Privacy Policy
Fenton Behavioral Health Services, L.L.C., NOTICE OF PRIVACY PRACTICES:
PLEASE REVIEW THE FOLLOWING NOTICE OF PRIVACY PRACTICES CAREFULLY, AS THIS
PRIVACY NOTICE IS REQUIRED TO BE GIVEN TO YOU BY THE HEALTH INSURANCE
PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) of 1996. THIS NOTICE DESCRIBES
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION.
TREATMENT AND PAYMENT:
Fenton Behavioral Health Services (FBHS) may, in whole or part, use or disclose your protected health
information for various reasons without your consent or authorization. (Note: Your health care
information relates to your past, present or future physical or mental health condition). For example, and
not limited to, consulting a primary care physician. FBHS will use your protected health information to
contact your health insurance provider for coverage confirmation and reimbursement for provided
treatment. You have the right to have access to this information and object to uses and disclosures of
your protected health care information.
NOTE: FBHS uses either a secure electronic billing process or the USPS system for reimbursement
purposes, and filing claims, These processes are compliant with the HIPPA electronic transaction
regulation requirements. FBHS billing processes will use your protected health information to obtain
payment for the services provided to you while you were on the premises, this includes communication
with your insurance carrier for approval of treatment provided.
HEALTH CARE SERVICES AND PRACTICES:
The "Health Care Operations" of FBHS, relates to your protected health care information in that it may
be used or disclosed to assist the function of FBHS. They may be used or disclosed for some or all of the
following:
Administrative activities/ Business management
Medical reviews, legal services, auditing and/or reviews of compliance
Training of students, employees or practitioners involved in the health care field
Employee reviews
Quality improvement
Credentialing, accreditation, licensing or certification
Fenton Behavioral Health Services may also use or disclose your protected health information to: --
Contact you to cancel, reschedule or remind you of an appointment. This includes (and not necessarily
in this order): Using the phone number(s) that you have provided to FBHS to contact you. Using our
practice name to identify ourselves as the caller. Asking for you specifically by first and last name and,
in the event that you are not available to receive our call, we will leave a message with the recipient of
our phone call or on an answering service device. The nature of your appointment with FBHS will be
kept in strictest confidence. If you have a specific request regarding how we may contact you, please
submit a written request to Fenton Behavioral Health Services. This request must include the following:
The phone number(s) where you wish to be contacted in order for us to cancel, reschedule or remind you
of an appointment.
WITHOUT YOUR CONSENT OR AUTHORIZATION:
There are some instances where FBHS may be required, by the Federal Policy Rules law, to use or
disclose your protected health care information beyond treatment, operations or payment, without your
authorization or objection. They are as follows:
(1) When legally required, by Federal, State or local laws Fenton Behavioral Health Services will use or
disclose your protected health care information
(2) To report abuse or neglect. This includes, with great respect to professional judgment, that either you
have been the victim of abuse or neglect or that you have perpetrated abuse or neglect of another
person or persons
(3) For criminal investigations, audits, inspections
(4) When there is a risk to the public such as:
Notification of a person who has been exposed to a communicable disease
To report disease (in order to prevent or control it as permitted by law)
(5) Fenton Behavioral Health Services may be required to use or disclose your protected health care
information to a law enforcement official:
To report a crime. This includes, with great consideration to professional judgment, that you either
have recently been the victim of a crime or have carried out activities that would deem in
necessary to summons the attention, intervention, assistance or evaluation of a law enforcement
official
To pursue court orders (summons, warrant, subpoena)
To report physical injuries. This includes, with great respect to professional judgment, that you have
sustained physical injuries that require the attention, intervention, assistance or evaluation of a
professionally trained medical personnel
To identify a missing person or a suspect. This includes, with great respect to professional judgment,
that you have either been reported as a missing person or are suspected to be involved in a case
where another person has been reported as missing
(6) Fenton Behavioral Health Services may also use or disclose your protected health information in the
event that we believe your health or safety or that of the public is in jeopardy
(7) Fenton Behaviors Health Services may also use or disclose your protected health information for
worker's compensation issues to comply with the worker's compensation laws.
WHERE YOUR PROTECTED HEALTH CARE INFORMATION CAN BE USED WITHOUT
YOUR AUTHORIZATION BUT WHERE YOU MAY OBJECT:
The following are circumstances where Fenton Behavioral Health Services may use or disclose your
protected health information without your authorization but where you may object:
In the event that Fenton Behavioral Health Services needs to contact a family member or close friend
that is involved in your care in order to: Notify others of your condition if it is probably harmful to
you or others, or of your death.
Fenton Behavioral Health Services will not disclose your protected health information for other reasons
not covered in this notice without your written authorization unless otherwise required by law, as stated
above, and you have the right to:
Obtain a paper copy of this notice in addition to the one you may have already received from Fenton
Behavioral Health Services A copy of your protected health information. These records will include
records your therapist uses for making decisions regarding your care and treatment and billing
records. These records will not include psychotherapy notes, information for use in a civil, criminal
or administrative action or proceeding and/or protected information to which access is prohibited by
law. NOTE: if you would like a copy of your protected health information or would like to inspect
them, you must submit a written request. Fenton Behavioral Health Services may charge you a fee
for any administrative costs incurred in this process.
Request a restriction on uses and disclosures of your protected health information. This request must
be in writing and specify the information you would like restricted. Fenton Behavioral Health
Services is not required to agree to a restriction that you request and will notify you with a
written reason why your request was denied. You may submit a written disagreement regarding
your denied request. If Fenton Behavioral Health Services does agree with your restrictions,
Fenton Behavioral Health Services may violate that agreement if deemed necessary by law.
Have your protected health information amended by your therapist if you feel this information is
incomplete or incorrect. This request must be made in writing, specifying the information you
request to be amended. This request may be denied by Fenton Behavioral Health Services and
you will be provided with a written reason why your request was denied. You may submit a
written disagreement regarding your denied request.
To receive a notice ("accounting") if your protected health care information is used for other
purposes other than treatment, payment, or health care operations.
Your records cannot be inspected or copied by you if Fenton Behavioral Health Services believes, with
great respect to professional judgment, that this inspection or copy may endanger your life or that of
another person.
Fenton Behavioral Health Services is required by law to maintain the privacy of your protected health
information and provide you with this "NOTICE OF PRIVACY". Fenton Behavioral Health Services
reserves the right to change the terms of this notice. If this were to occur, you will receive a copy of the
revised addition.
In the event that you wish to air a complaint regarding Fenton Behavioral Health Services and/or your
privacy rights in any way, you have the right to do so. Please contact Fenton Behavioral Health Services
(810) 629-4224.
Thank you for your time in reviewing this Notice of Privacy Practices.
Sincerely,
Fenton Behavioral Health Services, L.L.C.
1122 N. Leroy St., Suite C., Fenton, MI 48430
PRIVACY NOTICE IS REQUIRED TO BE GIVEN TO YOU BY THE HEALTH INSURANCE
PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) of 1996. THIS NOTICE DESCRIBES
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION.
TREATMENT AND PAYMENT:
Fenton Behavioral Health Services (FBHS) may, in whole or part, use or disclose your protected health
information for various reasons without your consent or authorization. (Note: Your health care
information relates to your past, present or future physical or mental health condition). For example, and
not limited to, consulting a primary care physician. FBHS will use your protected health information to
contact your health insurance provider for coverage confirmation and reimbursement for provided
treatment. You have the right to have access to this information and object to uses and disclosures of
your protected health care information.
NOTE: FBHS uses either a secure electronic billing process or the USPS system for reimbursement
purposes, and filing claims, These processes are compliant with the HIPPA electronic transaction
regulation requirements. FBHS billing processes will use your protected health information to obtain
payment for the services provided to you while you were on the premises, this includes communication
with your insurance carrier for approval of treatment provided.
HEALTH CARE SERVICES AND PRACTICES:
The "Health Care Operations" of FBHS, relates to your protected health care information in that it may
be used or disclosed to assist the function of FBHS. They may be used or disclosed for some or all of the
following:
Administrative activities/ Business management
Medical reviews, legal services, auditing and/or reviews of compliance
Training of students, employees or practitioners involved in the health care field
Employee reviews
Quality improvement
Credentialing, accreditation, licensing or certification
Fenton Behavioral Health Services may also use or disclose your protected health information to: --
Contact you to cancel, reschedule or remind you of an appointment. This includes (and not necessarily
in this order): Using the phone number(s) that you have provided to FBHS to contact you. Using our
practice name to identify ourselves as the caller. Asking for you specifically by first and last name and,
in the event that you are not available to receive our call, we will leave a message with the recipient of
our phone call or on an answering service device. The nature of your appointment with FBHS will be
kept in strictest confidence. If you have a specific request regarding how we may contact you, please
submit a written request to Fenton Behavioral Health Services. This request must include the following:
The phone number(s) where you wish to be contacted in order for us to cancel, reschedule or remind you
of an appointment.
WITHOUT YOUR CONSENT OR AUTHORIZATION:
There are some instances where FBHS may be required, by the Federal Policy Rules law, to use or
disclose your protected health care information beyond treatment, operations or payment, without your
authorization or objection. They are as follows:
(1) When legally required, by Federal, State or local laws Fenton Behavioral Health Services will use or
disclose your protected health care information
(2) To report abuse or neglect. This includes, with great respect to professional judgment, that either you
have been the victim of abuse or neglect or that you have perpetrated abuse or neglect of another
person or persons
(3) For criminal investigations, audits, inspections
(4) When there is a risk to the public such as:
Notification of a person who has been exposed to a communicable disease
To report disease (in order to prevent or control it as permitted by law)
(5) Fenton Behavioral Health Services may be required to use or disclose your protected health care
information to a law enforcement official:
To report a crime. This includes, with great consideration to professional judgment, that you either
have recently been the victim of a crime or have carried out activities that would deem in
necessary to summons the attention, intervention, assistance or evaluation of a law enforcement
official
To pursue court orders (summons, warrant, subpoena)
To report physical injuries. This includes, with great respect to professional judgment, that you have
sustained physical injuries that require the attention, intervention, assistance or evaluation of a
professionally trained medical personnel
To identify a missing person or a suspect. This includes, with great respect to professional judgment,
that you have either been reported as a missing person or are suspected to be involved in a case
where another person has been reported as missing
(6) Fenton Behavioral Health Services may also use or disclose your protected health information in the
event that we believe your health or safety or that of the public is in jeopardy
(7) Fenton Behaviors Health Services may also use or disclose your protected health information for
worker's compensation issues to comply with the worker's compensation laws.
WHERE YOUR PROTECTED HEALTH CARE INFORMATION CAN BE USED WITHOUT
YOUR AUTHORIZATION BUT WHERE YOU MAY OBJECT:
The following are circumstances where Fenton Behavioral Health Services may use or disclose your
protected health information without your authorization but where you may object:
In the event that Fenton Behavioral Health Services needs to contact a family member or close friend
that is involved in your care in order to: Notify others of your condition if it is probably harmful to
you or others, or of your death.
Fenton Behavioral Health Services will not disclose your protected health information for other reasons
not covered in this notice without your written authorization unless otherwise required by law, as stated
above, and you have the right to:
Obtain a paper copy of this notice in addition to the one you may have already received from Fenton
Behavioral Health Services A copy of your protected health information. These records will include
records your therapist uses for making decisions regarding your care and treatment and billing
records. These records will not include psychotherapy notes, information for use in a civil, criminal
or administrative action or proceeding and/or protected information to which access is prohibited by
law. NOTE: if you would like a copy of your protected health information or would like to inspect
them, you must submit a written request. Fenton Behavioral Health Services may charge you a fee
for any administrative costs incurred in this process.
Request a restriction on uses and disclosures of your protected health information. This request must
be in writing and specify the information you would like restricted. Fenton Behavioral Health
Services is not required to agree to a restriction that you request and will notify you with a
written reason why your request was denied. You may submit a written disagreement regarding
your denied request. If Fenton Behavioral Health Services does agree with your restrictions,
Fenton Behavioral Health Services may violate that agreement if deemed necessary by law.
Have your protected health information amended by your therapist if you feel this information is
incomplete or incorrect. This request must be made in writing, specifying the information you
request to be amended. This request may be denied by Fenton Behavioral Health Services and
you will be provided with a written reason why your request was denied. You may submit a
written disagreement regarding your denied request.
To receive a notice ("accounting") if your protected health care information is used for other
purposes other than treatment, payment, or health care operations.
Your records cannot be inspected or copied by you if Fenton Behavioral Health Services believes, with
great respect to professional judgment, that this inspection or copy may endanger your life or that of
another person.
Fenton Behavioral Health Services is required by law to maintain the privacy of your protected health
information and provide you with this "NOTICE OF PRIVACY". Fenton Behavioral Health Services
reserves the right to change the terms of this notice. If this were to occur, you will receive a copy of the
revised addition.
In the event that you wish to air a complaint regarding Fenton Behavioral Health Services and/or your
privacy rights in any way, you have the right to do so. Please contact Fenton Behavioral Health Services
(810) 629-4224.
Thank you for your time in reviewing this Notice of Privacy Practices.
Sincerely,
Fenton Behavioral Health Services, L.L.C.
1122 N. Leroy St., Suite C., Fenton, MI 48430