Pineland BHDD Services
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.
If you have any questions about this Notice, please contact Patricia Donaldson, Privacy Officer, at
This Privacy Notice describes how Pineland may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding health information that we maintain about you and a brief description of how you may exercise these rights. This Notice further states the obligations we have to protect your health information.
Protected Health Information means health information (including identifying information about you) we have collected from you or received from your health care providers, health plans, or your employer. It may include information about your past, present or future physical or mental health conditions, the provision of your health care, and payment for your health care services.
We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information. We are also required to comply with the terms of our current Privacy Notice.
II. How We Will Use and Disclose Your Health Information
We will use and disclose your health information as described in each category listed below. For each category, we will explain what we mean in general, but not describe all specific uses or disclosures of health information.
A. Uses and Disclosures for Treatment, Payment and Operations
1. For Treatment.
- With your signed approval, we may disclose your health information to another health care provider (e.g., your primary care physician or a laboratory) working outside of Pineland for purposes of your treatment.
- We may also disclose your health information among Pineland clinicians (including clinicians other than your therapist) and other staff. For example, our staff may discuss your care at a case conference. Authorization is not needed for this purpose.
2. For Payment.
We may use or disclose your health information, with your signed approval, so that the treatment and services you receive are billed to, and payment is collected from, your health plan or other third party payer. By way of example, we may disclose your health information to permit your health plan to take certain actions before your health plan approves or pays for your services. These actions may include:
- making a determination of eligibility or coverage for health insurance;
- reviewing your services to determine if they were medically necessary;
- reviewing your services to determine if they were appropriately authorized or certified in advance of your care; or
- reviewing your services for purposes of utilization review, to ensure the appropriateness of your care, or to justify the charges for your care. (for example, your health plan may ask us to share your health information in order to determine if the plan will approve additional visits to your therapist).
3. For Health Care Operations.
We may use and disclose health information about you with your signed approval for our health care operations. These uses and disclosures are necessary to run our organization and make sure that our individuals receive quality care. These activities may include, by way of example, quality assessment and improvement, reviewing the performance or qualifications of our clinicians, training students in clinical activities, licensing, accreditation, business planning and development, and general administrative activities. We may combine health information of many of our individuals to decide what additional services we should offer, what services are no longer needed, and whether certain treatments are effective.
We may also use and disclose your health information to contact you to remind you of your appointment and inform you about possible treatment options or alternatives that may be of interest to you. If you do not want us to conduct the two activities listed in this paragraph, please notify the Privacy Officer (Patricia Donaldson) in writing at P. O. Box 745, Statesboro, GA 30459.
B. Further Uses and Disclosures
1. Persons Involved in Your Care.
With your signed approval, we may disclose health information about you to a friend or family member who is involved in your care. Likewise, we may provide health information about you to someone who helps pay for your care or to notify a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.
We may use and disclose your health information in an emergency situation without your signed approval. By way of example, we may provide your health information to a paramedic who is transporting you in an ambulance. If a clinician is required by law to treat you and your treating clinician has attempted to obtain your authorization but is unable to do so, the treating clinician may nevertheless use or disclose your health information to treat you.
3. As Required By Law.
We may disclose health information about you without your signed approval when required to do so by federal, state or local law. For example, to Medical Examiners, by Court Order of a Superior Court of the State of Georgia, for Peace Officers conducting a felony investigation (last known address of individual), to Worker’s Compensation, and because of criminal/dangerous intent or actions.
4. To Avert a Threat to Health or Safety.
We may use and disclose health information about you without your signed approval to prevent a serious and imminent threat to your health or safety or to the health or safety of the public or another person. Under these circumstances, we will only disclose health information to someone who is able to help prevent or lessen the threat. This includes disaster situations and child or elderly abuse and neglect.
We may also disclose health information about a individual who is a victim of a crime, without a court order or without being required to do so by law. However, we will do so only if the disclosure has been requested by a law enforcement official and the victim agrees to the disclosure or, in the case of the victim’s incapacity, the following occurs:
- the law enforcement official represents to us that (i) the victim is not the subject of the investigation and (ii) an immediate law enforcement activity to meet a serious danger to the victim or others depends upon the disclosure; and
- we determine that the disclosure is in the victim’s best interest.
5. National Security and Protective Services for the President and Others.
We may disclose medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law. We may also disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or so they may conduct special investigations.
III. Right to Revoke Authorizations for Uses and Disclosures.
You have the right to revoke an authorization at any time. If you revoke your authorization we will not make any further uses or disclosures of your health information under that authorization, unless we have already taken an action relying upon the uses or disclosures you have previously authorized.
IV. Other Rights Regarding Your Health Information.
A. Right to Inspect and Copy.
You have the right to request an opportunity to inspect or copy health information used to make decisions about your care – whether they are decisions about your treatment or payment of your care. You must submit your request in writing to the Site Manager. We will charge a fee for the cost of copying, mailing and supplies. For therapeutic reasons, the Medical Doctor or Clinical Psychologist may deny your request to inspect or copy your health information. Appeals must be made in writing to the Medical Director.
B. Right to Amend.
You have the right to request us to amend any health information used to make decisions about your care, whether they are decisions about your treatment or payment of your care. To request an amendment, you must submit a written document to the physician and tell us why you believe the information is incorrect or inaccurate. We may deny your request for an amendment if it does not include a reason to support the request. We may also deny your request if you ask us to amend health information that:
- was not created by us, unless the person or entity that created the health information is no longer available to make the amendment;
- is not part of the health information we maintain to make decisions about your care;
- is not part of the health information that you would be permitted to inspect or copy; or
- is accurate and complete.
If we deny your request to amend, we will send you a written notice of the denial stating the basis for the denial. You may appeal in writing to the Medical Director.
C. Right to an Accounting of Disclosures.
You have the right to request that we provide you with an accounting of disclosures we have made of your health information. An accounting is a list of disclosures. But this list will not include certain disclosures of your health information (for example, those we have made for purposes of treatment, payment, and health care operations). To request an accounting of disclosures, you must submit your request in writing to the Site Manager. The request must state the time period, which may not be longer than six years and can’t include dates before April 14, 2003. The first request within a 12-month period will be free. For additional requests during the same 12-month period, we will charge you for the costs of providing the accounting. We will notify you of the amount we will charge and you may choose to withdraw or modify your request before we incur any costs.
D. Right to Request Restrictions.
You have the right to request a restriction on the health information we use or disclose about you for treatment, payment or health care operations. To request a restriction, you must request the restriction in writing to the physician. We are not required to agree to a restriction that you may request. If we do agree, we will honor your request unless the restricted health information is needed to provide you with emergency treatment.
E. Right to Request Confidential Communications.
You have the right to request that we communicate with you about your health care only in a certain location or through a certain method. For example, you may request that we contact you only at home. To request such a confidential communication, you must make your request in writing to the Site Manager. We will try to accommodate all reasonable requests. You do not need to give us a reason for the request; but your request must specify how or where you wish to be contacted.
F. Right to a Paper Copy of this Notice.
You have the right to obtain a paper copy of this Privacy Notice at any time. To obtain a paper copy, contact your Site Manager.
V. Confidentiality of Substance Abuse Records
For individuals who have received treatment, diagnosis or referral for treatment from our substance abuse programs, the confidentiality of drug or alcohol abuse records is protected by federal law and regulations. As a general rule, we may not tell a person outside the programs that you attend any of these programs, or disclose any information identifying you as an alcohol or drug abuser, unless:
- you authorize the disclosure in writing; or
- the disclosure is permitted by a court order; or
- the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation purposes; or
- you threaten to commit a crime either at the substance abuse program or against any person who works for those programs.
Federal law and regulations governing confidentiality of drug or alcohol abuse permit us to report suspected child abuse or neglect under state law to appropriate state or local authorities.
Please see 42 U.S.C. § 290dd-2 for federal law and 42 C.F.R., Part 2 for federal regulations governing confidentiality of alcohol and drug abuse patient records.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact Patricia Donaldson, individual Rights Coordinator, at 1-912-764-6906. We will assist you with writing your complaint, if you request such assistance. We will not retaliate against you for filing a complaint.
VII. Changes to this Notice
We reserve the right to change the terms of our Privacy Notice. We also reserve the right to make the revised Notice effective for all health information we already have about you as well as any health information we receive in the future. We will post a copy of the current Notice at our main office and at each site where we provide care. You may obtain a copy of the current Privacy Notice by asking for one any time you are at our offices.