This notice describes how medical information about you may be used and disclosed, how certain substance use disorder (SUD) patient records are protected, and how you can get access to this information. Please review it carefully.
Questions about this notice may be directed to the Privacy Officer at (463) 999-9203 or info@empoweryouhealth.org. You have the right to receive a paper or electronic copy of this notice.
When it comes to your health information, you have certain rights. We will help you exercise these rights as required by law.
You may ask to inspect or obtain an electronic or paper copy of your medical record and other health information we maintain about you. We will provide access within the time required by law and may charge a reasonable, cost-based fee when permitted.
You may ask us to correct health information that you believe is incorrect or incomplete. We may deny the request in certain circumstances, but we will explain the reason in writing as required by law.
You may ask us to contact you in a specific way, such as at a particular telephone number, email address, or mailing address. We will accommodate reasonable requests.
You may ask us not to use or share certain health information for treatment, payment, or health care operations. We are generally not required to agree, except in circumstances required by law. If you pay for a health care service or item in full out of pocket, you may ask us not to disclose information about that service or item to your health plan for payment or health care operations, and we will honor the request unless the disclosure is required by law.
You may ask for an accounting of certain disclosures of your health information. The accounting generally covers the six years before your request and does not include every type of disclosure, such as many disclosures for treatment, payment, or health care operations.
You may ask for a paper copy of this notice at any time, even if you previously agreed to receive it electronically.
If a person has legal authority to act on your behalf, such as a legal guardian, health care representative, or person holding an applicable power of attorney, that person may exercise your privacy rights as permitted by law. We may verify that authority before taking action.
If you believe your privacy rights have been violated, you may contact the Privacy Officer at (463) 999-9203 or info@empoweryouhealth.org. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.
For certain health information, you may tell us your preferences about what we share. When applicable, you may tell us whether and how to:
Certain psychotherapy notes and other specially protected records generally require written authorization for uses or disclosures unless an exception under law applies.
We may use your health information and share it with health professionals involved in your care, as permitted by applicable law.
We may use and share health information to bill for services and obtain payment from health plans or other responsible parties, as permitted by applicable law.
We may use and share health information to operate our practice, coordinate services, improve quality, train our workforce, conduct compliance activities, and manage our organization, as permitted by applicable law.
HIPAA and other laws may permit or require us to use or disclose health information without your written authorization in specific circumstances. Depending on the circumstances and applicable law, these may include:
Indiana law and other federal laws may provide additional protection for certain health information, including some mental health, SUD, HIV-related, genetic, and other sensitive information. When another law provides greater privacy protection than HIPAA, we follow the more protective requirement.
Certain records relating to substance use disorder diagnosis, treatment, or referral for treatment may be protected by 42 CFR Part 2 in addition to HIPAA. When Empower You creates or maintains records that are subject to Part 2, we follow the additional confidentiality requirements that apply to those records.
Part 2 records generally require your consent for many uses and disclosures. Where permitted by Part 2, you may provide consent for uses and disclosures for treatment, payment, and health care operations. Part 2 also permits certain uses and disclosures without consent in specifically defined circumstances, such as certain medical emergencies, audits and evaluations, research, reports of suspected child abuse or neglect, certain crimes on program premises or against program personnel, and disclosures authorized by a qualifying court order.
Part 2 records receive special protection in civil, criminal, administrative, and legislative proceedings against a patient. We will not use or disclose Part 2 records, or testify about information from those records, in proceedings against you unless the requirements of Part 2 are satisfied, including your written consent or an appropriate Part 2 court order and other required legal process.
When Part 2 information is disclosed under a valid consent for treatment, payment, or health care operations to a recipient that is subject to HIPAA, that recipient may be permitted to redisclose the information as allowed by HIPAA, subject to Part 2's continuing restrictions on use of the information in legal proceedings against you.
When applicable, you may have additional rights concerning Part 2 records, including rights related to consent, certain disclosure information, and complaints. You may file a Part 2 complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for exercising your rights.
If Empower You operates a federally assisted SUD treatment program subject to Part 2, this Notice is intended to serve as a combined HIPAA Notice of Privacy Practices and Part 2 patient privacy notice for the health information covered by that program.
We may change the terms of this Notice, and the changes may apply to health information we already maintain as well as information we receive in the future. The current Notice will be available upon request, at our offices, and on our website.
Privacy Officer
Empower You Mental Health & Wellness
Phone: (463) 999-9203
Email: info@empoweryouhealth.org
Carmel: 600 E Carmel Dr, Suite 117, Carmel, IN 46032
Indianapolis: 5210 Commerce Circle, Suite B, Indianapolis, IN 46237
Website: www.empoweryouhealth.org
You may also file a privacy complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or through the HHS Office for Civil Rights complaint process.
We will not retaliate against you for filing a complaint or exercising a privacy right.
Patients may be asked to acknowledge receipt or availability of this Notice. Signing an acknowledgment confirms receipt or access to the Notice; it does not authorize special uses or disclosures of health information and is not a condition of receiving care.