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.

Green Mountain Treatment Center is committed to providing you with the highest quality substance use disorder treatment services. An essential part of that commitment is protecting the confidentiality of your health information according to applicable law. This notice describes your rights and our duties under federal law with respect to your Protected Health Information (“PHI”). PHI is information about you that may identify you and that relates to your past, present or future physical or mental health or condition; the provision of healthcare services to you; or the past, present, or future payment for the provision of health care services to you.

Confidentiality of Alcohol and Drug Treatment Information

As a patient receiving substance use disorder treatment and recovery services, your PHI is subject to heightened privacy protections under a federal law known as “Part 2”. See 42 U.S.C. § 290dd-2; 42 C.F.R. Part 2. Under Part 2, we may not disclose information about your care and treatment, including acknowledging your current or past presence at our treatment facility, unless:

  1. You or your personal representative consent in writing;
  2. The disclosure is allowed by a court order;
  3. The disclosure is made to medical personnel in a medical emergency;
  4. The disclosure is made to authorities to report suspected child abuse or neglect;
  5. The disclosure is made to a qualified service organization/business associate;
  6. The disclosure is made to qualified personnel for research, audit, or program evaluation;
  7. The disclosure is made in connection with a suspected crime committed on our premises or a crime against any person who works for us or about any threat to commit such a crime;
  8. The disclosure is made to the Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining our compliance with the Health Insurance Portability and Accountability Act and/or related laws or regulations; or
  9. The disclosure is made to a public health authority and involves information relating to the cause of your death.

Other than as stated above or as allowed by applicable law, we will not use or disclose your PHI without your written authorization.

Client Rights

  • Right to Inspect and Copy PHI. You have the right to inspect and obtain a copy of your PHI maintained by us. If we maintain your PHI in an electronic format, you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your medical information in the form or format you request, if it is readily producible in such form or format. If your medical information is not readily producible in the form or format you request, your medical information will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for copying and transmitting a paper copy of your PHI and for transmitting your PHI in electronic format.
  • Right to Request an Accounting of Disclosures. You have the right to obtain an accounting from us by written request describing certain disclosures of your PHI that we have made in the prior six- year period. We are not required by law to document certain disclosures (such as disclosures made pursuant to your written authorization). If you request an accounting more than once in a 12-month period, we may charge you a reasonable cost-based fee for the additional accountings.
  • Right to Request an Amendment to Your Medical Record. If you believe medical information that may be used to make decisions about your care is incorrect or incomplete, you may ask us to amend the information by written request. Your request must include a reason for the amendment and the specific information you want us to amend. If we agree to your request, we will amend your medical information as requested. We may also agree to make some changes you ask for but not others. We may deny your request if we believe the records are complete and accurate, if the records were not created by us and the creator of the record is available, or if the records are otherwise not subject to patient access under law. You have the right to respond in writing to our explanation of denial, and to require that your request, our denial, and your statement of disagreement, if any, be included in future disclosures of the disputed medical record.
  • Right to Request Confidential Communications. You have the right to request that we communicate with you about your PHI in a certain way or at a certain location. For example, you can ask that we only contact you at your work office instead of at home. To request alternative communications of your PHI, you must submit your request in writing to the Privacy Officer identified at the end of this notice. We are only obligated by law to accommodate reasonable requests.
  • Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose for treatment, payment, or health care operations. To request a restriction, you must make your request, in writing, to the Privacy Officer at the address set forth at the end of this notice. We are not required to agree to the requested restriction unless you request that we not disclose your out-of-pocket payments to a health plan as discussed in the next bulleted item below.
  • Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your PHI with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
  • Right to Revoke Specific Authorizations. You have the right to revoke any authorization that you have provided to us that permits us to use or disclose PHI except to the extent that action has already been taken in reliance upon that authorization.
  • Right to Notification of a Breach. You have the right to be notified in the event that we (or one of our business associates or qualified service organizations) discover a breach involving your unsecured PHI.

Changes to This Notice

We are required to abide by the terms of this notice, which are currently in effect. We reserve the right to change the terms of this notice at any time and make the new notice effective for all PHI that we maintain at that time. Notification of revisions to this notice will be provided as follows (i) upon request; (ii) electronically via our website, and (iii) posted in our treatment facility.

Complaints

If you believe your privacy rights have been violated, you may file a complaint in writing with Green Mountain Treatment Center at the addressed listed below. Violation of Part 2 is a crime and suspected violations may also be reported to the U.S. Attorney’s Office for the District of New Hampshire at (603) 225-1552. You may also submit a claim with the U.S. Department of Health and Human Services, Office of Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, (877) 696-6775. We will not retaliate against you for filing a complaint.

Questions

If you would like a copy of this notice, wish to exercise any of the rights listed in this notice, or if you have questions and would like additional information you may contact our Privacy Officer either in writing or by phone: Lisa Perry, Director of Compliance/Privacy Officer, Granite Recovery Centers, 6 Manor Parkway, Salem, NH 03079, tel: (603) 328-8633.

Effective Date

This notice is effective as of June 17, 2019.