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.

Your Health Information is Private

CommonHealth Recovery understands that information we collect about you and your health is personal. Keeping your health information private is one of our most important responsibilities. We are committed to protecting your health information and following all laws regarding the use of your health information. The law states we must keep your health information private from other people who do not need to know it.

You may ask that we not share certain healthcare information. You must make your request in writing. In some instances, we may not be able to grant your request. If that happens, we will explain the reasons to you.

You may ask to be contacted at a location you name and in a manner you prefer. CommonHealth Recovery has an automated call reminder system to help remind our clients of their upcoming appointment. You will have the opportunity to let us know if you want an appointment reminder.

Who shares and sees my health information?

Your private health information may be used by healthcare providers such as doctors, nurses, psychologists, therapist, and social workers who provide care for you. They may need your private health information to plan your care. We share information about you on a need-to-know basis to help you get the services you need.

We may share information about you to be paid for services. We send a claim to your insurance or to Medicaid for payment. The claim has all the information about what services you received. We review healthcare information and claims to ensure you get quality care and all laws about providing and paying for your healthcare are being followed.

We may use information about you for performance improvement activities. For example, we may use information to review our treatment and services and to evaluate the performance of staff. We may combine information about many clients to help us decide what additional services we need to offer or eliminate.

We pledge not to sell or distribute your personal information to third parties unless legally mandated by state or federal law. We maintain strict confidentiality measures and prioritize the security of your data to ensure its protection and integrity.”

May I see my health information?

You have the right to inspect your record and request a copy of your medical record. Your first copy is free. We may charge a fee for additional copies.

What if I think something in my record is incorrect?

Our goal is to keep your information up-to-date and to correct inaccurate information. If you think some of the information is wrong, you may ask that it be changed or that new information be added. This is called an amendment. You may ask for the amendment be sent to anyone who has received your health information. Your request must be in writing, with a reason to support the request. Send request to the company ombudsman. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may deny your request if you ask to amend information that was not created by CommonHealth Recovery, unless the entity that created the information is no longer able to do so or if the information is not part of the information kept by CommonHealth Recovery or is accurate and complete.

Can I limit who can see my information and restrict access to what can been seen?

You have the right to request restrictions on the information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the information we disclose to someone who is involved in your care or the payment for your care. We are not required to agree. However, if we do agree we will comply with your request unless the information is needed to give you emergency treatment. Make requests to limit information in writing to the company ombudsman.

To request restrictions, you must make your request in writing and state the following: 1. What information you want limited. 2. Whether you want to limit our use, disclosure, or both. 3. To whom you want the limits applied. This is done on the release of information form.

What if I need for my health information to go somewhere else?

You will be asked to sign a separate form called a Release of Information Form allowing your health information to go to another entity. Your authorization instructs CommonHealth Recovery what information is to be sent, where and to whom. The release is good until you revoke the release at any time. You can request in writing that a previously signed Release of Information be canceled or limited at any time. After we receive your written cancellation, we will not share any information, but it cannot be helped if information was shared before the request was received.

Can I know who has received information about me?

You may ask for a list called an Accounting of Disclosures of any places where health information may have been sent unless it was for treatment, for payment to make sure you received quality care, or to make sure laws are being followed. We also will not send you a list of persons or facilities to whom we sent information if you signed a Release of Information Form allowing us to send the information.

Could my health information be released without my authorization?

There are times when by law we must share private health information, even if you do not sign a Release of Information Form.

CommonHealth Recovery must report:

Abuse, neglect, or exploitation of a dependent adult to the Department for Community Based Services. Any instance of child neglect, exploitation, or abuse to the Department for Community Based Services and/or police. Any threats against persons to the intended victim and to the police.

CommonHealth Recovery must share information with:

Agencies or persons with a need to know when a client needs hospitalization. Police or law enforcement for reasons as required by law or in response to a court order. Law enforcement purposes include limited information requests for identification and locations purposes; pertaining to victims of crime; suspicion of death because of criminal conduct; and a medical emergency when a crime is likely to have occurred. A coroner investigating any death of a client of CommonHealth Recovery. The Federal Government when they are investigating activity to protect the country, the President of the United States, and/or other government officials. If you introduce your personal mental health or substance, use in court proceedings, you give up your right to privacy.

Substance Use Health Information

If you are receiving substance use services, your health information is protected under federal regulation, 42 CFR, Part 2 that may give additional privacy protection.

How do I file a complaint?

If you think we have not protected your privacy and wish to file a complaint, send your complaint to the CommonHealth Recovery Ombudsman in writing to PO Box 55522, Lexington KY 40555. You may also call (502) 661-1444 Ext. 201.

What will happen to me if I file a complaint?

Absolutely nothing. It is against the law for CommonHealth Recovery to take any retaliatory or other negative action against you if you file a complaint.

CommonHealth Recovery is required to abide by the terms of this notice. However, we reserve the right to change it. We reserve the right to make the revised notice effective for information we already have about you as well as future information we receive. A current copy of this notice will be posted in all CommonHealth Recovery locations, at www.commonhealthky.com and can be sent upon request. You will be offered a copy of this notice each time you initiate services at CommonHealth Recovery.