What
is this document?
Treatment
Payment
Healthcare
Operations
Right
to a Listing of Disclosures
Right
to Request Restrictions
Right
to a Request Confidential Communications
Right
to a Copy of this Notice
DaySpring Behavioral Health Services
is committed to protecting the privacy
of your health care information and to
provide you with a notice of privacy practices.
We are required by law to protect health
information about you. give you notice
of our legal duties and privacy practices.
and follow the terms of the notice currently
in effect.
DaySpring reserves the right to change
our privacy practices at anytime. If privacy
practices change, a revised notice will
be posted on our website and you will
also be provided a paper copy of the revised
notice on your next visit following the
change.
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What
is This Document?
This Notice of Privacy Practices describes
how DaySpring may use and disclose your
medical information. It also describes
your rights to access and control your
medical information.
We may use and disclose your protected
health information without written authorization
in the following circumstances. Your protected
health information may be used and disclosed
by DaySpring staff that are involved in
your care and treatment for the purpose
of providing health care services to you,
to pay your health care bills, to support
the operation of DaySpring, and any other
use required by law.
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Treatment
We may use and disclose Protected Health
Information about you to provide, coordinate,
or manage your health care and related
services with our agency. This may include
communicating with other DaySpring providers
regarding your treatment and coordinating
and managing your health care with others.
EXAMPLE: A clinician treating you may
also need to share your PHI in order to
coordinate different services with other
DaySpring staff members. We may also disclose
PHI about you to professionals outside
the Agency who may be involved in your
care after you leave our services, such
as service providers or others who may
provide services that are part of your
continued care.
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Payment
We may use and disclose PHI about you
for our payment activities. Common payment
activities include, but are not limited
to: determining eligibility or coverage
under a health plan, billing and collection
actions through such departments. We may
disclose your PHI to another health care
provider or covered entity for its payment
activities.
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Healthcare
Operations
We may use or disclose your PHI in order
to support the business activities of
DaySpring. These operations are necessary
to operate our healthcare business and
to make sure consumers receive quality
care. Common operation activities include
but are not limited to: conducting quality
assessment and improvement activities:
reviewing the competence of health care
professionals: training health care professionals,
arranging for legal or auditing services,
business management and planning and communicating
with you about the services you received
by DaySpring providers. For example, we
may use your PHI to conduct internal audits
to verify billing being conducted properly
or to contact you for the purpose of conducting
satisfaction surveys.
We may use and disclose protected health
information without your authorization.
DaySpring may be required to use and disclose
your PHI without your consent when:
- The use and/or disclosure is required
by law
- The use and/or disclosure is necessary
for public health activities
- The disclosure relates to victims
of abuse, neglect or domestic violence
- The use and or disclosure is for
health oversight activities
- The disclosure is for judicial and
administrative proceedings
- The disclosure is for law enforcement
purposes
- The use and/or disclosure relates
to decedents
- The use and/or disclosure is to avert
a serious threat to health or safety
- The use and/or disclosure relates
to specialized government functions
- The use and/or disclosure relates
to correctional institutions and
in other law enforcement custodial situations.
We must obtain a separate, specific authorization
from you to use and/or disclose your PHI
for any purpose not covered by this Notice
or the laws that apply to us. In other
words, the consent you already provided
will not be enough to use and/or disclose
your information for any purpose that
is not described in this Notice.
You have the right to revoke this authorization,
at any time, in writing. After we receive
your cancellation, we will not disclose
PHI about you except for disclosures that
were° being processed before receipt
of your cancellation.
Your rights regarding your protected
health information are described below.
You are required to submit a written request
to exercise any of these rights.
Right to inspect and copy. You have the
right to inspect and obtain a copy of
your protected health information that
is used to make decisions about your care.
This right does not apply to a very narrow
category of information referred to as
"psychotherapy notes".
Oklahoma law permits a fee of $1.00 for
first page and $0.50 thereafter. We also
may charge postage if you request that
we mail the information. We may deny your
request to inspect and/or copy your PHI
in certain limited circumstances. If you
are denied access, you may request that
the denial be reviewed by a licensed health
care professional chosen by us. We will
comply with the outcome of the review.
Right to amend. If you feel that PHI that
we created is incorrect or incomplete,
you any request an amendment, through
clarifying language limited to 250 words.
We cannot delete or destroy any information
already included in your PHI. You must
provide a reason that supports your amendment
request.
We may deny your request if you ask to
amend information that:
- We did not create, unless you prove
that the creator of information is not
longer available to amend the record
- The information is not part of the
records that we maintain
- The information is not part of the
information that you would be permitted
to inspect and copy; or
- The information is accurate and complete.
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Right
to a Listing of Disclosures
You have the right to request a written
list of disclosures we have made, if any,
regarding your PHI. This right applies
to disclosures for purposes other than
those made to carry out treatment, payment
and health care operations as described
in this notice. Your request must state
a time period that cannot be longer than
six (6) years and cannot include any dates
before April 14, 2003. If you request
a list of disclosures more than once in
12 months, we can charge you a reasonable
fee.
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Right
to Request Restrictions
You have the right to request that we
restrict the use and disclosures of your
Protected Health Information. Your request
must state the specific restriction requested
and to whom you want the restriction to
apply. We are not required to agree to
your requested restrictions. If we agree,
we will comply with your request unless
the information is otherwise required
by law, or needed to provide emergency
treatment to you.
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Right
to a Request Confidential Communications
You have the right to request that we
communicate with you about protected health
information in a certain way or at a certain
location. For example, you can ask that
we only contact you at work or by mail.
We will accommodate all reasonable requests.
Your request must specify how or where
you wish to be contacted.
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Right
to a Copy of this Notice
You have the right to a paper copy of
this Notice. Copies of this Notice will
be posted and available for distribution
at each location where services are provided
and on our website. If you have questions
or need to report a problem: If you believe
your privacy rights have been violated,
you may file a complaint with us or with
the Secretary of the Department of Health
and Human Services.
To file a complaint with us, or if you
would like more information about our
privacy practices, contact our Privacy
Officer at (918) 712-0859. The Privacy
Officer’s mailing address is: 2761
E. Skelly Drive, Suite 703, Tulsa, Oklahoma
74105-6285.
To file a complaint with the Secretary
of the Department of Health and Human
Services, you must submit a written complaint
within 180 days of when you should have
known of the circumstances that led to
the complaint. You will not be penalized
for filing a complaint.
 Download
a copy of this Notice of Privacy Practices
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