MENU 888-880-5511 THIS NOTICE DESCRIBES HOW MEDICAL AND DRUG AND ALCOHOL RELATED INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. General Information Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) 42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under these laws, Harbor Hall, Inc. may not say to a person outside Harbor Hall, Inc. that you attend the program, nor may Harbor Hall, Inc. disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law. Harbor Hall, Inc. must obtain your written consent before it can disclose information about you for payment purposes. For example, Harbor Hall, Inc. must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before Harbor Hall, Inc. can share information for treatment purposes or for health care operations. However, federal law permits Harbor Hall, Inc. to disclose information without your written permission: 1. Pursuant to an agreement with a business associate; 2. For research, audit or evaluations; 3. To report a crime committed on Harbor Hall, Inc.’s premises or against Harbor Hall’s personnel; 4. To medical personnel in a medical emergency; 5. To appropriate authorities to report suspected child abuse or neglect 6. As allowed by a court order For example, Harbor Hall, Inc. can disclose information without your consent to obtain legal or financial services, or to another medical facility to provide health care to you, as long as there is a business associate agreement in place. Before Harbor Hall, Inc. can use or disclose any information about your health in a manner which is not described above, it must first obtain your specific written consent allowing it to make the disclosure. Any such written consent may be revoked by you in writing. Your Rights Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. Harbor Hall, Inc. is not required to agree to any restrictions you request, but if it does agree then it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency. You have the right to request that we communicate with you by alternative means or at an alternative location. Harbor Hall, Inc. will accommodate such requests that are reasonable and will not request an explanation from you. Under HIPAA you also have the right to inspect and copy your own health information maintained by Harbor Hall, Inc., except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal or administrative proceeding or in other limited circumstances. Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in Harbor Hall, Inc.’s records, and to request and receive an accounting of disclosures or your health related information made by Harbor Hall, Inc. during the six years prior to your request. You also have the right to receive a paper copy of this notice. Harbor Hall Inc.’s Duties Harbor Hall is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. Harbor Hall, Inc. is required by law to abide by the terms of this notice. Harbor Hall, Inc. reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. Until such amendment is made, Harbor Hall, Inc. is required by law to comply with this Notice. Harbor Hall, Inc. will provide written notice to each patient of it’s intent to make revisions in the privacy policy. Complaints and Reporting Violations You may complain to Harbor Hall, Inc. and the secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. You will not be retaliated against for filing such a complaint. Violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs. Complaints about your Privacy rights, or how Harbor Hall, Inc. has handled your health information should be directed to Holly Krasiejko, Human Resources Director, by calling this office at (888) 880-5511. If Holly is not available, you may make an appointment for a personal conference in person or by telephone within two working days. If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to: DHHS, Office of Civil Rights 200 Independence Avenue, S.W. Room 509F HHH Building Washington, DC 20201 PROUD MEMBERS OF: Harbor Hall is a non-profit offering a variety of addiction treatment services since 1974. Proudly serving four locations in Northern Michigan. PETOSKEY OUTPATIENT 2236 E. Mitchell Rd, Ste. #5 Petoskey, MI 49770 Direct: 231-347-9880 PETOSKEY RESIDENTIAL 704 Emmet Street Petoskey, MI 49770 Toll Free: 888-880-5511 Direct: 231-347-5511 CHARLEVOIX S.H.A.R.P. Safe Harbor Adolescent Recovery Program 951 Mill St. East Jordan, MI 49727 sharp@charlevoixcountry.org CHEBOYGAN 520 N. Main St, Ste. #202 Cheboygan, MI 49721 Direct: 231-597-9235 Copyright © 2019 Harbor Hall Site by Common Angle