Notice of Privacy Practices

Last modified: May 13, 2021

Boulder Care Provider Group, P.A.

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices (the "Notice") describes how Boulder Care Provider Group, P.A. ("we" or "our") may use and disclose your health information in accordance with federal and state law, including 42 U.S.C. § 290dd–2 and 42 C.F.R. Part 2, the Confidentiality of Substance Use Disorder Patient Records (“Part 2”) and the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).This Notice describes our legal obligations and privacy practices with respect to your health information, and also describes your rights to access and control your health information.

PERMITTED USES AND DISCLOSURES OF YOUR HEALTH INFORMATION:

We will obtain your written authorization to use or disclose your health information unless we are permitted or required to disclose your health information in accordance with applicable law, including Part 2 and HIPAA. To the extent any state law or regulation is more restrictive than Part 2 or HIPAA with respect to the use or disclosure of your health information, we will comply with the more restrictive law.

The following are circumstances in which we may use or disclose your health information without your consent:

Within Our Organization: Our personnel who have a need for your information in connection with their duties that arise out of the provision of diagnosis, treatment, or referral for treatment may use and share your information.

Qualified Service Organizations / Business Associates: We may disclose your information to third party “business associates” and “qualified service organizations” that perform various services on our behalf, such as transcription, billing, and collection services, and that agree to protect the privacy of your health information.

Medical Emergencies. In the event of a bona fide medical emergency in which your prior authorization cannot be obtained, we may disclose your identifying information to medical personnel. We will obtain your authorization prior to disclosing your information for non-emergent treatment.

Child Abuse or Neglect. We are obligated to report incidents of suspected child abuse and neglect to the appropriate state or local authorities.

Legal Proceedings. We may disclose your health information pursuant to court orders or other legal proceedings that meet the requirements of applicable law, including Part 2.

Reporting Crimes on Our Premises or Against Our Personnel. We may disclose information related to an individual who commits or threatens to commit a crime on our premises or against our personnel to a law enforcement agency or official. We are permitted to disclose information regarding the circumstances of the incident, including the suspect’s name, address, last known whereabouts, and status as a patient in our program.

Deceased Persons. We may disclose information relating to the cause of death of a patient under laws requiring the collection of death or other vital statistics or permitting inquiry into the cause of death.

Audits. We may disclose your health information to entities who are legally permitted to perform audits of our facilities. Those entities are required to maintain the privacy of your information.

Research. Under certain circumstances, we may disclose your health information to researchers who are conducting a specific research project. Your identifying information will never be published without your written authorization.

FDA Reporting. We may disclose patient identifying information to medical personnel of the Food and Drug Administration (“FDA”) who assert a reason to believe that the health of any individual may be threatened by an error in the manufacture, labeling, or sale of a product under FDA jurisdiction, and that the information will be used for the exclusive purpose of notifying patients or their physicians of potential dangers.

Aggregated or De-Identified Information. We may disclose aggregated information about our participants, and information that does not identify any individual as a participant, in accordance with applicable law.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION:

Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless permitted or required by law. Without your authorization, we are expressly prohibited from using or disclosing your health information for marketing purposes. We may not sell your health information without your authorization. Your health information will not be used for fundraising. If you provide us with an authorization for certain uses and disclosures of your information, you may revoke such authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION:

You have the right to inspect and copy your health information. We will provide a summary or a copy upon request, usually within 30 days.

You may request an amendment of your health information if you think it is incorrect or incomplete; we will review your request and get you an answer within 60 days. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to our statement and we will provide you with a copy of any such rebuttal.

You have the right to request a restriction on the use or disclosure of your health/personal information. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to a restriction that you may request, except if the requested restriction is on a disclosure to a health plan for a payment or health care operations purpose regarding a service that has been paid in full out-of-pocket.

You have the right to request to receive confidential communications from us by alternative means or at an alternate location. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.

You have the right to receive an accounting of certain disclosures of your health information that we have made, paper or electronic, except for certain disclosures which were pursuant to an authorization or certain other purposes.

You have the right to obtain a paper copy of this Notice, upon request, even if you have previously requested its receipt electronically by e-mail.

REVISIONS TO THIS NOTICE:

We reserve the right to revise this Notice and to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. You are entitled to a copy of the Notice currently in effect. Any significant changes to this Notice will be posted on our website. You then have the right to object or withdraw as provided in this Notice.

BREACH OF HEALTH INFORMATION:

We will notify you if a reportable breach of your unsecured protected health information is discovered, in accordance with applicable law. Notification will be made to you no later than 60 days from the breach discovery and will include a brief description of how the breach occurred, the protected health information involved and contact information for you to ask questions.

COMPLAINTS:

Complaints about this Notice or how we handle your health information should be directed to our Privacy Officer at: 111 SW Naito Pkwy, Suite 200, Portland, Oregon 97204. If you are not satisfied with the manner in which a complaint is handled you may submit a formal complaint to the 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/, or with the United States Attorney for the judicial district in which the violation occurs. We will not retaliate against you for filing a complaint.

We must follow the duties and privacy practices described in this Notice. We will maintain the privacy of your health information and to notify affected individuals following a breach of unsecured protected health information. If you have any questions about this Notice, please contact us at (866) 288-5885 and ask to speak with our Privacy Officer.

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

By agreeing to this document, you acknowledge that you have received or been given an opportunity to receive this Notice of Privacy Practices.