Notice of Privacy Practices and Personal Health Information Policy

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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.

USE AND DISCLOSURE OF HEALTH INFORMATION

Monarch Health Addiction Recovery Clinics may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Your health information may be used or disclosed only after Monarch Health has obtained your written consent.

Monarch Health has established policies to guard against unnecessary disclosure of your health information.

SUMMARY OF THE CIRCUMSTANCES UNDER WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AFTER YOU HAVE PROVIDED YOUR WRITTEN CONSENT:

To Provide Treatment. Monarch Health may use your health information to coordinate care within Monarch Health and with others involved in your care, such as your attending physician and other health care professionals, family members, suppliers of medical equipment who have agreed to assist Monarch Health in coordinating care.

To Obtain Payment. Monarch Health may include your health information in invoices to collect payment from third parties for the care you receive from Monarch Health.

To Conduct Health Care Operations. Monarch Health may use and disclose health information for its own operations in order to facilitate the function of Monarch Health and as necessary to provide quality care to all of Monarch Health ‘s patients. Health care operations includes such activities as:

Quality assessment and improvement activities.
Activities designed to improve health or reduce health care costs.
Protocol development, case management and care coordination.
Contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment.
Professional review and performance evaluation.
Accreditation, certification, licensing or credentialing activities.
Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
Business planning and development including cost management and planning related analyses and formulary development.
Business management and general administrative activities of Monarch Health.
For example Monarch Health may use your health information to evaluate its staff performance, combine your health information with other Clinic patients in evaluating how to more effectively serve all Clinic patients, disclose your health information to Clinic staff and contracted personnel for training purposes, use your health information to contact you as a reminder regarding a visit to you, or contact you as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).

For Appointment Reminders. Monarch Health may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

For Treatment Alternatives. Monarch Health may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED WITHOUT FIRST RECEIVING YOUR WRITTEN CONSENT.

When Legally Required. Monarch Health will disclose your health information when it is required to do so by any Federal, State or local law.

When There Are Risks to Public Health. Monarch Health may disclose your health information for public activities and purposes.

To Report Abuse, Neglect Or Domestic Violence. Monarch Health is allowed to notify government authorities if Monarch Health believes a patient is the victim of abuse, neglect or domestic violence.

To Conduct Health Oversight Activities. Monarch Health may disclose your health information to a health oversight clinic for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Monarch Health, however, may not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.

In Connection With Judicial And Administrative Proceedings. Monarch Health may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when Monarch Health makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

For Law Enforcement Purposes. As permitted or required by State law, Monarch Health may disclose your health information to a law enforcement official for certain law enforcement purposes.

Coroners and Medical Examiners. Monarch Health may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.

For Worker's Compensation. Monarch Health may release your health information for worker's compensation or similar programs.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than is stated above, Monarch Health will not disclose your health information other than with your written authorization. If you or your representative authorizes Monarch Health to use or disclose your health information, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

You have the following rights regarding your health information that Monarch Health maintains:

Right to request restrictions. You may request restrictions on certain uses and disclosures of your health information.

Right to receive confidential communications. You have the right to request that Monarch Health communicate with you in a specific way.
Right to inspect and copy your health information. You have the right to inspect and copy your health information, including billing records.
Right to amend health care information. You or your representative has the right to request that Monarch Health amend your records, if you believe that your health information is incorrect or incomplete.
Right to an accounting. You or your representative have the right to request an accounting of disclosures of your health information made by Monarch Health for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing.
Right to a paper copy of this notice. You or your representative has a right to a separate paper copy of this Notice and all policies relative to it at any time even if you or your representative has received this Notice previously. To obtain a separate paper copy, please contact: Office Administrator, Monarch Health, 521 E. Washington Avenue, Madison, WI 53703.

DUTIES OF MONARCH HEALTH

Monarch Health is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices. Monarch Health is required to abide by the terms of this Notice as may be amended from time to time. Monarch Health reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If Monarch Health changes its Notice, Monarch Health will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative has the right to express complaints to Monarch Health and to the Secretary of DHHS at 200 Independent Ave, SW, Washington, DC, phone (Toll free) 877- 696-6775, if you or your representative believes that your privacy rights have been violated. Any complaints to Monarch Health should be made in writing to Clinic Manager, Monarch Health, 521 E. Washington Avenue, Madison, WI 53703.

Monarch Health encourages you to express any concerns you may have regarding the privacy of your information. There will never be any type of retaliation against you for filing a complaint.

EFFECTIVE DATE This Notice became effective beginning December 1, 2019. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT the Office Administrator, Monarch Health, 521 E. Washington Avenue, Madison, WI 53703.