You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated.
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Include you in a directory
• Provide mental health care
• Market our services and sell your information
• Raise funds
We may use and share your information as we:
• Do research
• Treat you
• Comply with the law
• Run our organization
• Respond to organ and tissue donation requests
• Bill for your services
Get an electronic or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to amend your medical record
• You can ask us to amend health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communication
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you ask us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
You can ask for a paper copy of this notice at any time.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will ensure the person has this authority before we take any action.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
If you are not able to tell us your preference we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. In these cases, we never share your information unless you give us written permission:
• Marketing purposes
• Most sharing of psychotherapy notes
• Sale of your information
•In the case of fundraising we may contact you for fundraising efforts, but you can tell us not to contact you again.
We typically use or share your health information in the following ways.
• We can use your health information and share it with other professionals who are treating you.
• We can use and share your health information to run our practice, improve your care, and contact you when necessary.
• We can use and share your health information to bill and get payment from health plans or other entities.
• Electronic Exchange. Your information may be shared w/ other providers, labs and radiology groups through our EHR system as listed:
LabCorp, Open Dental, eCW, CCNVA, NRV Computing, The Coding Network, RxStrategies, 340B FQHC, PharmaForce, Luma, Aladade, i2i Systems, Vax Care, The Kroger Co., Gayatri Ankem, Physician Select Management, FORVIS, SOTA.
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
We can share health information about you for certain situations such as:
• Preventing disease
• Preventing or reducing a serious threat to anyone’s health or safety
• Helping with product recalls
• Reporting suspected abuse, neglect, or domestic violence
• Reporting adverse reactions to medications
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions as military, national security, and presidential protective services
• Respond to lawsuits and legal actions
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
If you feel your Privacy Rights have been violated, please ask our staff for a Privacy Complaint Form. Our Security Officer will review the form and promptly notify you of the actions our office will take.
• Or you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights bysending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting http://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html
• We will not retaliate against you for filing a complaint.
Community Health Center of the New River Valley
Bronie Reynolds, M.S. Ed.
Compliance Program Manager/Privacy & Security Officer
Phone: 540-381-0820
This Notice of Privacy Practices is effective March 1, 2017, Updated on 12/11/19
Community Health Center of the New River Valley (CHCNRV) provides an array of health care services, including substance use disorder diagnosis, treatment, and referral for treatment. As described in the Center’s Notice of Privacy Practices, patient medical records are protected by federal and state laws and regulations, including the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Certain substance use disorder records are also protected by the federal regulations governing the Confidentiality of Substance Use Disorder Patient Records (42 CFR Part 2 (“Part 2”). The Center’s Part 2 unit consist of Medical Providers when providing MAT services and Behavioral Health Providers providing therapeutic services. In accordance with 42 CFR § 2.22, the following is a written summary of the Part 2 regulations. Generally, a Part 2 Program may only acknowledge that an individual is present or disclose outside the Part 2 Program information identifying a patient as having or having had a substance use disorder in the following instances:– The patient’s written consent is obtained in accordance with subpart C of Part 2, – An authorizing court order is entered in accordance with subpart E of Part 2, – The patient’s records are disclosed to medical personnel to the extent necessary to meet a bona fide medical emergency (42 CFR § 2.51), – The disclosure is for the purpose of conducting scientific research (42 CFR § 2.52), or – The disclosure is for the purpose of an audit or evaluation (42 CFR § 2.53). Any violation of Part 2 may be reported: -To Ashley Slagel-Perry at Community Health Center of the New River Valley, 215 Roanoke St., Christiansburg, VA 24073, 540-381-0820, slagelperry@chcnrv.org. -To the United States Attorney, Daniel P. Bubar, 310 1st Street, S.W., Room 906, Roanoke, VA 24011, 540-857-2250, Brian.McGinn@usdoj.gov. - To the Substance Abuse and Mental Health Services Administration (SAMHSA) office responsible for opioid treatment program oversight at: SAMHSA Opioid Treatment Program Compliance Officer contact the SAMHSA Center for Substance Abuse Treatment (CSAT) at 866-BUP-CSAT (866-287-2728) or infobuprenorphine@samhsa.hhs.gov. If a patient commits a crime on the premises of the Part 2 Program or against personnel of the Part 2 Program, information related to the commission of that crime is not protected. Reports of suspected child abuse and neglect made under state law to appropriate state or local authorities are not protected. After receiving and reviewing this form, we will ask you to acknowledge that you have received it. If you have any questions about this form or its content, please ask a member of our staff to contact Ashley Slagel-Perry at Community Health Center of the New River Valley, 215 Roanoke St., Christiansburg, VA 24073, 540-381-0820, slagelperry@chcnrv.org.