HIPAA Notice of Privacy Practices
Effective Date: January 2024
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
4 Seasons Recovery Center is committed to protecting your health information. This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or healthcare operations, and for other purposes permitted or required by law.
Our Responsibilities
We are required by law to:
- Maintain the privacy and security of your protected health information
- Provide you with this notice of our legal duties and privacy practices
- Follow the terms of the notice currently in effect
- Notify you if we are unable to agree to a requested restriction
- Notify you in the event of a breach of your unsecured PHI
How We May Use and Disclose Your Health Information
1. For Treatment
We may use and disclose your health information to provide, coordinate, or manage your healthcare and related services. This includes consultation between healthcare providers regarding your treatment and referrals to other providers.
Example: We may share your treatment information with your primary care physician or psychiatrist to coordinate your care.
2. For Payment
We may use and disclose your health information to obtain payment for services we provide. This includes billing your insurance company and collecting payment from you or a third party.
Example: We may submit claims to your insurance company that include information about your diagnosis and treatment.
3. For Healthcare Operations
We may use and disclose your health information for our healthcare operations, including quality assessment, staff training, licensing, and business planning.
Example: We may use your information to evaluate the quality of care you received or for staff training purposes.
Special Protections for Substance Abuse Treatment Records
Federal law (42 CFR Part 2) provides additional privacy protections for substance abuse treatment records. We cannot disclose information identifying you as having or having had a substance use disorder unless:
- You provide written consent
- The disclosure is allowed by a court order
- The disclosure is made to medical personnel in a medical emergency
- The disclosure is made to qualified personnel for research, audit, or program evaluation
Violation of federal law and regulations is a crime. Suspected violations may be reported to appropriate authorities.
Other Uses and Disclosures
We may use or disclose your health information without your authorization in the following situations:
- As Required by Law: When required by federal, state, or local law
- Public Health Activities: To prevent or control disease, injury, or disability
- Health Oversight Activities: To authorized health oversight agencies for audits, investigations, or inspections
- Judicial and Administrative Proceedings: In response to a court order or lawful subpoena
- Law Enforcement: For law enforcement purposes as required by law
- To Avert Serious Threat: To prevent a serious threat to health or safety
- Coroners and Medical Examiners: For identification purposes or to determine cause of death
- Workers' Compensation: As authorized by workers' compensation laws
Your Rights Regarding Your Health Information
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your health information. We may charge a reasonable fee for copying and mailing costs.
Right to Amend
If you believe your health information is incorrect or incomplete, you may request an amendment. We may deny your request in certain circumstances.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we made of your health information for purposes other than treatment, payment, or healthcare operations.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your health information. We are not required to agree to your request except in certain circumstances.
Right to Request Confidential Communications
You have the right to request that we communicate with you about your health information in a certain way or at a certain location.
Right to a Paper Copy of This Notice
You have the right to obtain a paper copy of this notice at any time, even if you have agreed to receive it electronically.
Right to Revoke Authorization
You have the right to revoke any authorization you have given us to use or disclose your health information, except to the extent we have already acted in reliance on your authorization.
Exercising Your Rights
To exercise any of your rights described in this notice, please submit a written request to:
Privacy Officer
4 Seasons Recovery Center
8300 N Valley Circle Boulevard, Room C
West Hills, California 91304
Phone: (805) 991-8850
Email: privacy@4seasonsrecovery.com
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.
To file a complaint with us, contact our Privacy Officer using the information above.
To file a complaint with the Department of Health and Human Services, visit: www.hhs.gov/hipaa/filing-a-complaint
Changes to This Notice
We reserve the right to change this notice at any time. Any changes will apply to all health information we maintain. The current notice will be posted in our facility and on our website.
Acknowledgment of Receipt:
You will be asked to sign an acknowledgment that you have received this Notice of Privacy Practices. This acknowledgment will be maintained in your medical record.