This notice describes how medical information regarding your health care, including payment for health care is protected by two federal laws: The Health Insurance Portability and Accountability Act of 1966 (“HIPAA”), 42 U.S.C. & 1320d et seq., 45 C.R.F. Part 160 & 164, and the confidentiality Law, 42 U.S.C. & 290dd-2, 42 C.F.R. Part 2. Under these laws, River Rocks Recovery, LLC. may not say to a person outside of River Rocks Recovery, LLC. that you attend the program, nor may River Rocks Recovery, LLC. disclose information identifying you as an alcohol or drug abuser or disclose any other protected information except as permitted by federal law.
This Notice Describes Our Practices and Those of:
- Any health care professional allowed to enter information into your chart.
- Any employee we allow to help you while you are here; and
- All employees of any hospital, clinic, laboratory, or other facility affiliated with River Rocks Recovery.
River Rocks Recovery uses health information about you for treatment, to obtain payment for treatment for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of River Rocks Recovery. We understand that health information about you and your health is personal. We are committed to protecting health information about you. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information. River Rocks Recovery is required by law to:
- Make sure that medical information that identifies you is kept private;
- give you this notice of our legal duties and privacy practices with respect to medical information about you;
- accommodate reasonable requests you may make to communicate health information by alternative means or alternative locations; and,
- follow the terms of this notice that is currently in effect.
- For Treatment:
River Rocks Recovery may use your health information to provide you with medical treatment for services. For Example, information obtained by a health care provider, such as physician, nurse, or other person providing health care services to you, will need information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them during your treatment and note how you respond to the actions.
- For Payment:
River Rocks Recovery may use and disclose your health information to others for purposes of receiving payments for treatment and services that you receive. For example, a bill may be sent to you or a third party, such as an insurance company, HMO, or health plan. The information of the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
- For Health Care Operations:
River Rocks Recovery may use and disclose health care information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk, or quality improvement personnel, and others to:
- Evaluate the performance of our staff;
- assess the quality of care and outcomes in your case and similar cases;
- learn how to improve our facilities and services; and,
- determine how to continually improve the quality and effectiveness of the health care we provide.
- For Drug Testing:
You voluntarily consent to the collection and testing of your specimen and certify that the specimen identified on this form is my own and has not been adulterated in any manner. I certify that the information provided on this form and on the specimen, is accurate. I further authorize River Rocks Recovery to release the results of this testing to the ordering facility and/or my insurance company. I authorize my insurance company to pay and mail directly to River Rocks Recovery and its affiliated laboratories all benefits for payment of services rendered. I also authorize River Rocks Recovery and its affiliated laboratories to endorse any checks received on my behalf for payment of services provided. I hereby irrevocably assign to River Rocks Recovery and its affiliated laboratories all benefits under any policy of insurance indemnity agreement, or any collateral source as defined by statute for services provided. This assignment includes all rights to collect benefits directly from my insurance company and all rights to proceed against my insurance company in any action including legal suit, if for any reason my insurance company fails to make payment to benefits due. This assignment also includes all rights to recover attorney fees and costs for such action brought by the provider as my assignee.
- For Appointments/Health Related Products and Services:
River Rocks Recovery may use your information to contact you to provide appointment reminders. River Rocks Recovery may also contact you to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you.
- For Others Involved In Your Care:
River Rocks Recovery may release relevant health information to a family member, friend, or anyone else you designate in order for that person to be involved in your case or payment related to your case. River Rocks Recovery may also disclose health information to those assisting in disaster relief efforts so that others can be notified a status, our condition, status and location.
- For Fundraising:
River Rocks Recovery does not use information for fundraising unless authorized, in writing, by you.
- As Required By Law or As Needed:
River Rocks Recovery may use and disclose information about you as required by law. For example, River Rocks Recovery may disclose information for the following purposes:
- For judicial and administrative proceedings pursuant to a court order.
- To prevent or control disease, injury, or disability.
- To report births and deaths.
- To report reactions to medications or problems with products.
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease.
- To notify the proper authorities if we believe a client has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
- Your health information may be disclosed to avert a serious threat to the health and safety of you and any person pursuant to applicable law.
- Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
- Your health information may be used or disclosed in order to comply with laws and regulations related to Worker’s Compensation.
- For Public Health:
Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities (State Health Department, Center for Disease Control, Etc.) to prevent or control disease, injury, or disability, or for other public health activities.
- For Health Oversight Activities:
River Rocks Recovery may disclose your health information to a health oversight agency for activities authorized by law. Examples of these activities include audits, investigations, and inspections to monitor the health care system and compliance with laws and regulations.
- For Other Uses:
Other uses and disclosures will be made only with your written authorization. You may revoke an authorization except to the extent River Rocks Recovery has taken action in reliance to it.
- For Collaboration:
To receive appropriate and comprehensive treatment from the clinical and support team while enrolled in our program, we may need to collaborate with additional employees and/or contractors of River Rocks Recovery, and its subsidiaries on your behalf. This would include imperative information that is regarding your current emotional and mental state(s), scheduling, or clinical and medical appointments as well as attendance in groups or sessions. If communication transpires, it will always be on a “need-to-know” basis and minimal information will be discussed. This collaboration includes visits to Specialists, Emergency Room Visits, Urgent Cares, and Clinics, COVD 19 information and testing, Urine Drug Screenings and Breathalyzer Test results. By signing this consent, you agree to allow communication between all employees and contractors of River Rocks Recovery and its subsidiaries. - DATA:
“SMS consent will not be shared with any third party, nor will the phone numbers for SMS purposes”
Your Health Information Rights Under HIPAA you have the right to:
- Obtain a copy of this notice of information practices upon request.
- Request an amendment to your health information under certain circumstance.
- Request a confidential communication of your health information by alternative means or at alternative locations. Please be advised that this request for alternative means or locations of communications applies only to this provider or location.
- Receive an accounting of disclosures made of your health information.
- Request a restriction on certain uses and disclosures of your information; however, River Rocks Recovery is not required to agree to a requested restriction.
River Rocks Recovery reserves the right to change the terms of this notice and make the new terms effective for all protected health information kept by River Rocks Recovery. River Rocks Recovery will post a copy of the current notice in the facility. You may also get a current copy by contacting our Executive Director at jennifer@riverrocksrecovery.com
Complaints:
If you believe your privacy rights have been violated, you may file a complaint with River Rocks Recovery, or:
Ohio Department of Mental Health and Addiction Services
30 East Broad Street, 36th Floor
Columbus, OH 43215
To file a complaint with River Rocks Recovery, submit a written complaint to our Executive Director (at the address of this notice). You will not be penalized for filing a complaint.
Contact Information for Questions or to File a Complaint:
If you have questions about this notice, want to exercise one of your rights that are described in this notice, or want to file a complaint, please contact River Rocks Recovery at:
675 N. University Blvd.
Middleton OH 45042
(888) 905) 6281
