NOTICE TO CLIENTS: THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY.

LifeNet is committed to protecting Client privacy and understands the importance of safeguarding client health information under Federal law. Client information about client past, present, or future health, the healthcare or mental health care received, or the payment for the healthcare is called “Protected Health Information”. LifeNet is required by law to protect the personal health information that we receive or create and to give clients this notice. LifeNet reserves the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information. Clients will receive a copy of any changes to this notice upon request. This notice is effective as of April 14, 2003.

Use and Sharing of Your Protected Health Information –We may share your protected health information without your written permission (authorization) for the following:

1. For treatment: We can use or disclose client health information to provide, coordinate, or manage health care or related services. This includes providing care to you, consulting with another health care provider about you, and referring you to another health care provider. For example, your information may be shared with the pharmacist filling your prescriptions or with another healthcare agency to which you are referred. You may also be contacted by LifeNet to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you unless you request otherwise.
2. For payment: Your protected health information may be released to your insurance provider (Value Options, Medicaid, Medicare, etc.) for the purpose of LifeNet receiving payment for providing you with needed healthcare services. We may also give information to persons who help pay for your care.
3. For health care operations: Your protected health information may be used in healthcare operations. For example, activities to improve health care, evaluating programs; case management and care coordination; reviewing the competence, qualifications, performance of health care professionals; conducting training programs and resolving internal grievances; conducting accreditation, certification, licensing, or credentialing activities; providing medical review, legal services, or auditing functions; and engaging in business planning and management or general administration.
4. When required by law: LifeNet will share protected health information about you when required by federal, state, or local law. Your protected health information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
5. For emergencies: Your protected health information may be released to other healthcare providers in the event you need emergency care.
6. For public health activities: Your protected health information may be released to a pubic health authority or federal organization that is permitted by law to collect information in the event of a communicable disease, defective healthcare device or problems with a biological product (food or medication).
7. For research: Your protected health information may be disclosed to researchers when the research is being conducted under established protocols to ensure the privacy of your information.
8. Relating to deaths: Your protected health information may be disclosed to a coroner, medical examiner, or funeral director if it is needed to carry out their duties.
9. For health oversight activities: Your protected health information may be shared with an agency responsible for monitoring the health care system for activities authorized by law. These activities may include audits, investigations, inspections, and licensing.
10. To prevent threats to health or safety: In order to avoid a serious threat to health or safety, we may share protected health information with law enforcement or other persons who might prevent or reduce the threat of harm.
11. To law enforcement: Your protected health information may be released if asked to do so by a law enforcement official:
    • In response to a court order, subpoena, warrant, summons, or similar process;
    • To identify or locate a suspect, fugitive, material witness, or missing person;
    • About a death we believe may be the result of criminal conduct;
    • About criminal conduct on LifeNet premises (clinic or housing); and
    • In emergency situations to report a crime, the location of the crime or victims; or the identity, description, or location of the person who committed the crime..
12. For lawsuits and disputes: If you are involved in a lawsuit or dispute, we may disclose protected health information about you in response to a subpoena, discovery request or other lawful request by someone else involved in the dispute, but only if efforts have been made to tell you about the request (written or telephone) or to obtain an order protecting the information requested.
13. For government purposes: LifeNet may share the protected health information of military personnel and veterans in certain situations, with correctional facilities in certain situations, with other government programs for eligibility and enrollment, and for national security reasons.

Your Rights Regarding Your Protected Health Information

1. Your protected health information may not be released for any other purpose than that which is identified in this notice.
2. Your protected health information may be released only after receiving written authorization from you except for the purposes of treatment, payment, healthcare operations and other purposes on the first page of this notice.
3. You may revoke your authorization to release confidential healthcare information at any time.
4. LifeNet may contact you for the purposes of raising funds to support LifeNet’s operations. You will not be asked to make any contributions but you may be asked to volunteer your success stories, satisfaction surveys, or pictures.
5. You have the right to restrict the use of your protected health information. However, LifeNet may choose to refuse your restriction if it is in conflict of providing you with quality healthcare or in the event of an emergency situation.
6. You have the right to receive confidential communication about your health status.
7. You have the right to review and photocopy any/all portions of your healthcare information. LifeNet must release the information to you within 30 days of your written request (or 60 days if stored off site). We may charge you a reasonable fee to cover copying costs. In addition, there may be situations where we may decide to deny your request for access. We will not provide access to psychotherapy notes, information we collect for legal reasons, or if we believe the disclosure will endanger your life or health or that of another person. If we deny your request, you will be informed of the reasons for the denial and explain your appeal rights. You may choose to get a summary instead of a copy of the whole record.
8. You have the right to request changes to your healthcare information. This means you may submit a written request that we correct or add information to our records. We will respond to your request within 60 days (with up to a 30-day extension, if needed). We may deny your request if we determine that your protected health information is accurate and complete, was not created by us and/or is not part of our records, or is a type of information that we cannot disclose. If we deny your request, we will give you a written explanation including your rights to have your request and our denial part of your record. If we approve the request to change information we will not destroy or change our records, but we will add the correct information to your records and make a note in your records that you have provided the information.
9. You have the right to know who has accessed your protected health information and for what purpose. There will be no charge for one list per year. The list of disclosures given to you will not include the following disclosures:
   1. Used to provide patient care, payment for services or healthcare operations,
   2. Provided to you, the client,
   3. Provided to employees responsible for the your care,
   4. Provided to national security or intelligence,
   5. If provided to correctional facilities or law enforcement officials, and
   6. Accessed prior to April 14, 2003.
10. You have the right to possess a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
11. LifeNet is required by law to protect the privacy of its clients. It will keep confidential any and all patient healthcare information and will provide clients with a list of duties or practices that protect confidential healthcare information.
12. We will not disclose information about you related to testing for Human Immunodeficiency Virus or Acquired Immune Deficiency Syndrome without your specific written permission, unless the law allows or requires us to disclose the information.

Your Rights Regarding Your Protected Health Information about your treatment for alcohol and drug abuse

If you are also being treated for alcohol or drug abuse, your records are protected by federal law and regulations found in the Code of Federal Regulations at Title 42, Part 2. LifeNet will not tell any unauthorized person outside of LifeNet that you are being treated for alcohol or drug abuse, without your written permission. We will not disclose any information identifying you as an alcohol, drug, or substance user, except as allowed by law. LifeNet may only disclose information about your treatment for alcohol or drug abuse without your permission in the following circumstances:

1. Pursuant to a special court order that complies with 42 Code of Federal Regulations Part 2 Subpart E;
2. To medical personnel in a medical emergency;
3. To qualified personnel for research, audit, or program evaluation;
4. To report suspected child abuse or neglect; or
5. To Advocacy, Inc. and/or the Texas Department of Protective and Regulatory Services, as allowed by law, to investigate a report that you have been abused or have been denied your rights.

Federal and State laws prohibit re-disclosure of information about alcohol or drug abuse treatment without your permission. Federal rules restrict any use of information about alcohol or drug abuse treatment to criminally investigate or prosecute any alcohol or drug abuse patient.

Your Right to Make a Complaint

1. You have the right to complain to LifeNet if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please submit your complaint in writing to LifeNet’s Client Rights Protection Officer. You must file your complaint within 180 days of when you knew or should have known about the event that you think violated your privacy rights. We will not discriminate against you for filing a complaint with LifeNet. All complaints will be investigated.
   
   ATTN: Anna Lucchesi
   Clinical Director
   LifeNet Community Behavioral Healthcare
   9708 Skillman Street
   Dallas, TX 75243-5150
   214-221-1934 alucchesi@lifenettexas.org.
   
   
2. You may also file a complaint with:
   North Texas Behavioral Health Authority (NTBHA) 

   1201 Richardson Drive, Suite 270

   Richardson, Texas 77508

   1-877-653-6363 (Toll Free) 

   or 214-366-9407
   U.S. Dept. of Health and Human Services 

   1301 Young Street, Suite 1169 

   Dallas, TX 75202 

   (214) 767-4056 

   (214) 767-8940 (TDD) 

   (800) 368-1019 (toll free OCR Hotline)
   
   
3. For complaints against alcohol or drug abuse treatment programs, contact the United States Attorney’s Office for the judicial district in which the violation occurred.
   
   United States Attorney – Northern District of Texas
   1100 Commerce St., 3rd floor
   Dallas, TX 75242-1699
   (214) 659-8600

For further information about this Privacy Notice, please contact:

Shea Abraham,
LifeNet Health Information Manager
214-932-1989
sabraham@lifenettexas.org