Bradford Evolve Treatment Services, LLC – Notice of Privacy Practices
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.
THE EFFECTIVE DATE OF THIS NOTICE IS February 14, 2022.
As your treatment provider of choice, Bradford Evolve Treatment Services, LLC (which is owned by Bradford Health Services, LLC (hereinafter referred to as “Bradford,” “Facilities”, “us”, “our” or “we”)) is required by law (including the Privacy Rule: 45 C.F.R. Part 160 and Subparts A and E of Part 164) to protect the privacy and security of your Protected Health Information. We are also required to provide you with this Notice regarding our legal duties, policies, and procedures to protect and maintain the privacy of your Protected Health Information. We are required to follow the terms of this Notice unless (and until) it is revised. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for the protected health Information that we maintain and use, as well as for any Protected Health Information that we may receive in the future. Should the terms of this Notice change, we will make a revised copy of the Notice available to you. This Notice will be available at our Facilities for individuals to take with them and we will post a copy of this Notice in a prominent location in our Facilities. This Notice will also be posted and made available electronically on our website.
In addition to the obligations related to your Protected Health Information created by the Privacy Rule, we will also abide by the requirements imposed by more stringent State and Federal laws, including, but not limited to, 42 C.F.R. Part 2. Under 42 C.F.R. Part 2, we may disclose your Protected Health Information pursuant to your written authorization or without your authorization in the circumstances described below.
Permitted Uses and Disclosures of Your Health Information
General Uses and Disclosures. Under applicable law, we are permitted to use and disclose your Protected Health Information for the following purposes, without obtaining your permission or authorization (subject to the limitations described below):
Treatment. We are permitted to use and disclose your Protected Health Information internally in the provision and coordination of your health care. We may disclose and/or provide access to your Protected Health Information to the personnel involved in the operation of our sites/facility for treatment purposes, including, but not limited to: physicians, allied health professionals (nurse practitioners, physician assistants, etc.), counselors, therapists, dietary consultants, nurses, psychologists, social workers, recreational therapists, pharmacists, medical equipment suppliers, diagnostic providers, laboratory technicians and other health care providers working in the Facilities; these individuals may not be employees of Bradford Health Services, LLC. We may disclose your Protected Health Information among the facilities owned/operated by Bradford without your authorization if such disclosure is necessary for treatment purposes (i.e., continuity of care). You may request a complete list of the facilities owned/operated by Bradford from the personnel of the facility at which you received this notice. We may use or disclose your Protected Health Information to other individuals or entities outside of our organization for treatment purposes pursuant to your written authorization. For example, we may disclose your Protected Health Information to your primary health care provider, consulting providers, and to other health care personnel who have a need for such information for your care and treatment, if you provide written authorization to do so.
Payment. We may use and disclose your Protected Health Information, pursuant to your written authorization, so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company/health plan or other third party, including determining the applicability of any health insurance coverage. For example, a bill sent to your insurance company may include information that identifies you and your medical information if you provide written authorization to do so.
Health Care Operations. We are permitted to use and disclose your Protected Health Information for certain administrative, legal and quality improvement activities that are necessary for us to operate our Facilities and to support our functions of treatment and payment, including, but not limited to, quality assurance, auditing, licensing or credentialing activities, and for educational purposes. We may disclose your Protected Health Information among the facilities owned/operated by Bradford Health Services without your authorization if such disclosure is necessary for operational purposes. You may request a complete list of the facilities owned/operated by Bradford Health Services from the personnel of the facility at which you received this notice. For example, we can use your Protected Health Information to evaluate our quality of care provided to patients.
Uses and Disclosures Among Internal Sites/Facilities. The health care providers and sites/facilities owned/operated by Bradford may share your Protected Health Information with each other, without your authorization, as necessary, to carry out treatment, payment, and health care operations. You may request a complete list of the facilities owned/operated by Bradford Health Services from the personnel of the facility at which you received this notice.
Uses and Disclosures Required by Law. We may use and disclose your Protected Health Information when required to do so by law, including, but not limited to, in response to judicial and administrative proceedings; in responding to a law enforcement request for information; and/or in order to alert law enforcement to criminal conduct on our premises; Information related to a patient’s commission of a crime on our premises or against our workforce member(s) is not protected by 42 C.F.R. Part 2 and may be disclosed without your written authorization.
Appointment Reminders. We may contact you to send you reminder notices of future appointments for your treatment and/or continuous care.
Care Coordination, Refill Reminders, Alternative Therapies. We may provide you with refill reminders about a drug or biologic that is currently being prescribed for you, but only if any financial remuneration received by us in exchange for making the communication is reasonably related to our cost of making the communication. Except where we receive financial remuneration in exchange for making the communication, we may also communicate with you for the following treatment and health care operations purposes: (a) for your treatment, including case management or care coordination, or to direct or recommend alternative treatments, therapies, health care providers, or settings of care, (b) to describe a health-related product or service (or payment for such product or service) that is provided by, or included in a plan of benefits, including communications about a health care provider network or health plan network, replacement of, or enhancements to, a health plan, and/or (c) for case management or care coordination, contacting of individuals with information about treatment alternatives, and related functions to the extent these activities are not considered treatment.
Medical Emergencies. We may disclosure your Protected Health Information to medical or other appropriate personnel to the extent necessary to respond to a bona fide medical emergency.
Regulatory Agencies, Audits and Evaluation Activity. We may disclose your Protected Health Information to a health care oversight agency for activities authorized by law, including, but not limited to, licensure, investigations, and inspections. These activities are necessary for the government and certain private health oversight agencies to monitor the health care system, government programs, and compliance with civil rights. Use and/or disclosure of your Protected Health Information for such purposes may be made without written authorization if the audit and/or evaluation involves review of your Protected Health Information on our premises or in the event we obtain written agreement the recipient will not further use or disclose the information to any individuals or entities that are not part of our OCHA.
Research. We may disclose your Protected Health Information for the purpose of conducting scientific research if the recipient of the information is a HIPAA-covered entity or business associate that has obtained and documented a waiver or alteration of authorization, consistent with the requirements of the HIPAA Privacy Rule at 45 C.F.R. § 164.512(i).
Business Associates/Qualified Services Organizations. We may disclose your Protected Health Information to business associates/qualified services organizations who provide services to us, pursuant to a written agreement that contains terms regarding protection of your Protected Health Information in accordance with 45 C.F.R. §164.504 and 42 C.F.R. Part 2.
Reports of Suspected Child Abuse and/or Neglect. We may disclose your Protected Health Information to a local, state, or federal government authority, including social services or a protective services agency authorized by law to receive such reports, if we have a reasonable belief of child abuse and/or neglect. Information related to suspected child abuse and/or neglect is not protected by 42 C.F.R. Part 2 and may be disclosed without your written authorization.
Coroners, Medical Examiners, Funeral Directors. We may disclose your Protected Health Information to a coroner or medical examiner. This may be necessary, for example, to determine a cause of death. We may also disclose your Protected Health Information to funeral directors, as necessary, to carry out their duties.
Fundraising. We may use or disclose your Protected Health Information to make a fundraising communication to you, for the purpose of raising funds for our own benefit. With each fundraising communication, we will provide you with an opportunity to elect not to receive any further fundraising communication. We will also make reasonable efforts to ensure that if you opt out of such communications you are not sent future fundraising communications. We may also use or disclose to a business associate/qualified services organization the following Protected Health Information for the purpose of raising funds for our own benefit: (a) demographic information relating to you, including your name, address, other contact information, age, gender, and date of birth, (b) the dates of health care provided to you, (c) the department or area of service that provided you treatment, (d) your treating physician, (e) outcome information, and (f) your health insurance status.
Marketing (by the organization). We may use or disclose your Health Information for the purpose of making a “face-to-face” marketing communication and/or related to a promotional gift of nominal value provided by us.
Uses and Disclosures Which Require Your Written Authorization. As required by applicable law, all other uses, and disclosures of your Protected Health Information (not described above) will be made only with your written permission, which is called an Authorization. You may revoke your Authorization at any time. The revocation of your Authorization will be effective immediately, except to the extent that: we have relied upon it previously for the use and disclosure of your Protected Health Information; the Authorization was obtained as a condition of obtaining insurance coverage where other law provides the insurer with the right to contest a claim under the policy; or where your Protected Health Information was obtained as part of a research study and is necessary to maintain the integrity of the study. Authorization may be revoked by communicating the revocation to a workforce member of our organization and/or in writing. Below are examples of potential disclosures of your Protected Health Information which may be made pursuant to your Authorization (the list is illustrative and not exhaustive):
Care Coordination. Pursuant to your written Authorization, we may disclose your Protected Health Information to other health care providers and/or facilities not owned/operated by Bradford for the purpose of you receiving treatment from those providers.
Payment. As noted above, pursuant to your written Authorization, we may disclose your Protected Health Information to an insurance company/health plan or other third party (as designated by you) to provide charge information and/or to collect payment for the treatment and services you received.
Public Health Activities. Pursuant to your written Authorization, we may disclose your Protected Health Information for public health reporting, including, but not limited to, reporting communicable diseases and vital statistics, product recalls and adverse events, or notifying person(s) who may have been exposed to a disease or are at risk of contracting or spreading a disease or condition.
Threats to Health and Safety. Pursuant to your written Authorization, we may use or disclose your Protected Health Information if we believe, in good faith, that the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public or is necessary for law enforcement to identify or apprehend an individual.
Specialized Government Functions. If you are a member of the U.S. Armed Forces, pursuant to your written Authorization, we may disclose your Protected Health Information as required by military command authorities; to authorized federal officials for national security reasons; and/or the Department of State for medical suitability determinations.
Workers’ Compensation. Pursuant to your written Authorization, we may disclose your Protected Health Information as authorized by and to the extent necessary to comply with State laws relating to workers’ compensation or other similar programs.
Marketing and/or Sale of Protected Health Information. Pursuant to your written Authorization, we may disclose your Protected Health Information to third parties for marketing purposes. If the marketing involves financial remuneration, the written authorization you provide will include notice that such remuneration is involved.
Patient Rights
You have the following rights concerning your Protected Health Information:
Right to Receive Written Notification of a Breach of Your Unsecured Protected Health Information. You have the right to receive written notification of a breach of your unsecured Protected Health Information if it has been accessed, used, acquired, or disclosed in a manner not permitted by the Privacy Rule. We will provide this notification by first-class mail or, if necessary, by such other substituted forms of communication allowable by law or you may request in writing to receive a notification of a breach by email.
Right to Inspect and/or Copy Your Health Information. Upon written request, you have the right to inspect and copy your own Protected Health Information contained in a designated record set which is maintained by or for the Facilities. A “designated record set” contains medical and billing records and any other records that we use for making medical/clinical decisions about you. However, we are not required to provide you access to all the Health Information that we maintain. For example, this right of access does not extend to psychotherapy notes or information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative proceeding. Where permitted by the Privacy Rule, you may request that we review certain denials to inspect and copy your Protected Health Information. Instead of copies, we can provide you with a summary of your Protected Health Information if you agree to the form and cost of such summary. If you request a paper copy or summary explanation of your Protected Health Information, we may charge you a reasonable fee for copying costs, postage, and any other costs associated with preparing the summary or explanation. Instead of paper copies, if your Protected Health Information is maintained in an electronic health record, you may request that we provide the information in electronic form to either you or to a designated third party if such designation is clear, conspicuous, and specific. We may charge you a reasonable cost-based fee for an electronic copy, which shall not exceed our labor costs in responding to the request. We may, in some cases, deny your request to inspect and copy your Health Information and will notify you in writing of the reasons for our denial and provide you with information regarding your rights to have our denial reviewed.
Right to Request Restrictions on the Use and Disclosure of Your Health Information. You have the right to request restrictions on the use and disclosure of your Protected Health Information for treatment, payment and health care operations. We will consider, but do not have to agree to, such requests. However, we must agree to restrict the disclosure of your Protected Health Information to a health plan if: (a) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and (b) the Health Information pertains solely to a health care item or service for which you, or someone other than the health plan on your behalf, has paid in full. As detailed above, uses and/ disclosures of your Protected Health Information to a health plan requires your written authorization.
Right to Request an Amendment of Your Health Information. You have the right to request an amendment of your Protected Health Information maintained by us. We may deny your request if we determine that you have asked us to amend information that: was not created by us, unless the person or entity that created the information is no longer available; is not part of the designated record set maintained by us; is Protected Health Information that you are not permitted to inspect or copy; or we determine that the information that is the subject of the request is accurate and complete. If we disagree with your requested amendment, we will provide you with a written explanation of the reasons for the denial, an opportunity to submit a statement of disagreement, and a description of how you may file a complaint.
Right to an Accounting of Disclosures of Your Health Information. You have the right to receive an accounting of disclosures of your Protected Health Information made by us. With respect to Protected Health Information contained in paper form, our accounting will not include: disclosures related to treatment, payment or health care operations; disclosures to you or disclosures based upon your Authorization; disclosures to individuals involved in your care; incidental disclosures; disclosures to correctional institutions or law enforcement officials; disclosures for facility directories; disclosures that are part of a Limited Data Set (as defined by the Privacy Rule); or disclosures that occurred prior to April 14, 2003 or as otherwise allowed by the Privacy Rule. You may request an accounting of applicable disclosures made by us within six (6) years prior to the date of your request. If you request an accounting more than once in a 12-month period, we may charge you a reasonable cost-based fee to comply with your additional request.
Right to Alternative Communications. You have the right to receive confidential communications of your Protected Health Information by a different means or at a different location than currently provided. For example, you may request that we only contact you at home or by mail. Such requests must be made in writing.
Right to Receive a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically.
Contact Information and How to Report a Privacy Rights Violation. If you want to exercise any of these rights, have any questions, or feel that your privacy rights have been violated, please contact us. If you believe that your privacy rights have been violated or that we have violated our own privacy practices, you may file a complaint with our Privacy Officer. Requests may be submitted to us in writing and sent to the address below or by telephone. We will not retaliate against you in any way should you file a complaint.
Bradford Health Services
Attn: Privacy Officer
2101 Magnolia Avenue, Suite 518
Birmingham, Alabama 35205
Telephone: (205) 251-7753
You may also file a complaint with the Department of Health and Human Services Office for Civil Rights; complaints may be submitted via mail to: Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Room 509F HHH Building, Washington, D.C. 20201. Violation of 42 C.F.R. Part 2 by a Part 2 program is a crime and suspected violations may be directed to United States Attorney for the judicial district in which the violation occurs as well as to the Substance Abuse and Mental Health Services Administration (SAMHSA) office responsible for opioid treatment program oversight. A directory for the Offices of the United States Attorneys may be located online at https://www.justice.gov/usao/find-your-united-states-attorney.