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 will refer hereinafter Hallmark Youthcare Richmond, Inc. as the Facility and its employees who have access to patient’s information.

If you have any questions about this Notice please contact: Please contact our main office at (804) 784-2200​.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices calling the admissions office.

1.) Uses and Disclosures of Protected Health Information

Uses and Disclosures of Protected Health Information Based Upon Your Written Consent

You will be asked by the Facility to sign a consent form. Once you have consented to use and disclosure of your protected health information for treatment, payment and healthcare operations by signing the consent form, the Facility will use or disclose your protected health information as described in this Section 1. Your protected health information may be used and disclosed by the Facility, our Facility staff and others outside of the Facility that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the operation of the Facility.

Following are examples of the types of uses and disclosures of your protected healthcare information that the Facility is permitted to make once you have signed our consent form. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our Facility once you have provided consent.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that has already obtained your permission to have access to your protected health information. For example, we would disclose your protected health information, as necessary, to a medical hospital that provides care to you. We will also disclose protected health information to other facilities that may be treating you when we have the necessary permission from you to disclose your protected health information. For example, your protected health information may be provided to a consultant to which you have been referred to ensure that the Facility has the necessary information to diagnose or treat you.

In addition, we may disclose your protected health information from time-to-time to another facility or healthcare provider (e.g., a specialist or laboratory) who, at the request of the Facility, becomes involved in your care by providing assistance with your healthcare diagnosis or treatment by the Facility.

Payment: Your protected health information will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of the Facility. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities.

Visitors will be asked to sign their name and indicate your name and code. We may also call you by name in the lobby.

We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the Facility. Whenever an arrangement between the Facility and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your physician or the Facility has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object

We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, the Facility may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your healthcare will be disclosed.

Facility Directories: Unless you object, we will use and disclose in our room assignment directory your name and the location at which you are receiving care.

Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, legal guardian or any other person you identify, your protected health information that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.

We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, the Facility shall try to obtain your consent as soon as reasonably practical after the delivery of treatment. If the Facility or another facility in the practice is required by law to treat you and the Facility has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your protected health information to treat you.

Communication Barriers: We may use and disclose your protected health information if your physician or another physician in the Facility attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the Facility determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object

We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:

Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products, to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required.

Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Facility’s premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.

Personal Information: Hallmark Youthcare does not sell or share personal information with third parties for marketing/promotional purposes. No mobile information will be shared, sold, or conveyed to third parties for marketing/promotional purposes

2.) Your Rights

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record for as long as we maintain the protected health information. This record contains medical information and any other records that the Facility uses for making decisions about you.

Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to your medical record.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

The Facility is not required to agree to a restriction that you may request. If the Facility believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If the Facility does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with the Facility. You may request a restriction by putting it in writing to the Privacy Officer.

You may have the right to have the Facility amend your protected health information. This means you may request an amendment of protected health information about you in a designated record for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Contact if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for the Facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to obtain a paper copy of this notice from us, upon request.

NOTICE OF PRIVACY PRACTICES

Effective Date:  2/16/2026

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.

This Notice Describes:

HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION.
HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION.

YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH THE PRIVACY CONTACT IF YOU HAVE ANY QUESTIONS.

We will refer hereinafter to Hallmark Youthcare Richmond, Inc. as the Facility and its employees who have access to patients’ information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services.

We are committed to protecting the privacy of your health information. We are required by the Health Insurance Portability and Accountability Act (HIPAA) to: (i) maintain the privacy of your protected health information;  (ii) provide you with the Notice of our legal duties and privacy practices regarding your protected health information; (iii) abide by the terms of the Notice currently in effect; and (iv) notify you in the event of a breach of your unsecured protected health information.

This Notice is prepared in accordance with the regulations governing the privacy of substance use disorder (SUD) treatment records found at 42 CFR Part 2 (“Part 2”).

We may change the terms of our notice, at any time. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling the Admissions Office.

Uses and Disclosures of Protected Health Information

Uses and Disclosures of Protected Health Information Based Upon Your Written Consent

You will be asked by the Facility to sign a consent form. Once you have consented to use and disclosure of your protected health information for treatment, payment and healthcare operations by signing the consent form, the Facility will use or disclose your protected health information as described in this Section 1. Your protected health information and/or SUD Records may be used and disclosed by the Facility, our Facility staff and others outside of the Facility that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the operation of the Facility.

The following are examples of the types of uses and disclosures of your protected healthcare information that the Facility is permitted to make once you have signed our consent form. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our Facility once you have provided consent.

Single Consent and Thereafter of SUD Records: You may provide a single consent for all future uses or disclosures of SUD Records for the purposes of treatment, payment and/or healthcare operations, so that we may use and disclose your SUD Records.  Following consent for treatment, payment and/or healthcare operations, SUD Records may be further disclosed by the Facility without your written consent, as allowed under HIPAA regulations.

Treatment: We will use and disclose your protected health information and/or SUD Records to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that has already obtained your permission to have access to your protected health information and/or SUD Records. For example, we would disclose your protected health information and/or SUD Records, as necessary, to a medical hospital that provides care to you. We will also disclose protected health information to other facilities that may be treating you when we have the necessary permission from you to disclose your protected health information and/or SUD Records. For example, your protected health information may be provided to a consultant to which you have been referred to ensure that the Facility has the necessary information to diagnose or treat you.

In addition, we may disclose your protected health information from time-to-time to another facility or healthcare provider (e.g., a specialist or laboratory) who, at the request of the Facility, becomes involved in your care by providing assistance with your healthcare diagnosis or treatment by the Facility.

Payment: Your protected health information and/or SUD Records will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations: We may use or disclose, as needed, your protected health information and/or SUD Records in order to support the business activities of the Facility. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities.

Visitors will be asked to sign their name and indicate your name and code. We may also call you by name in the lobby.

We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the Facility. Whenever an arrangement between the Facility and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

Other Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization

Other uses and disclosures of your protected health information and/or SUD Records not covered by this Notice will be made only with your written authorization, unless otherwise permitted or required by law as described below. SUD Records are subject to stricter federal confidentiality rules than other health information and in many cases cannot be used or disclosed without your written authorization. Most uses and disclosures of psychotherapy notes and most uses and disclosures for marketing purposes require your authorization before we may use your health information for these purposes. Additionally, with certain limited exceptions, we are not allowed to sell or receive anything of value in exchange for your health information without your written authorization.

You may revoke this authorization, at any time, in writing, except to the extent that your physician or the Facility has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object

We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, the Facility may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your healthcare will be disclosed.

Facility Directories: Unless you object, we will use and disclose in our room assignment directory your name and the location at which you are receiving care.

Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, legal guardian or any other person you identify, your protected health information that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.

We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare. Disclosure of SUD Records is subject to a stricter standard.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, the Facility shall try to obtain your consent as soon as reasonably practical after the delivery of treatment. If the Facility or another facility in the practice is required by law to treat you and the Facility has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your protected health information to treat you. Disclosure of SUD Records is subject to a stricter standard.

Communication Barriers: We may use and disclose your protected health information if your physician or another physician in the Facility attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the Facility determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.

Fundraising Communications: The Facility may use or disclose your records to fundraise for the benefit of the Facility only if you are first provided with a clear opportunity to elect not to receive fundraising communications.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object

We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:

As Required by Law: We may use or disclose your protected health information and/or SUD Records to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

Public Health: We may disclose your protected health information and/or SUD Records for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases: We may disclose your protected health information and/or SUD Records, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: We may disclose protected health information and/or SUD Records to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect: We may disclose your protected health information and/or SUD Records to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your protected health information and/or SUD Records to medical personnel of the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products, to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required.

Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Limits on Use of SUD Records in Legal Proceedings: Your SUD Records, or testimony relaying the content of such records, cannot be used or disclosed in civil, criminal, administrative, or legislative proceedings unless based on your written consent, or a court order after notice and you or the holder of the record are given an opportunity to be heard. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal means requiring disclosure before the requested record is used or disclosed.

Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Facility’s premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information and/or SUD Records may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Public Safety: Consistent with applicable federal and state laws, we may disclose your protected health information and/or SUD Records, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.

Potential Redisclosure of Your Health Information

 Your health information that is disclosed under this Notice may be subject to redisclosure by the recipient. Please be aware that once your health information leaves our control, it may no longer be protected by federal privacy regulations, and its subsequent use may not be limited by the Facility.

Your Rights

The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and copy your protected health information and/or SUD records. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record for as long as we maintain the protected health information. This record contains medical information and any other records that the Facility uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; SUD counseling notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information.

Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to your medical record. We may charge a reasonable fee for copying and mailing costs.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information and/or SUD Records for the purposes of treatment, payment or healthcare operations, or to restrict disclosure to family members or others involved in your care. Your request must state the specific restriction requested and to whom you want the restriction to apply.

The Facility is not required to agree to a restriction that you may request. If the Facility believes it is in your best interest to permit use and disclosure of your protected health information and/or SUD Records, they will not be restricted. If the Facility does agree to the requested restriction, we may not use or disclose your protected health information and/or SUD Records in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with the Facility. You may request a restriction by putting it in writing to the Privacy Officer.

You have the right to request the Facility amend your protected health information. This means you may request an amendment of protected health information and/or SUD Records about you in a designated record for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Contact if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice. It excludes disclosures we may have made to you, for the Facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to request a record of all disclosures of your SUD Records in electronic form for the past 3 years. You have a right to an accounting of all disclosure of other specific information outlined in HIPAA that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to request confidential communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. Please submit a request in writing to our Privacy Contact specifying how or where you wish to be contacted. We will accommodate reasonable requests.

You have the right to a list of disclosures by an intermediary. You have the right to request a list of disclosures by an intermediary for the past 3 years. Your request must specify the disclosing intermediary.

You have the right to obtain a paper or electronic copy of this notice from us, upon request.

You have the right to discuss this Notice. You have the right to discuss the Notice with the Privacy Contact or office.

You have the right to elect not to receive fundraising communications, as discussed above.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer at the contact information below. You will not be retaliated against for filing a complaint.

Contact Information

Privacy Officer
Phone: 352-789-9730
Email:  Jean@AcuteBH.com

To File a Complaint with HHS:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints/

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