NOTICE OF PRIVACY PRACTICES
BRAINS is a mental health facility bound by HIPAA and Recipient Rights regulations. The following is information notifying you of your protections and rights.
BRAINS obtains information about you on first day of service by obtaining the signed consent to treatment (information provided to us or obtained before signing is optional but can help to streamline the intake process). Consent to treatment will typically include your legal name, signature, date of birth, and insurance information. Your patient information is stored as an electronic medical record and on BRAINS’ secure server. BRAINS will only disclose information for purposes of treatment, care coordination, payment, business operation, when required by law, or with your written permission. BRAINS participates with Great Lakes Health Connect, the leading Health Information Exchange (HIE) in Michigan, to advance the delivery and coordination of healthcare. By signing the contract as Guarantor, you consent to care coordination efforts with your referring physician. If you wish to revoke our right to release information to Great Lakes Health Connect, please inform us both verbally and in writing.
Privacy Commitment: The information we collect is private. We are required to give you a notice of our privacy practices. Only people who have both the need and legal right may see your information.
Treatment: We may disclose medical/mental health information about you to coordinate your health care.
Payment: We may use and disclose information so that the care you get can be properly billed and to receive payment.
Business Operation: We may need to use and disclose information for our business operation. For example, we may use information to review the quality of care you have received.
As Required by Law: We will release information when required by law. This could include matters relating to law enforcement, national security, subpoenas or other court orders, communicable diseases, disaster relief, review of our activities by governmental accrediting agencies, and to avert a serious threat to health (suicide/homicide threat), safety (abuse/neglect), or other types of emergencies.
With your permission: If you give us permission in writing, we may use and disclose your personal information. If you give us permission, you have the right to change your mind/revoke it. This must also be in writing. We cannot change any previous disclosures made without your permission.
Exceptions: For certain kinds of records, your permission may be needed even for release for treatment, payment, and business operations.
Your Privacy Rights
You have the following rights regarding the health information we have about you.
Right to inspect and receive a copy of information in the file: In most cases, you have the right to look at or get copies of your records. You may be charged a fee for the cost of copying your records.
Right to Amend: You may ask us to change your records if you feel that there is a mistake. We can deny your request for certain reasons, but we must give you a written reason for our denial.
Right to a list of disclosures: You have the right to ask for a list of disclosures made. This list will not include the times that information was disclosed for treatment, payment, or health care operations. The list will also not provide information shared directly with you, your family, or information that was sent with your authorization.
Right to request restrictions: You have the right to ask for limits on how your information is used or disclosed. We are not required to agree to such requests.
Right to request confidential communications: You have the right to ask that we share information with you in a certain way or in a certain place. For example, you may ask us to send information to your work address instead of your home. If we are concerned with the security of the records being shared in this manner, we will discuss this with you.
Changes to This Notice
We reserve the right to revise this notice. A revised notice will be effective for medical information we already have about you as well as any information we may receive in the future. We are required by law to comply with whatever notice is currently in effect. Any changes to HIPAA or Recipient Rights can be found at www.michigan.gov/som.
Note: Privacy Policies can be different between state and federal standards/laws. The facility will adhere to the more stringent of these policies for privacy rights whenever possible. These policies are adapted as the government deems appropriate, not BRAINS.
How to Use Your Rights
Complaints and communications to us: If you want to exercise your rights under this notice or if you wish to communicate with us about privacy issues/file a complaint, *you can write to:
Attn: Client Rights Advisor
3292 North Evergreen Dr NE
Grand Rapids, MI 49525
*You will not be penalized for filing a complaint. One of the managing partners will contact you regarding your concern.
Complaints to the Federal Government: If you believe that your privacy rights have been violated, you have the right to file a complaint with the federal government. *You may write to:
Office of Civil Rights
Department of Health and Human Services
200 Independence Avenue S.W.
Washington, D.C. 20201
Email: [email protected]
*You will not be penalized for filing a complaint with the federal government.
Electronic Records Security: Electronic records, billing, communication, and other use of technology will be used at BRAINS. We will maintain standards of security and encryption to protect the safety or your record. InSync Patient Portal contains personal and confidential medical records. Unauthorized attempts to access, defeat or circumvent security features, to use the system for other than intended purposes, to deny service to authorized users, to access, obtain, alter, damage, or destroy information, or otherwise to interfere with the system or its operation are prohibited as per federal laws. Evidence of such acts will be disclosed to law enforcement authorities.
Research Purposes: BRAINS will be actively involved in various internal and external research endeavors. We will comply with all research standards and Institutional Review/External Review Board protocols to protect the confidentiality/security of your information.
Copies of this notice: You have the right to receive an additional copy of this notice at any time. Even if you have received this notice electronically, a paper copy will still be provided for you upon request. You can find the Notice of Privacy Practices and Recipient Rights and Responsibilities posted in BRAINS’ waiting area and online at, www.brainspotential.com/new-clients.