Notice of Privacy Practices

Our Commitment to Your Privacy

Amazing Care Counseling and Recovery Agency, LLC ("we," "us," or "the Agency") is a Louisiana Department of Health (LDH) licensed Behavioral Health Services (BHS) provider. We are committed to protecting the privacy of your protected health information ("PHI"). We are required by law to:

• Maintain the privacy and security of your PHI;
• Provide you with this Notice of our legal duties and privacy practices;
• Notify you following a breach of unsecured PHI;
• Follow the terms of the Notice currently in effect; and
• Comply with the Health Insurance Portability and Accountability Act (HIPAA), 45 CFR Parts 160 and 164; the Confidentiality of Substance Use Disorder Patient Records regulation, 42 CFR Part 2; the Louisiana Behavioral Health Services Provider Licensing Standards (LAC 48:I, Chapter 56); and all other applicable state and federal privacy laws.

How We May Use and Disclose Your Information

The following categories describe the ways we may use and disclose your PHI without your written authorization:

• Treatment. We may use and disclose your PHI to provide, coordinate, and manage your behavioral health care, including communicating with other clinicians, primary care providers, and treatment team members involved in your care.
• Payment. We may use and disclose your PHI to obtain payment or reimbursement for services rendered, including verifying insurance eligibility, billing your health plan, and obtaining prior authorization.
• Health Care Operations. We may use your PHI for internal operations such as quality assessment, staff training and supervision, accreditation, licensing, audits, utilization review, and business planning.
• Required by Law. We will disclose PHI when required by federal, state, or local law, including reporting suspected child or elder abuse, neglect, or domestic violence.
• Public Health and Safety. We may disclose PHI to public health authorities, to prevent serious threats to health or safety, and to report adverse events.
• Health Oversight. We may disclose PHI to LDH, the Office of Behavioral Health, the U.S. Department of Health and Human Services, and other agencies authorized to audit or investigate us.
• Judicial and Administrative Proceedings. We may disclose PHI in response to a court order, subpoena, or other lawful process, subject to additional protections under 42 CFR Part 2 for substance use disorder records.
• Coroners, Funeral Directors, and Organ Donation. We may disclose PHI as necessary to carry out their duties.
• Workers' Compensation. We may disclose PHI as authorized by Louisiana workers' compensation laws.
• Business Associates. We may share your PHI with contractors who perform services on our behalf (such as billing, IT, or recordkeeping). All Business Associates are required by written agreement to safeguard your information.

Special Protections for Substance Use Disorder Records

Records identifying you as a person with a substance use disorder are given additional federal protection under 42 CFR Part 2. Generally, we may not say to a person outside the program that you attend the program, or disclose any information identifying you as having a substance use disorder, unless:

• You consent in writing on the form required by 42 CFR Part 2;
• The disclosure is allowed by a court order; or
• The disclosure is made to medical personnel in a bona fide medical emergency, to qualified personnel for research, audit, or program evaluation, or to report a crime committed on program premises or against program personnel.

Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program, or about any threat to commit such a crime. Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.

Uses and Disclosures Requiring Your Written Authorization

The following uses and disclosures require your written authorization, which you may revoke in writing at any time:

• Most uses and disclosures of psychotherapy notes;
• Uses and disclosures for marketing purposes;
• Sale of PHI; and
• Any other use or disclosure not described in this Notice.

Your Rights Regarding Your Health Information

You have the following rights with respect to your PHI:

• Right to Inspect and Copy. You may inspect and obtain a copy of your designated record set, in paper or electronic form, subject to limited exceptions. We may charge a reasonable, cost-based fee.
• Right to Amend. You may request that we amend PHI you believe is incorrect or incomplete. We may deny the request under certain circumstances and will provide a written explanation.
• Right to an Accounting of Disclosures. You may request a list of certain disclosures we have made of your PHI for purposes other than treatment, payment, or health care operations.
• Right to Request Restrictions. You may request restrictions on the use or disclosure of your PHI. We are not required to agree, except where the disclosure is to a health plan for payment or operations and the service has been paid for in full out of pocket.
• Right to Request Confidential Communications. You may request that we communicate with you in a specific way (e.g., only by mail, only at a certain phone number) and we will accommodate reasonable requests.
• Right to a Paper Copy of This Notice. You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
• Right to Be Notified of a Breach. You will be notified following any breach of unsecured PHI.
• Right to 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 PHI.

To exercise any of these rights, please submit your request in writing to our Privacy Officer at the address below.

Changes to This Notice

We reserve the right to change this Notice at any time and to make the revised Notice effective for all PHI we maintain. The current Notice will be posted in our facility, on our website, and made available upon request.

Complaints

If you believe your privacy rights have been violated, you may file a written complaint with our Privacy Officer or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.

Acknowledgment

You have the right to receive a paper copy of this Notice. You may also obtain the most current version on our website at any time.