Privacy STatement

35% off when you mention code FIRSTVISIT

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective April 14, 2003, Little Peace of Hafen llc. is required by law to maintain the privacy of your medical information, provide this notice to you, and abide by the terms of this notice.

How We Use Your Health Information

When you receive care from Little Peace of Hafen, we may use your health information for treating you, billing for services, and conducting our normal business known as health care operations. Examples of how we use your information include:

Treatment

We keep records of the care and services provided to you. Health care providers use these records to deliver quality care to meet your needs. For example, your therapist may share your health information with another practitioner who will assist in your treatment. Some health records, including confidential communications with other mental health professionals or substance abuse treatment records may have additional restrictions for use and disclosure under state and federal laws.

Payment

We keep billing records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment from you or other third party payers. We may also contact your third party payer to verify coverage for your care or to notify them of upcoming services that may need prior notice or approval. For example, we may disclose information about the services provided to you to claim and obtain payment from your third party payer. If you pay full cash price for services, you may request a restriction of information to your third party payer.

Health Care Options

We use health information to improve the quality of care, train staff and students, provide customer service, manage costs, conduct required business duties, and make plans to better serve our communities. For example, we may use your health information to evaluate the quality of treatment and services provided by our therapists, psychiatrists, psychologists, case managers, and other health care workers.

Other Services We Provide

We may also use your health information to recommend treatment alternatives, tell you about health services and products that may benefit you, share information with family and friends involved in your care (authorized by you through a written release), share information with third parties who assist us with treatment, payment, and health care operation, and remind you of an appointment. By signing the acknowledgement form that you received this form, you authorize us to view your medication history.

Your Individual Rights

You have the right to:

Request restrictions on how we use and share your health information. We will consider all requests for restrictions carefully, but are not required to agree to any restriction.
Request that we use a specific telephone number or address to communicate with you.
Inspect and copy your health information, including billing records. There is a charge of $.25 per page copied. Under limited circumstances, we may deny you access to a portion of your health information and you may request a review of the denial.*
Request corrections or additions to your health information.*
Request an accounting of certain disclosers of your health information made by us. The accounting does not include disclosers made for treatment, payment, and health care operations and some disclosures required by law. Your request must state the period of time desired for the accounting, which must be within the six years prior to your request and excludes dates prior to April 14, 2003. The first accounting is free, but a fee will apply if more than one request is made in a 12 month period.*

All other uses and disclosers, not described in this notice, require your signed authorization. You may revoke your authorization at any time with the written statement. The following are examples:

Our Privacy Responsibilities

Little Peace of Hafen, llc., is required by law to:

Contact Us

If you would like further information about your privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that we made about access toyour health information please email Little Peace of Hafen at Info@littlepeaceofhafen.com or visit our office 459 E 1000 S Pleasant Grove, 84062 . We will investigate all complaints and will not retaliate against you for filing a complaint. You may also file a written complaint with the Office of Civil Rights, 200 Independence Avenue, S.W. Room 509F HHH Bldg., Washington, D.C. 20201.