This notice describes how medical information about you may be disclosed and how you can get access to this information. Please review it carefully.
WRITTEN SUMMARY OF FEDERAL REGULATION: CONFIDENTIALITY OF ALCOHOL & DRUG ABUSE PATIENT RECORDS
The clinic staff shall not convey to a person outside of the program that a patient receives services from the program or disclose any information identifying a patient as an alcohol or other drug services patient unless the patient consents in writing for the release of information, the disclosure is allowed by a court order, or the disclosure is made to a qualified personnel for a medical emergency, research, audit or program evaluation purposes.
Federal laws and regulations do not protect any threat to commit a crime, any information about a crime committed by a patient either at the program or against any person who works for the program.
Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or Local authorities.
We must have your written authorization to use your PHI for any other reasons than listed above. This notice tells you our rules for using PHI. We have to follow what we say in this notice. You may revoke this authorization to release your information, with some limitations, at any time in writing.
The law says we must keep your PHI private. It also says that we must tell you in writing:
You have certain rights under the privacy laws:
You must make the above requests in writing. Your request should be sent to:
Anchor Addiction and Wellness Center
Attn: Medical Records Custodian
3 Medical Drive, Chillicothe, OH 45601.
We must reply to you within (15) days after receipt of your request. We will respond in writing with our determination. You may request copies of this notice by contacting our office at (740) 779-6612. Copies are also posted within our office.
You may complain to us if you believe your privacy rights have been violated. You may contact our Medical Records Custodian at our office. You also have the right to complain to the Secretary of the Department of Health and Human Services.