: (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on Woodland Centers’ premises, (6) medical emergency and it is likely a crime has occurred. Criminal Activity: We may disclose if we believe that the use or disclosure is necessary to prevent or lessen a serious threat to the health and safety of a person or the public ("Duty to Warn"). We also may disclose if it is necessary for law enforcement authorities to identify or apprehend an individual. Military Activity and National Security: We may disclose for (1) activities deemed necessary by appropriate military command authorities, (2) determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to a foreign military authority if you are a member of that foreign military service. Also, we may disclose to authorized federal officials for national security and intelligence activities. Workers Compensation: We may disclose to comply with workers compensation laws and other similar legally established programs. Inmates: We may disclose if you are an inmate of a correctional facility and your doctor or therapist created or received PHI about you in the course of providing care to you while you are an inmate. Limited Data Set: For the purposes of research, public health, or healthcare operations, we may disclose information as part of a limited data set. A limited data set is information that has removed from it anything that might identify you to the recipient. Required Uses and Disclosures: Under the law, we are required to maintain the privacy of PHI, to provide clients with this Notice, to make disclosures to you, to make disclosures to the Secretary of Health and Human Services to investigate or determine our compliance with federal privacy regulations, and to make disclosures as required by the Minnesota Government Data Privacy Act. Chemical Dependency Information: Chemical dependency information kept about you by Woodland Centers has special confidentiality protections under federal law. If you have a chemical dependency diagnosis, or are a client of our Outpatient Chemical Dependency Program, Detoxification Unit, DWI School, or Alternatives, we may not say to a person outside the program that you attend the program or disclose any information identifying you as an alcohol or drug abuser UNLESS: 1) you sign a valid authorization; 2) the disclosure is made in keeping with a Court order requiring you to obtain chemical dependency services from us; or 3) the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation purposes. In some circumstances, violation of privacy and confidentiality laws may be prosecuted as a crime. Suspected violations may be reported to appropriate authorities (see "How to File a Complaint" at the end of this Notice). Your Privacy Rights You have the right to copy and review your PHI. You may look at or obtain a copy of PHI we maintain about you (including but not limited to medical and billing records). You have this right for as long as we keep the PHI. Under federal law, however, you do not have the right to look at or copy: personal notes kept by your doctor or therapist; information about you we have gathered for use in civil, criminal, or administrative actions or proceedings; and PHI that is subject to law that prohibits you from looking at it. If your request to look at or copy your PHI is denied, you may be able to appeal that decision. Please contact our Health Information Management Services if you have questions about reviewing or copying your PHI. You have the right to ask for a restriction of the use and disclosure of your PHI It is very rare for us to use or disclose your PHI without your permission. However, you have the right to ask us to NOT use or disclose any part of your PHI for treatment, payment, healthcare operations, or in the situations described in this Notice. Your request must state the specific restriction you want and to whom the restriction applies. We are not required to agree to restrictions you request. If you want us to bill your insurance company for the services you receive here, there is certain information we must disclose to do that. There are federal and state laws which require us to disclose certain information, even if you do not want us to. Also, if your doctor or therapist believes it is in your best interest to disclose the PHI, your request for restriction may be denied. If your request for restriction is approved, the PHI will only be disclosed if it is needed to provide you emergency treatment. Please discuss any such request for restriction with your doctor or therapist; however, any request for restriction must be made in writing to our Privacy Officer. You have the right to ask for confidential communications by alternate means or at an alternate location. We will agree to reasonable requests. We may ask for information as to how payment will be handled or for a specific alternate address or other method of contact. You do not have to give us a reason for your request. Your request must be made in writing to our Privacy Officer. You have the right to ask that your PHI be amended. Sometimes we may record information about you that is incorrect. If you believe that to be the case, you may ask that it be changed. In certain cases, we may deny your request for the PHI to be changed. If we deny your request, you have the right to file a statement of disagreement and have it attached to the disputed PHI. We also may prepare a response to your statement of disagreement; if we do, you will be provided a copy of it and it may also be attached to the disputed PHI. Please make any request for such changes in writing to our Privacy Officer. You have the right to receive a listing of certain disclosures we have made, if any, of your PHI. This listing is for the types of disclosures described in this Notice. The listing only includes disclosures made after April 14, 2003, but does not include disclosures made: a) to carry out treatment, payment, or healthcare operations b) to you c) with your authorization d) legally, but without your consent (in the situations described in this Notice) You have the right to a paper copy of this notice. You may, upon request, receive a paper copy of this notice. It is also available on our web site: woodlandcenters.com How to File a Complaint You may complain to us, the State of Minnesota or the Secretary of Health and Human Services if you believe we have violated your privacy rights. You may file a complaint with us about a possible violation of your privacy rights by contacting our Client Service Representative. We will not retaliate against you for filing a complaint. Contact information: Client Service Representative Woodland Centers Box 787 Willmar, MN 56201 320-235-4613 800-992-1716 Secretary US Department of Health and Human Services 200 Independence Avenue SW Washington, DC 20201 877-696-6775 Department of Human Rights State Office Building St. Paul, MN 55155 Division of Licensing Department of Human Services Building 444 Lafayette Road North St. Paul, MN 55155 651-296-2539