THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Your health record contains personal information about you and your health. State and federal law protects the confidentiality of this information. “Protected health information” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services. The confidentiality of alcohol and drug abuse patient records is specifically protected by federal law and regulations. Realign Detox is required to comply with these additional restrictions. This includes a prohibition, with very few exceptions, on informing anyone outside the program that you attend the program or disclosing any information that identifies you as an alcohol or drug abuser. The violation of federal laws or regulations by this program is a crime. If you suspect a violation, you may file a report to the appropriate authorities in accordance with federal regulations.
How We May Use and Disclose Health Information About You
For Treatment. We may use medical and clinical information about you to provide you with treatment or services.
For Payment. With your authorization, we may use and disclose medical information about you so that we can receive payment for the treatment services provided to you.
For Health Care Operations. We may use and disclose your PHI for certain purposes in connection with the operation of our program.
Without Authorization. Applicable law also permits us to disclose information about you without your authorization in a limited number of other situations, such as with a court order. These situations are explained on the following pages.
With Authorization. We must obtain written authorization from you for other uses and disclosure of your PHI.
Your Rights Regarding Your PHI
Rights of Access to Inspect and Copy. You have the right, which may be restricted in certain circumstances, to inspect and copy PHI that may be used to make decisions about your care. We may charge a reasonable, cost-based fee for copies.
Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information, although we are not required to agree to the amendment.
Right to an Accounting of Disclosures. You have the right to request an accounting of the disclosures that we make of your PHI.
Right to Request Restrictions. You have the right to request a restriction or limitation on the use of your PHI for treatment, payment, or health care operations. We are not required to agree to your request.
Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at certain locations.
Right to a Copy of This Notice. You have the right to a copy of this notice.
You have the right to file a complaint in writing to us or the Secretary of Health and Human Services if you believe we have violated your privacy rights. We will not retaliate against you for filing a complaint.
If you have any questions about this Notice of Privacy Practices, please contact us at:
Email: info@realigndetox.com
Phone: +1 (866) 218-8120
This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with all applicable law. It also describes your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will make available a revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request, or providing one to you at your next appointment.
Complaints
If you believe we have violated your privacy rights, you may file a complaint in writing to us by notifying us, at info@realigndetox.com or by phone at +1 (866) 218-8120. We will not retaliate against you for filing a complaint. You may also file a complaint with the U.S. Secretary of Health and Human Services:
200 Independence Avenue, S.W.
Washington, D.C. 20201
(855) 977-6335
