THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW SUBSTANCE USE DISORDER RECORDS MAY RECEIVE ADDITIONAL PROTECTION, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice applies to River’s Bend, P.C. and its workforce at the Troy and West Bloomfield locations, including in-person and telehealth services. In this notice, “health information” includes protected health information under HIPAA and, when applicable, substance use disorder patient records protected by 42 CFR Part 2.

Your Rights

When it comes to your health information, you have rights. River’s Bend will help you exercise these rights as required by law.

Get a copy of your medical record

You may ask to inspect or receive 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.

Ask us to correct your record

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 when required.

Request confidential communications

You may ask us to contact you in a specific way or at a specific location. We will accommodate reasonable requests as required by law.

Ask us to limit what we use or share

You may ask us not to use or disclose certain information for treatment, payment, or health care operations. We are not always required to agree. If you pay for a service in full out of pocket, you may ask us not to disclose that service to your health plan for payment or health care operations, unless a law requires the disclosure.

Request an accounting of certain disclosures

You may request a list of certain disclosures of your health information as provided by law. Some disclosures, such as many disclosures for treatment, payment, and health care operations, may not be included.

Get a copy of this notice

You may ask for a paper or electronic copy of this Notice of Privacy Practices at any time.

Choose someone to act for you

If you have given someone medical power of attorney, if someone is your legal guardian, or if another person is authorized by law to act for you, that person may exercise your rights. We will verify the person’s authority before acting.

File a complaint

You may complain if you believe your privacy rights have been violated. River’s Bend will not retaliate against you for filing a complaint. You may contact River’s Bend using the privacy contact information in this notice. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

Your Choices

For certain health information, you may tell us your preferences about what we share. Depending on the information and the law that applies, your choices may include sharing information with family, friends, or others involved in your care, responding to a disaster relief situation, or other uses that require your written permission.

River’s Bend does not sell your protected health information. We do not use your health information for business-partner promotions. If a use or disclosure is not permitted by this notice or by law, we will obtain your written authorization before using or disclosing the information.

How We Typically Use or Share Health Information

Treatment

For health information not subject to 42 CFR Part 2, HIPAA generally permits us to use and disclose health information to provide, coordinate, or manage your treatment. When Part 2 applies, we use or disclose Part 2 records with your consent or as otherwise permitted by Part 2.

Payment

We may use and disclose health information to bill and collect payment for services and to obtain authorization or coverage information. Part 2 records are used or disclosed for payment with consent or as otherwise permitted by Part 2.

Health care operations

We may use and disclose health information to operate River’s Bend, improve quality, train staff, conduct compliance activities, and manage services. Part 2 records are used or disclosed for these purposes with consent or as otherwise permitted by Part 2.

Business associates and contractors

We may share information with vendors and contractors that perform services for us. When HIPAA applies, business associates are required to protect PHI through appropriate agreements. Part 2 contractors must also meet applicable confidentiality requirements.

Other Uses and Disclosures Permitted or Required by Law

Subject to applicable conditions and more protective laws, River’s Bend may use or disclose health information for purposes such as:

• Public health activities and reporting permitted by law
• Health oversight, audits, evaluations, licensing, accreditation, and compliance activities
• Reporting suspected abuse, neglect, or exploitation when required or permitted by law
• Responding to certain legal proceedings, court orders, or law enforcement requests when permitted by law
• Workers’ compensation and other programs authorized by law
• Preventing or reducing a serious and imminent threat to health or safety when disclosure is permitted by law
• Medical emergencies
• Certain research activities that satisfy legal requirements
• Certain activities involving deceased individuals, coroners, medical examiners, or funeral directors
• Other uses or disclosures required by law

Many of these disclosures are subject to specific legal conditions. When a more protective federal or Michigan law applies, River’s Bend follows the more protective requirement.

Additional Protections for Substance Use Disorder Records

Substance use disorder patient records that are maintained by a program subject to 42 CFR Part 2 receive additional confidentiality protections. River’s Bend obtains your consent for most uses and disclosures of Part 2 records unless an exception applies.

• You may provide a consent for future uses or disclosures for treatment, payment, and health care operations as permitted by Part 2.
• With your consent, Part 2 records may be shared with providers or health care organizations for permitted purposes. If a recipient is subject to HIPAA, it may redisclose the information as permitted by HIPAA, subject to Part 2 restrictions that continue to apply to legal proceedings.
• Part 2 records generally may not be used or disclosed in a civil, administrative, criminal, or legislative proceeding against you unless you provide written consent or the requirements for a Part 2 court order and applicable legal process are satisfied.
• Part 2 records may be disclosed without consent in certain limited circumstances, including bona fide medical emergencies, certain audits and evaluations, certain research, child abuse or neglect reporting as required by law, crimes on program premises or against program personnel, and other circumstances permitted by Part 2.

Psychotherapy Notes and Other Sensitive Information

Psychotherapy notes receive special protection under HIPAA and generally require your written authorization for use or disclosure except in limited circumstances. Other federal or Michigan laws may provide additional protection for mental health information, substance use disorder information, genetic information, HIV-related information, and other sensitive records. River’s Bend follows the more protective law when it applies.

Our Responsibilities

• Maintain the privacy and security of your health information as required by law
• Provide you with this notice and follow the duties and privacy practices described in the notice that is currently in effect
• Notify you as required if a breach occurs that may have compromised the privacy or security of your information
• Obtain your written authorization or consent when required by HIPAA, Part 2, Michigan law, or other applicable law
• Allow you to revoke an authorization or consent in writing to the extent permitted by law, except for actions already taken in reliance on it
• Not retaliate against you for exercising your privacy rights or filing a complaint

Changes to This Notice

River’s Bend may change the terms of this notice, and the revised notice may apply to all health information we maintain. A current notice will be available upon request, at River’s Bend offices, and on our website.

Questions, Requests, and Complaints

Privacy Contact: River’s Bend Privacy Officer / Compliance Office

Troy Office 550 Stephenson Highway, Suite 200 Troy, MI 48083 (248) 585-3239 Fax: (248) 616-9759

West Bloomfield Office 7125 Orchard Lake Road, Suite 110 West Bloomfield, MI 48322 (248) 702-6132 Fax: (248) 702-6133

Email: [email protected]  |  Website: www.riversbendpc.com

HHS Office for Civil Rights: www.hhs.gov/hipaa/filing-a-complaint  |  Phone: 1-877-696-6775