PRIVACY POLICY

HIPPA - West Ridge Academy

Privacy Practices

(Effective date 8/15/2010)

1.0 General
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, then sign the Acknowledgement of Receipt (Section 2.0, page 6 of this notice), and return the Acknowledgement of Receipt to West Ridge Academy.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements for healthcare organizations concerning the use and disclosure of individual health information. This information, known as protected health information (PHI), includes virtually all individually identifiable health information held by a healthcare organization — whether received in writing, in an electronic medium, or as an oral communication. This notice describes the privacy practices of the behavioral healthcare organization (West Ridge Academy). The organization covered by this notice may share health information in order to carry out Treatment, Payment, or Health Care Operations.

1.1 Our Legal Duty
We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information.

1.2 Uses and Disclosures of PHI
The privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of health care Treatment, Payment, and Health Care Operations. Here are some examples of what that might entail:

Treatment includes providing, coordinating, or managing health care by one (1) or more health care providers or doctors. Treatment also can include coordination or management of care between a provider and a third party, and consultation and referrals between providers. For example, we may share health information about you with physicians who are treating you.
Payment includes activities by this Plan, other plans, or providers to obtain premiums, make coverage determinations and provide reimbursement for health care. This can include eligibility determinations, reviewing services for medical necessity or appropriateness, utilization management activities, claims management, and billing; as well as “behind the scenes” plan functions such as risk adjustment, collection, or reinsurance. For example, we may share information about your coverage or the expenses you have incurred with another health plan in order to coordinate payment of benefits.
Health care operations include activities by this organization (and in limited circumstances other organizations or providers) such as wellness and risk assessment programs, quality assessment and improvement activities, customer service, and internal grievance resolution. Health care operations also include vendor evaluations, credentialing, training, accreditation activities, underwriting, premium rating, arranging for medical review and audit activities, and business planning and development. For example, we may use information about your claims to review the effectiveness of wellness programs.

The amount of health information used or disclosed will be limited to the “Minimum Necessary” for these purposes, as defined under the HIPAA rules. We may also contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

1.3 Other Allowable Uses and Disclosures of PHI
In certain cases, your health information can be disclosed without authorization to a family member, close friend, or other person you identify who is involved in your care or payment for your care. Information describing your location, general condition, or death may be provided to a similar person (or to a public or private entity authorized to assist in disaster relief efforts). You’ll generally be given the chance to agree or object to these disclosures (although exceptions may be made, for example if you are not present or if you are incapacitated). In addition, your health information may be disclosed without authorization to your legal representative.

We are also allowed to use or disclose your health information without your written authorization for uses and disclosures required by law, for public health activities, and other specified situations, including:

Disclosures to Workers’ Compensation or similar legal programs, as authorized by and necessary to comply with such laws
Disclosures related to situations involving threats to personal or public health or safety
Disclosures related to situations involving judicial proceedings or law enforcement activity
Disclosures to a coroner or medical examiner to identify the deceased or determine cause of death; and to funeral directors to carry out their duties
Disclosures related to organ, eye or tissue donation, and transplantation after death
Disclosures subject to approval by institutional or private privacy review boards and subject to certain assurances by researchers regarding necessity of using your health information and treatment of the information during a research project
Certain disclosures related to health oversight activities, specialized government or military functions and Health and Human Services investigations

Except as described in this notice, other uses and disclosures will be made only with your written authorization. You may revoke your authorization as allowed under the HIPAA rules. However, you can’t revoke your authorization if we have taken action relying on it. In other words, you can’t revoke your authorization with respect to disclosures we have already made.

1.4 Your individual rights
You have the following rights with respect to your health information we maintain. These rights are subject to certain limitations, as discussed below. This section of the notice describes how you may exercise each individual right. See the “Contract” section of this notice for information on how to submit requests.

1.4.1 Right to request restrictions on certain uses and disclosures of your health information and we have the right to refuse
You have the right to ask that we restrict the use and disclosure of your health information for Treatment, Payment, or Health Care Operations, except for uses or disclosures required by law. You have the right to ask that we restrict the use and disclosure of your health information to family members, close friends, or other persons you identify as being involved in your care or payment for your care. You also have the right to ask that we restrict use and disclosure of health information, to notify those persons of your location, general condition, or death — or to coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise this right, your request to West Ridge Academy must be in writing.

We are not required to agree to a requested restriction. If we do agree, a restriction may later be terminated by your written request, by agreement between you and us (including an oral agreement), or unilaterally by us for health information created or received after you’re notified that we have removed the restrictions. We may also disclose health information about you if you need emergency treatment, even if we have agreed to a restriction.

1.4.2 Right to receive confidential communications of your health information
If you think that disclosure of your health information by the usual means could endanger you in some way, we will accommodate reasonable requests to receive communications of health information from us by alternative means or at alternative locations.

If you want to exercise this right, your request to us must be in writing and you must include a statement that disclosure of all or part of the information could endanger you. This right may be conditioned on you providing an alternative address or other method of contact and, when appropriate, on you providing information on how payment, if any, will be handled.

1.4.3 Right to inspect and copy your health information
With certain exceptions, you have the right to inspect or obtain a copy of your health information in a “Designated Record Set.” This may include medical and billing records maintained for a health care provider; enrollment, payment, claims adjudication, and case or medical management record systems maintained by a plan; or a group of records we use to make decisions about individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings. In addition, we may deny your right to access, although in certain circumstances you may request a review of the denial. If you want to exercise this right, your request to us must be in writing.

If we do not maintain the health information but know where it is maintained, you will be informed of where to direct your request.

1.4.4 Right to amend your health information that is inaccurate or incomplete
With certain exceptions, you have a right to request that we amend your health information in a Designated Record Set. We may deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by us (unless the person or entity that created the information is no longer available), is not part of the Designated Record Set, or is not available for inspection (e.g., psychotherapy notes or information compiled for civil, criminal, or administrative proceedings). If you want to exercise this right, your request to us must be in writing, and you must include a statement to support the requested amendment.

1.4.5 Right to receive an accounting of disclosures of your health information
You have the right to a list of certain disclosures we have made of your health information. This is often referred to as an “accounting of disclosures.” You generally may receive an accounting of disclosures if the disclosure is required by law, in connection with public health activities, or in similar situations listed in the “Other allowable uses or disclosures of your health information” section of this notice, unless otherwise indicated below. You may be entitled to an accounting of disclosures that we should not have made without authorization.

You may receive information on disclosures of your health information going back for six (6) years from the date of your request, but not earlier than April 14, 2003 (the general date that the HIPAA privacy rules are effective) or April 14, 2004 for the Health Care Reimbursement Account (HCRA) or any EAP that may be subject to HIPAA. You do not have a right to receive an accounting of any disclosures made:

For Treatment, Payment, or Health Care Operations;
To you about your own health information;
Incidental to other permitted or required disclosures;
Where authorization was provided;
To family members or friends involved in your care (where disclosure is permitted without authorization);
For national security or intelligence purposes or to correctional institutions or law enforcement officials in certain circumstances; or
As part of a “limited data set” (health information that excludes certain identifying information).

In addition, your right to an accounting of disclosures to a health oversight agency or law enforcement official may be suspended at the request of the agency or official.

If you want to exercise this right, your request to us must be in writing. You may make one (1) request in any 12-month period at no cost to you, but we may charge a fee for subsequent requests. You’ll be notified of the fee in advance and have the opportunity to change or revoke your request.

1.4.6 Right to obtain a paper copy of this notice from us upon request
You have the right to obtain a paper copy of this Privacy Notice upon request. Even individuals who agreed to receive this notice electronically may request a paper copy at any time by contacting the clinical office.
1.5 Changes To This Notice
We must abide by the terms of the Privacy Notice currently in effect. However, we reserve the right to change the terms of its privacy policies as described in this notice at any time, and to make new provisions effective for all health information that we maintains. This includes health information that was previously created or received, not just health information created or received after the policy is changed. If changes are made to our privacy policies described in this notice, you will be provided with a revised Privacy Notice.

1.6 Complaints
If you believe your privacy rights have been violated, you may complain to us and to the Secretary of Health and Human Services. You won’t be retaliated against for filing a complaint. To file a complaint, please contact us.

1.7 Contact
For more information on our privacy policies or your rights under HIPAA, contact:
West Ridge Academy
Admissions Director
5500 West Bagley Park Road
West Jordan, Utah 84081
Phone: 801-282-1000
Fax: 801-282-1198

To contact the HIPPA Contact Officer at West Ridge Academy regarding a complaint, contact:
West Ridge Academy
Clinical Director

2.0 Acknowledgement of Receipt of Privacy Notice

For: West Ridge Academy

I, __________________________________, have received a copy of this office’s Notice

of Privacy Practices.

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Please Print Name

______________________________________________________
Signature

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Date