Privacy Statement

Notice of Health Care Information 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.

Rocky Mountain Neuropsychiatric Associates is committed to the protection of patients privacy and confidentiality of medical information. RMNA recognizes that patients depend upon us to safeguard their personal information and to uphold the privacy rights of patients. This notice, which is based upon state and federal law, as well as the RMNA code of ethics, confirms our commitment to preserving patient confidentiality and privacy and also confirms the RMNA will not use or disclose patient personal or health information except as described in this Notice. This Notice applies to all of the personal information gathered by and medical records generated by RMNA as well as records received from other providers.

USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
Without your authorization, RMNA may use and disclose your personal and/or health information for the following purposes:
Treatment: RMNA may use your personal and/or health information in the provision and coordination of your healthcare. RMNA may disclose all or any portion of your personal and/or health information to your attending RMNA physician, other RMNA psychiatrists, therapists and other affiliated health care providers who have legitimate need for such information to facilitate our care and treatment. Other ways we may use and disclose your information for purposes related to treatment are:
Laboratory Support: Name, diagnosis and contact phone number may be required by laboratory and imaging and other medical resources for scheduling authorization and billing purposes.
Treatment Alternatives: To tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Appointment Reminders: To contact you as a reminder that you have an appointment for treatment or medical care at RMNA.
Payment: RMNA may release personal and/or health information about you for the purposes of determining insurance coverage, billing claims management, medical data processing, and reimbursement. The information may be released to an insurance company, or other entity (or their authorized representatives) involved in the payment of your medical bill and may include copies or excerpts of your medical record which are necessary for payment of the account. For example, a bill may include information that identifies you, your diagnosis, and the procedures, time and supplies used. RMNA may also provide information to other care providers who have been involved in your care, such as home health care agency or an ambulance company.
Healthcare Operations: RMNA may us and disclose your personal and/or health information during healthcare operations including quality assurance, utilization review, medical review, internal auditing, accreditation, certification, licensing activities of RMNA, medical research, and educational purposes. RMNA may engage outside companies to carry out certain aspects of healthcare operations. These entities are called 'Business Associates'. RMNA may need to disclose your information to Business Associates to allow them to perform their duties. The Business Associates will, in turn, use and disclose your information as they conduct business on behalf of RMNA. Examples of Business Associates include, but are not limited to, a copy service used by RMNA to copy medical records, consultants, accountants, lawyers, medical transcriptions and billing companies. RMNA requires their Business Associates to protect the confidentiality of your personal and health information in compliance with appropriate security laws and regulations.

OTHER USES AND DISCLOSURES THAT ARE REQUIRED OR PERMITTED WITHOUT AUTHORIZATION
Special situations and certain state and federal laws may require RMNA to use or release your information. For example, RMNA may be obligated to release your information for the following reasons:
RESEARCH: Under certain circumstances, RMNA may use and disclose your health information for approved clinical research. For example, a research project may involve comparing the health and recovery of patients who received one medication for their medical condition to those who received a different medication for the same condition.
REGULATORY AGENCIES: RMNA may disclose your personal and/or health information to government and certain private health oversight agencies, such as the Department of Public Health and Environment, the Federal Department of Health and Human Services, or the Board of Medical Examiners, for activities authorized by law including, but not limited to, licensure, certification, audits, investigations, and inspections. These activities are necessary to monitor compliance with the requirements of government programs.
LAW ENFORCEMENT/LITIGATION: RMNA may disclose your personal and/or health information for law enforcement purposes as required by law or in response to a court order.
PUBLIC HEALTH: As required by law, RMNA may disclose your personal and/or health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. For example, RMNA is required to report the existence of several communicable diseases including, but not limited to acquired immune deficiency syndrome (AIDS), to the Department of Public Health and Environment to protect the health and well-being of the general public.
WORKERS COMPENSATION: RMNA may release personal and/or health information about you to workers compensation or similar programs. These programs provide benefits for work related injuries or illnesses.
MILITARY VETERANS: RMNA may disclose your person & and/or health information as required by military command authorities, if you are a member of the armed forces.
AS OTHERWISE REQUIRED BY LAW: RMNA will disclose your personal and/or health information in any situation where such disclosures are required by law (such as child abuse. domestic abuse).

USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION
Without your authorization, RMNA may not disclose your personal and/or health information to persons outside of RMNA for purposes other than treatment, payment, healthcare operations, or special circumstances as listed above. In addition RMNA may not use or disclose specially sensitive information, such as AIDS/HIV, alcohol and drug abuse prevention and/or treatment, or mental health information without your specific authorization unless legally required to do so.
FAMILY/FRIENDS: With your authorization, RMNA may disclose your personal and/or health information to a friend or family member who is involved in your medical care. RMNA may also provide information to someone who helps pay for your care. RMNA may also tell your family or friends of your condition and that you are in the hospital. In addition RMNA may disclose information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. RMNA also may disclose your information to other people outside RMNA who may be involved in your medical care after you leave RMNA, such as clergy and others used to provide services that are part of your care.

YOUR RIGHTS RELATED TO YOUR PERSONAL AND HEALTH INFORMATION
Although all records concerning your treatment obtained at RMNA are the property of RMNA, you have the following rights concerning your personal and health information.
CONFIDENTIAL COMMUNICATIONS: You have the right to request confidential communications of your information by alternative means or at alternative locations. For example, you may request that RMNA only contact you at work or by mail.
REQUEST TO REVIEW AND COPY: You have the right to request a review and/or a copy of your health information except as restricted by your physician or by law. This right does not obligate RMNA to grant you access to certain types of information.
AMEND: You have the right to request an amendment or correction to your health information. If RMNA agrees that an amendment or correction is appropriate, we will ensure that the amendment or correction is attached to your medical record.
AN ACCOUNTING: You have the right to obtain a statement of the disclosures that have been made of your personal and health information other than by your authorization, other than disclosures made by you, and other than for the purpose of treatment payment, or operational purposes.
REQUEST RESTRICTIONS: You have the right to request restrictions on certain uses and disclosures of your information. If RMNA is able to agree to your request, we will abide by the restrictions.
RECEIVE A COPY OF THIS NOTICE: If this Notice has been provided to you electronically, upon request you have the right to receive a paper copy of this Notice.
REVOKE AUTHORIZATION: You have the right to revoke your authorization to use or disclose your information except to the extent that action has already been taken in reliance on your authorization.

IF YOU BELIEVE THAT YOUR RIGHTS HAVE BEEN VIOLATED
You may file a complaint with RMNA or with the Secretary of the Department of Health and Human Services. To gain information on how to file a complaint with RMNA, contact the office at 473-2346. All complaints must be submitted in writing addressed to RMNA 2860 S. Circle Dr. Ste. 160 Colorado Springs, Co 80906. You may be assured there will be no retaliation for filing a complaint.

CHANGES TO THIS NOTICE
RMNA will abide by the terms of the Notice currently in effect. RMNA reserves the right to change the terms of this Notice at any time. Any new notice provisions will be effective for all protected health information that it maintains. Any new revision to this Notice will be posted at your RMNA facility.

NOTICE EFFECTIVE DATE
The effective date of the Notice is February 10, 2005.