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.
We are required by law to maintain the privacy of your health information and to give you notices of our legal duties and privacy practices with respect to your protected health information. This Notice summarizes our duties and your rights concerning your protected health information and substance abuse disorder records. Our duties and your rights are set forth more fully in the Health Insurance Portability and Accountability Act (45 C.F.R. part 164) (“HIPAA”) and the federal law and regulations governing the confidentiality of substance abuse disorder records (42 U.S.C. § 290dd-2, 42 C.F.R. Part 2). We are required to abide by the terms of our Notice that is currently in effect.
Summary of Our Responsibilities
- 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.
Avery’s House is committed to protecting your privacy and developing technology that gives you the most powerful and safe online experience. This Statement of Privacy applies to the Avery’s House website and governs data collection and usage. By using the Avery’s House website, you consent to the data practices described in this statement.
For questions, comments or complaints about use of personal information, please contact us:
2416 North 113th St.
Apache Junction, AZ, 85120
Security of your Personal Information
Avery’s House secures your personal information from unauthorized access, use or disclosure. Avery’s House secures the personally identifiable information you provide on computer servers in a controlled, secure environment, protected from unauthorized access, use or disclosure. When personal information (such as a credit card number) is transmitted to other websites, it is protected through the use of encryption, such as the Secure Socket Layer (SSL) protocol.
Collection of your Personal Information
Avery’s House collects personally identifiable information, such as your e-mail address, name, home or work address or telephone number. Avery’s House also collects anonymous demographic information, which is not unique to you, such as your ZIP code, age, gender, preferences, interests and favorites.
There is also information about your computer hardware and software that is automatically collected by Avery’s House. This information can include: your IP address, browser type, domain names, access times and referring website addresses. This information is used by Avery’s House for the operation of the service, to maintain quality of the service, and to provide general statistics regarding use of the Avery’s House website.
Please keep in mind that if you directly disclose personally identifiable information or personally sensitive data through Avery’s House public message boards, this information may be collected and used by others. Note: Avery’s House does not read any of your private online communications.
Avery’s House encourages you to review the privacy statements of websites you choose to link to from Avery’s House so that you can understand how those websites collect, use and share your information. Avery’s House is not responsible for the privacy statements or other content on websites outside of the Avery’s House and Avery’s House family of websites.
Use of your Personal Information
Avery’s House collects and uses your personal information to operate the Avery’s House website and deliver the services you have requested. Avery’s House also uses your personally identifiable information to inform you of other products or services available from Avery’s House and its affiliates. Avery’s House may also contact you via surveys to conduct research about your opinion of current services or of potential new services that may be offered.
Avery’s House does not sell, rent or lease its customer lists to third parties. Avery’s House may, from time to time, contact you on behalf of external business partners about a particular offering that may be of interest to you. In those cases, your unique personally identifiable information (e-mail, name, address, telephone number) is not transferred to the third party. In addition, Avery’s House may share data with trusted partners to help us perform statistical analysis, send you email or postal mail, provide customer support, or arrange for deliveries. All such third parties are prohibited from using your personal information except to provide these services to Avery’s House, and they are required to maintain the confidentiality of your information.
Avery’s House does not use or disclose sensitive personal information, such as race, religion, or political affiliations, without your explicit consent.
Avery’s House keeps track of the websites and pages our customers visit within Avery’s House, in order to determine what Avery’s House services are the most popular. This data is used to deliver customized content and advertising within Avery’s House to customers whose behavior indicates that they are interested in a particular subject area.
Avery’s House websites will disclose your personal information, without notice, only if required to do so by law or in the good faith belief that such action is necessary to: (a) conform to the edicts of the law or comply with legal process served on Avery’s House or the site; (b) protect and defend the rights or property of Avery’s House; and, (c) act under exigent circumstances to protect the personal safety of users of Avery’s House, or the public.
Use and Disclosure Examples
Help manage the health care treatment you receive
We can use your health information and share it with professionals who are treating you.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.
Run our organization
- We can use and disclose your information to run our organization and contact you when necessary.
- We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.
Example: We use health information about you to develop better services for you.
Pay for your health services
- We can use and disclose your health information as we pay for your health services.
Example: We share information about you with your dental plan to coordinate payment for your dental work.
Administer your plan
- We may disclose your health information to your health plan sponsor for plan administration.
Example: a company contracts with us to provide a health plan, and we provide the company with certain statistics to explain the premiums we charge.
How else can we use or share your health information?
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 have to 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.
Help with public health and safety issues
We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
- We can use or share your information for health research.
Comply with the law
- 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.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
- We can share health information about you with organ procurement organizations.
- We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
- 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 such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
- We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Your Rights to Your Personal Health Information
Get a copy of your health and claims records
- You can ask to see or get a copy of your health and claims records 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 and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct health and claims records
- You can ask us to correct your health and claims records if you think they are 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 communications
- 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 consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
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.
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 asked 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.
Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
- 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 make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting us using the information on the back page.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696- 6775, or visiting www.hhs.gov/ocr/privacy/hipaa/ complaints/.
- We will not retaliate against you for filing a complaint.
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 payment for your care
- Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, 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
- Sale of your information
What We Do Not Do With Your Information
Information about your financial situation and medical conditions and care that you provide to us in writing, via email, on the phone (including information left on voicemails), contained in or attached to applications, or directly or indirectly given to us, is held in strictest confidence.
We do not give out, exchange, barter, rent, sell, lend, or disseminate any information about applicants or clients who apply for or actually receive our services that are considered patient confidential, restricted by law, or specifically restricted by a patient/client in a signed HIPAA consent form.
Uses and Disclosures of Information That We May Make Without Your Written Authorization
Information is only used as is reasonably necessary to process your application or to provide you with health or counseling services which may require communication between SpringBoard and health care providers, medical product or service providers, pharmacies, insurance companies, and other providers necessary to verify your medical information is accurate and determine the type of medical supplies or health care services you need. This is including, but not limited to, or to obtain or purchase any type of medical supplies, devices, medications, or insurance.
If you apply or attempt to apply to receive assistance through us and provide information with the intent or purpose of fraud or that results in either an actual crime of fraud for any reason including willful or un-willful acts of negligence whether intended or not, or in any way demonstrates or indicates attempted fraud, your non-medical information can be given to legal authorities including police, investigators, courts, and/or attorneys or other legal professionals, as well
We may use or disclose your protected health information for the following purposes without your written authorization:
Internal Program Communications
Our personnel may disclose your health information between or among themselves if they have a need for the information in connection with their duties that arise out of the provision of diagnosis, treatment, or referral for treatment of patients with substance use disorders.
Crimes on Program Premises or Against Program Personnel
We may disclose your health information to law enforcement officers to the extent the disclosure is directly related to crimes and threats to commit crimes on our premises or against our personnel.
Child Abuse Reporting
We may disclose your health information as required by state law to report suspected child abuse and neglect to appropriate state or local governmental authorities.
We may disclose your health information to medical personnel to the extent necessary to meet a bona fide medical emergency in which your prior informed consent for the disclosure cannot be obtained.
We may disclose your health information in response to a valid court order.
Audit and Evaluation Activities
We may disclose your health information to qualified persons who are conducting an audit or evaluation of our program.
We may disclose your health information for medical research purposes, subject to your authorization or approval by an institutional review board.
Qualified Service Organizations and/or Business Associates
We may disclose your health information under contracts for services with qualified service organizations and/or business associates outside of our program, which assist our program in providing health care.
Appointments and Services
We may use or disclose your health information to send you appointment reminders, or to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. Please advise us if you do not wish to receive such communications, and we will not use or disclose your information for such purposes. If you wish not to receive this kind of communication, you must advise us in writing at our contact address given above.
Uses and Disclosures of Information That We May Make With Your Written Authorization
We may use and disclose protected health information in the following instances only with your written authorization:
With your written authorization, we may disclose your protected health information to healthcare providers outside our program so that they may help treat you.
With your written authorization, we may use or disclose your protected health information so that we, or other healthcare providers, may obtain payment for treatment provided to you. For example, we may disclose information from your medical records to your health insurance company to obtain pre-authorization for treatment or submit a claim for payment.
With your written authorization, we may use or disclose your protected health information for certain healthcare operations that are necessary to run our program and ensure that our patients receive quality care. For example, we may use information from your medical records to review the performance or qualifications of physicians and staff; train staff; or make business decisions affecting the program.
Notes recorded by your mental health professional documenting the contents of a counseling session with you, which are known as “psychotherapy notes,” will be used only by your provider and will not otherwise be used or disclosed without your written authorization unless otherwise required by law.
We will not use your health information for marketing communications without your written authorization.
Limited Right to Use Non-Identifying Personal Information From Biographies, Letters, Notes, and Other Sources:
Any pictures, stories, letters, biographies, correspondence, or thank you notes sent to us become the exclusive property of SpringBoard. We reserve the right to use non-identifying information about our clients (those who receive services or goods from or through us) for fundraising and promotional purposes that are directly related to our mission.
Clients will not be compensated for use of this information and no identifying information (photos, addresses, phone numbers, contact information, last names or uniquely identifiable names) will be used without the client’s express advance permission.
You may specifically request that NO information be used whatsoever for promotional purposes, but you must identify any requested restrictions in writing. We respect your right to privacy and assure you no identifying information or photos that you send to us will ever be publicly used without your direct or indirect consent.
The Avery’s House website use “cookies” to help you personalize your online experience. A cookie is a text file that is placed on your hard disk by a webpage server. Cookies cannot be used to run programs or deliver viruses to your computer. Cookies are uniquely assigned to you, and can only be read by a web server in the domain that issued the cookie to you.
One of the primary purposes of cookies is to provide a convenience feature to save you time. The purpose of a cookie is to tell the web server that you have returned to a specific page. For example, if you personalize Avery’s House pages, or register with Avery’s House site or services, a cookie helps Avery’s House to recall your specific information on subsequent visits. This simplifies the process of recording your personal information, such as billing addresses, shipping addresses, and so on. When you return to the same Avery’s House web site, the information you previously provided can be retrieved, so you can easily use the Avery’s House features that you customized.
You have the ability to accept or decline cookies. Most web browsers automatically accept cookies, but you can usually modify your browser setting to decline cookies if you prefer. If you choose to decline cookies, you may not be able to fully experience the interactive features of the Avery’s House services or websites you visit.
Changes to this Statement
Avery’s House will occasionally update this Statement of Privacy to reflect company and customer feedback. Avery’s House encourages you to periodically review this Statement to be informed of how Avery’s House is protecting your information.