Notice of Privacy Practices

Uses and Disclosures for Treatment: We may make uses and disclosures of your protected health information as necessary for your treatment including sharing information in your medical record and details you provide about your symptoms, history, tests, procedures, and medications with doctors, nurses, and other professionals involved in your treatment. Our clinicians and staff may also use your information with modern technologies that may be provided by third parties, including artificial intelligence tools, to help suggest possible diagnoses, prevention strategies, or treatment options to you.

Uses and Disclosures for Payment: We may make uses and disclosures of your protected health information as necessary for payment purposes. During the normal course of business operations, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you. We may use your information to prepare a bill to send to you or to the person responsible for your payment.

Uses and Disclosures for Health Care Operations: We may use and disclose your protected health information as necessary, and as permitted by law, for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your protected health information for purposes of improving the clinical treatment and patient care.

Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, outcomes data collection, legal services, etc. At times it may be necessary for us to provide your protected health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.

Appointments and Services: We may contact you to provide appointment reminders or information about your treatment or other health-related benefits and services that may be of interest to you. You have the right to request, and we will accommodate reasonable requests by you, to receive communications regarding your protected health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. You may make your requests by sending your name and address to Privacy Officer, P.O. Box 2034, Mechanicsburg, PA 17055.

Research: As part of our mission to improve the care of patients, we may use or disclose your protected health information to plan or carry out research, as authorized by law. For example, we may use or disclose your protected health information for research purposes if the research has been approved by a specialized committee (including an Institutional Review Board and/or Privacy Board), whose purpose is to protect the privacy and confidentiality of protected health information and safety of patients.

Other Uses and Disclosures: We are permitted and/or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization for the following purposes:

• any purpose required by law;
• public health activities, such as required reporting of disease, injury, birth and death, or required public health investigations;
• if we suspect child abuse or neglect;
• if we believe you to be a victim of abuse, neglect, or domestic violence;
• to the Food and Drug Administration to report adverse events, product defects, or to participate in product recalls;
• to your employer when we have provided health care to you at the request of your employer;
• to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
• in response to a court or administrative ordered subpoena or discovery request;
• to law enforcement officials as required by law to report wounds and injuries and crimes;
• to coroners and/or funeral directors consistent with law;
• if necessary to arrange an organ or tissue donation from you or a transplant for you;
• if you are a member of the military we may also release your protected health information for national security or intelligence activities; and
• to workers' compensation agencies and others involved in workers' compensation systems for benefit determination and other workers' compensation purposes (more information is below).

Individuals Involved In Your Care: Unless you object, we may from time to time disclose your protected health information to designated family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with involved individuals without your approval. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.

Psychotherapy Notes: We must obtain your written authorization for most uses and disclosures of psychotherapy notes.

Marketing: We must obtain your written authorization to use and disclose your protected health information for most marketing purposes. You also have the right to request that we not send you any future marketing materials.

Sale of Protected Health Information: We must obtain your written authorization for any disclosure of your protected health information which constitutes a sale of protected health information.

Other Uses: Other uses and disclosures of your protected health information, not described above, will be made only with your written authorization. You may revoke your authorization, at any time, in writing, except to the extent that we have taken action in reliance on the authorization.

Part 2 Requirements: In accordance with the substance use confidentiality regulations at 42 C.F.R. Part 2 (Part 2), if we receive your SUD records, we may generally use and redisclose those records in accordance with HIPAA and we must limit the use or disclosure of your SUD records to that information which is necessary to carry out the purpose of the use or disclosure. We are prohibited from using or disclosing SUD records that we receive in connection with civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order. We must de-identify your SUD records in the event we redisclose those records to public health authorities. In the event we disclose your SUD records in connection with management audits, financial audits, or program evaluations conducted by federal, state, or local governmental agencies, we must require the recipient to agree in writing to maintain and destroy the information in accordance with Part 2.

You have the right to a copy and/or inspect much of the protected health information that we retain about you. All requests for access must be made in writing and signed by you or your personal representative. You may obtain a “Patient Access to Health Information Form” from the front office person. If you request a copy of your protected health information you may be charged a nominal fee for copying and postage.

You have the right to request in writing that protected health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests must be in writing, signed by you or your personal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, we may notify others who work with us if we believe that such notification is necessary. You may obtain an “Amendment Request Form” from the front office person or individual responsible for medical records.

You have the right to receive an accounting of certain disclosures made by us of your protected health information during the six (6) years prior to the date of your request. Requests must be made in writing and signed by you or your personal representative. “Accounting Request Forms” are available from the front office person or individual responsible for medical records. The first accounting in any 12-month period is free. You will be charged a fee for each subsequent accounting you request within the same 12-month period. You will be notified of the fee at the time of your request.

You have the right to request restrictions on uses and disclosures of your protected health information for treatment, payment, or health care operations. We are not required to agree to your restriction request, but will attempt to accommodate reasonable requests when appropriate. However, we must agree not to disclose your protected health information to your health plan if the disclosure is for payment or health care operations and relates to a health care item or service which you paid for in full out of pocket. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction by sending such termination notice to the individual responsible for medical records.

You have the right to request that we communicate with you in a certain way or at a certain location. Your request must be in writing and specify how and where you would like to be contacted. We will accommodate all reasonable requests.

You have the right to obtain a paper copy of this notice from us.

You have the right to be notified if you are affected by a breach of unsecured protected health information.

For patients whose medical treatment is covered under a state workers' compensation program, please note the following: As noted above, HIPAA permits us to use and disclose your protected health information for workers' compensation purposes without your written authorization. Written consent to use or disclose your protected health information may be required pursuant to our internal policies and/or state workers' compensation program rules in order to process your claims. Failure to provide any required written consent may result in your financial liability for medical services and supplies.

If you believe your privacy rights have been violated, you can file a complaint in writing with the Privacy Officer, Select Medical Corporation, P.O. Box 2034, Mechanicsburg, PA 17055. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.