1730 PROSPECT AVENUE - KANSAS CITY, MO 64127 - PH: (816) 421-6670 Topics Careers Privacy Practices Cost of Services Contact Us Donate Notice of Privacy Practices What are your rights? To obtain a paper copy of this notice To request restrictions on communications about your health care information by alternative; however HCBC is not required to agree to restrictions (45CFR 164.522) To receive confidential communications (45 CFR 164.522) To inspect and copy of your protected health information (45 CFR 164.524) To ask for the record to be changed if you believe you see a mistake or something that is not complete. However, we may deny the request if it is our judgment that information is correct To obtain an accounting of any disclosures of your health information (45 CFR 164.522) To withdraw your authorization at any time, unless your referral is from the criminal justice system. If you wish to exercise any of these rights, or to file a complaint, you must place your request in writing to the Privacy/Security Officer at the address below. Privacy Officer Heartland Center for Behavioral Change 1730 Prospect Kansas City, MO 64127 816-421-6670, ext.1296 If you are receiving services through the Department of Mental Health, you may also make a complaint to: Office of Constituent Services Missouri Department of Mental Health P.O. Box 687 Jefferson City, Missouri 65102 1-800-364-9687 Heartland Center for Behavioral Change (HCBC) is required by law to follow the practices described in this Notice of Privacy Practices. We reserve the right to revise the terms of that notice. If the terms are changed, you will be notified by receiving an updated Privacy Notice at your next office visit. Every time you visit HCBC for services, we collect information about you which includes treatment plans, progress notes and personal identifying information. This is your protected health information and HCBC must, by law, make sure that it is kept private. Usually we obtain your consent before sharing information about you to anyone outside the agency. However, there are some situations where the law allows communication without your consent. Treatment: We may release information to qualified professionals who work at HCBC and are involved in your treatment. If the services you receive are paid through public funding, we may also share information with the government representatives. Payment: We may send a bill to your insurance, Medicaid, Medicare or another third party payer, when applicable. The information included with the bill may include your diagnosis or treatment you have attended. Audit: Your records may be reviewed by auditors who verify services have actually been provided. Quality of Service: Information in your health record may be used to assess and improve the quality of services we provide. Serious/Unusual Incidents: By law, we must report alleged or suspected physical or sexual abuse or neglect that result in injury. All persons also have the right to file a complaint with the US Department of Health and Human Services: Office for Civil Rights US Dept. of Health & Human Services 200 Independence Avenue, S.W. Room 509F, HHH Building Washington D.C. 20201 There will be no retaliation against you for exercising your rights. HCBC IS ACCREDITED BY CARF INTERNATIONAL AND CERTIFIED BY THE MISSOURI DEPARTMENT OF MENTAL HEALTH