Please call : the
individual programs listed at the right, or call our administrative
office at 801-487-3276,
or email us at:
info@uafslc.org
Effective Date: 14 April 2003
HIPAA Privacy Notice
This Notice Describes How Information About You as
a Participant at the HOUSE OF HOPE May Be Used and Disclosed and How
You Can Get Access To This Information.
Please
Review It Carefully.
This
notice describes the confidentiality practices of the Utah Alcoholism
Foundation
Our pledge regarding client Information
We
understand that information about you and your treatment is personal.
We are committed to protecting all information about you we have
gathered. This notice applies to all the information regarding your
treatment stay at the House of Hope that we maintain. This notice will
tell you about the ways in which we may use and disclose this
information. It also describes our obligations and your rights
regarding the use and disclosure of all client information.
We are required by law to:
-
Make sure that client information that identifies you is kept
private;
-
Give you this notice of our legal duties and privacy practices with
respect to client information about you; and
-
Follow the terms of the notice that is currently in effect.
Your Rights Regarding Client Information About You
You
have the following rights regarding client information we maintain
about you:
-
Right to Inspect and Copy
i.
You have the right to inspect and copy
client information that may be used to make decisions about your
treatment. To inspect and copy client information that may be used to
make decisions about you, you must submit your request in writing. If
you request a copy of the information, we may charge a fee for the
costs of copying, mailing or other supplies associated with your
request.
ii.
We may deny your request to inspect and
copy in certain very limited circumstances. If you are denied access
to client information, you may request that the denial be reviewed.
-
Right to an Accounting of Disclosures
-
You have the right to request an “accounting of disclosures” where
such disclosure was made for any purpose other than treatment,
payment, or health care operations.
i.
To request this list or accounting of
disclosures, you must submit your request in writing. Your request
must state a time period, which may not be longer than six years and
may not include dates before April 2003. Your request should indicate
in what form you want the list (for example, paper or electronic). The
first list you request within a 12-month period will be free. For
additional lists, we may charge you for the costs of providing the
list. We will notify you of the cost involved and you may choose to
withdraw or modify your request at that time before any costs are
incurred.
-
Right to Request Restrictions
i.
You have the right to request a
restriction or limitation on the client information we use or disclose
about you for treatment, payment or health care operations. You also
have the right to request a limit on the client information we
disclose about you to someone who is involved in your care or the
payment for your care, like a family member or friend. For example,
you could ask that we not use or disclose information about specific
disclosures in therapy you made.
ii.
To request restrictions, you must make
your request in writing. In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our use,
disclosure or both; and (3) to whom you want the limits to apply, for
example, disclosures to your spouse.
iii.
HIPPA Privacy laws do not require
compliance with your request.
-
Right to Request Confidential Communications
i.
You have the right to request that we
communicate with you about client matters in a certain way or at a
certain location. For example, you can ask that we only contact you at
work or by mail.
ii.
To request confidential communications,
you must make a written request. We will not ask you the reason for
your request. We will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted.
-
Right to a Paper Copy of This Notice
i.
You have the right to a paper copy of
this notice. You may ask us to give you a copy of this notice at any
time. Even if you have agreed to receive this notice electronically,
you are still entitled to a paper copy of this notice. You may obtain
a paper copy of this notice upon written request. You may obtain a
copy of this notice at our website: www.uafslc.org
Changes to This Notice
We
reserve the right to change this notice. We reserve the right to make
the revised or changed notice effective for client information we
already have about you as well as any information we receive in the
future. We will post a copy of the current notice on the UAF website.
The notice will contain on the first page, in the top right hand
corner, the effective date.
Complaints
If you
believe your privacy rights have been violated, you may file a
complaint with The Utah Alcoholism Foundation Privacy Officer or with
the Secretary of the Department of Health and Human Services. All
complaints must be submitted in writing. You will not be penalized for
filing a complaint.
Other Uses of Client Information
Other
uses and disclosures of client information not covered by this notice
or the laws that apply to us will be made only with your written
permission. If you provide us permission to use or disclose client
information about you, you may revoke that permission, in writing, at
any time. If you revoke your permission, we will no longer use or
disclose client information about you for the reasons covered by your
written authorization. You understand that we are unable to take back
any disclosures we have already made with your permission, and that we
are required to retain our records of the care that we provided to
you.
Written Requests and Complaints
Send
all written requests and complaints to:
Utah Alcoholism Foundation
Attn: Tamara Rowe, Administrator, Privacy Officer
857 East 200 South
Salt Lake City, UT 84102
(801) 487-3276
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