Notice of Privacy

Notice of Privacy Practices

Click Here Download the Notice of Privacy

Your Information.  Your Rights.  Our Responsibilities

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.

When it comes to your health information, you have certain rights.  This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.  There may be limited circumstances which we may be unable to provide parts of the clinical chart due to the possibility of the information being harmful to the clients or others, in accordance with HIPAA.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
    • We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
    • We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.  We will provide you with a copy of this Notice at the time of your admission.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information on the back page.
  • You can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Avenue S.W., Washington D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

OUR USES AND DISCLOSURES

For certain health information, you can tell us your choices about what we share.  If you have a clear preference for how we share your information in the situations described below, talk to us.  Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are uncounscious, we may go ahead and share your information if we believe it is in your best interest.  We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

To treat you

  • We can use your health information and share it with other professionals who are treating you.

Example: a doctor treating you for an injury asks another doctor about your overall health condition.

To run our organization

  • We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: we use health information about you to manage your treatment and services.

Bill for your services

  • We can use and share your health information to bill and get payment from health plans or other entities.

Example: we give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research.  We have to meet many conditions in the law before we can share your information for these purposes.  For more information see:  www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

  • We can share health information about you for certain situations such as:
    • Preventing disease
    • Helping with product recalls
    • Reporting adverse reactions to medications
    • Reports suspected abuse, neglect or domestic violence
    • Preventing or reducing a serious threat to anyone’s health or safety

Do research

  • We can use or share your information for health research

Comply with the law

  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Work with a medical examiner or funeral home

  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies with the consent of your personal representative (i.e. executor of your estate)

Address workers’ compensation, law enforcement and other government requests

  • We can use or share health information about you:
    • For workers’ compensation claims with your signed consent
    • For law enforcement purposes or with a law enforcement official with your signed consent authorizing the release of information
    • With health oversight agencies for activities authorized by law with your signed consent authorizing the release of information
    • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

  • We can share health information about you in response to a court order in accordance with 42 CFR Part 2, or with your signed consent authorizing Bridgeway Behavioral Health to release that information.

Bridgeway Behavioral Health will not share any Protected Health Information EXCEPT in the following situations:

  • We have a signed authorization granting permission to share information with individuals, or entities, listed on the authorization.
  • In reporting instances of child abuse or neglect
  • In audits or evaluations
  • If we receive a specific court order
  • For internal program communications
  • In the case of medical emergencies – the only information disclosed will be what is relevant to the medical emergency
  • To other entities in which Bridgeway Behavioral Health has a business associate agreement.

 

We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this Notice and provide you with a copy of them.

We will no use or share your information other than as described here unless you tell us we can in writing.  If you tell us we can, you may change your mind at any time.  Let us know in writing if you change your mind.

For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

 

Changes to the Terms of this Notice

We can change the terms of this Notice, and the changes will apply to all information we have about you.  The new Notice will be available upon request, in our office, and on our website.

How to file a complaint

Please submit your complaint to:

David Chernof
Privacy Officer
Director of Quality and Standards
1570 S. Main Street
St. Charles, MO  63303
 

To submit a complaint to the Missouri Department of Mental Health

Office of Constituent Services
Department of Mental Health
P.O. Box 87
Jefferson City, MO  65102
 

For additional information on Bridgeway Behavioral Health’s privacy practice, contact:

Bridgeway Behavioral Health, Inc.
Administrative Offices
1570 S. Main Street
St. Charles, MO  63303
636-224-1000