CRISIS LINE 800-643-1102

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

When you receive treatment or benefits (such as Medicaid) from Border Region MHMR Community Center (BRMHMRCC).BRMHMRCC will obtain and/or create health information about you.  Health information includes any information that relates to (1) your past, present, or future physical or mental health or condition; (2) the health care provided to you; or (3) the past, present, or future payment for your health care.

The following notice tells you about BRMHMRCC’s duty to protect your health information, your privacy rights, and how BRMHMRCC may use or disclose your health information
 

BRMHMRCC’s Duties
	BRMHMRCC is required by law to protect the privacy of your health information.  This means that BRMHMRCC will not use or disclose your health information without your permission except in the ways we tell you in this notice.  BRMHMRCC will safeguard your health information and keep it private.  This protection applies to all health information BRMHMRCC has about you, no matter when you received services.  BRMHMRCC will not allow anyone to interview, photograph, film, or record you without your written permission.  BRMHMRCC will not tell anyone if you are receiving or have ever received services from BRMHMRCC, unless the law allows BRMHMRCC to disclose that information.
	BRMHMRCC will ask you for your written permission to use or disclose your health information unless BRMHMRCC is allowed to use or disclose your health information without your permission, as stated in this notice.  If you give your permission for BRMHMRCC to use or disclose your health information, you may revoke it at any time, but BRMHMRCC will not be liable for uses or disclosures made before you revoked your permission.  To revoke your permission, send a written statement, signed by you, to the privacy coordinator at a BRMHMRCC facility, saying that you want to revoke your permission
	BRMHMRCC is required to provide you with this notice of its legal duties and privacy practices.  BRMHMRCC is required to ask you to sign the last page to this notice saying that you have received it.  BRMHMRCC must follow the terms of this notice.  BRMHMRCC can change the contents of this notice.  If BRMHMRCC changes the contents of this notice, it will make the new notice available at its facilities and on its website, www.borderregion.org, within thirty days after the effective date of the changed notice.  The new notice will apply to all health information maintained by BRMHMRCC, no matter when BRMHMRCC got or created the information.
	BRMHMRCC employees must protect the privacy of your health information as part of their jobs with BRMHMRCC.  BRMHMRCC does not give employees access to your health information unless they need it as part of their jobs.  BRMHMRCC will punish employees who do not protect the privacy of your health information.
	If you are being treated for chemical dependency (drug and alcohol abuse), your records that relate to that treatment are protected by federal law and regulations found in the Code of Federal Regulations at Title 42, Part 2, Violation of these laws that protect chemical dependency treatment records is a crime, and suspected violations may be reported to appropriate authorities in accordance with federal regulations.  Federal law does not protect any information about a crime committed by an individual either at BRMHMRCC or against any person who works for BRMHMRCC or about any threat to commit such a crime.  Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.

Your Privacy Rights
	You have the right to look at or get a copy of the health information BRMHMRCC has about you, in most situations
	You have the right to ask BRMHMRCC to correct information in you records if you think the information is wrong.  BRMHMRCC may not destroy or change its records, but will add the correct information to your records and make a note in you records that you have provided the information.  Your request to correct the records must be in writing and must explain why you believe the correction should be made.
	You have the right to ask BRMHMRCC to limit the ways it uses or discloses your health information.  The law does not require BRMHMRCC to agree to the limits you request, but if it does agree, if must do as you ask
	You have the right to ask that BRMHMRCC contact you at a different location or in a different manner
	You have the right to get a copy of this notice from BRMHMRCC when you ask for it.

TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS.

BRMHMRCC may use your health information to provide treatment to you, to obtain payment for services provided to you, or for BRMHMRCC’s own health care operations, as allowed by law.

Health information about you may be exchanged between BRMHMRCC facilities, local mental health or mental retardation authorities, community centers, other designated providers, and subcontractees of mental health and mental retardation services, for purposes of treatment, payment, or health care operations, without your permission.

Treatment:  BRMHMRCC can use your health information to provide, coordinate, or manage health care or related services.  This includes providing care to you, consulting with another health care provider about you, and referring you to another health care provider.  For example, BRMHMRCC can use your health information to prescribe medication for you.

Payment:  BRMHMRCC can use your health information to get paid for providing health care to you or to provide benefits to you under a health plan such as the Medicaid program.  For example, BRMHMRCC can use your health information to bill your insurance company for health care provided to you.

Notice to applicants and recipients of financial assistance or payments under federal benefit programs; any information provided by you may be subject to verification through matching programs

Health Care Operations:  BRMHMRCC can use your health information for health care operations.  Health care operations include:  activities to improve the quality of health care; evaluating BRMHMRCC programs; developing procedures; case management and care coordination; reviewing the competence, qualifications, and performance of health care professionals and others; conducting training programs in areas related to health care; conducting accreditation, certification, licensing, or credentialing activities; providing medical review, legal services, or auditing functions; resolution of internal grievances; and engaging in business planning and management or the general administrative activities of BRMHMRCC.  For example, BRMHMRCC can use your health information to develop procedures for taking care of people in its facilities.

BRMHMRCC may also contact you to remind you of an appointment or to provide treatment alternatives or other health-related information that may interest you.

If you are being treated for chemical dependency.  BRMHMRCC will not disclose information about your treatment to anyone without your written permission, unless the law allows BRMHMRCC to disclose the information.  BRMHMRCC will use your health information to provide treatment to you.

BRMHMRCC will not disclose health information about you relating to HIV/AIDS without your specific written permission, unless the law allows BRMHMRCC to disclose the information.

Unless you are receiving treatment for chemical dependency, BRMHMRCC is permitted to use or disclose your health information without your permission for the following purposes.

When Required by Certain Judicial and Administrative Proceedings:
 

	In a license revocation proceeding.   BRMHMR may disclose your health information if you have filed a complaint against a doctor or other mental health or mental retardation professional and the information is needed in a license revocation proceeding
	In a proceeding to collect payment.    BRMHMRCC may disclose your health information to a court or administrative judge to collect payment for mental or emotional health services provided to you
	For court-ordered examination.  BRMHMRCC may disclose your health information if a court orders that you be examined for a mental or emotional condition or disorder
	In a criminal proceeding.    BRMHMRCC may disclose your health information in a criminal proceeding if a court has ordered or subpoenaed that the information be produced
	In a proceeding regarding abuse or neglect.  BRMHMRCC may disclose your health information to a court or administrative judge in a proceeding regarding the abuse or neglect of a resident of an institution
	In a commitment proceeding.  BRMHMRCC may disclose your health information in an involuntary commitment proceeding for court-ordered treatment or services
	In other judicial and administrative proceedings.  BRMHMRCC may disclose your health information in response to an order or subpoena issued by a court or administrative judge

For Other Purposes:
 

	When required by law.  BRMHMRCC can use or disclose your health information when state or federal law requires the use of disclosure
	To address a serious threat to health or safety.   BRMHMRCC may use or disclose your health information to medical or law enforcement personnel if BRMHMRCC determines that you or others are in danger and the information is necessary to prevent physical harm.
	For audits and evaluations.  BRMHMRCC may disclose your health information for management audits, financial audits, or program evaluations, but the people who receive your information cannot disclose your identity.
	For payment for services of a professional.  BRMHMRCC may disclose certain parts of your health information to people, corporations, or government agencies to pay for mental or emotional health services provided by a doctor or other person licensed to provide services.
	To doctors and other medical personnel.  BRMHMRCC may disclose your health information to a doctor or other person licensed to provide services for a mental condition or to personnel under their direction.
	In an emergency.  BRMHMRCC may disclose your health information to medical personnel in an emergency.
	For research.  BRMHMRCC may use or disclose your health information if a research board approves the use of confidential health information for a research project, or if information identifying you is removed from the health information.  Information that identifies you will be kept confidential.
	To a government authority if BRMHMRCC thinks that you are a victim of abuse.  BRMHMRCC may disclose your health information to a person legally authorized to investigate a report that you have been abused or have been denied your rights.
	To Advocacy, Inc.  BRMHMRCC may disclose your health information to Advocacy, Inc., in accordance with federal law, to investigate a complaint by you or on your behalf
	To comply with legal requirements.  BRMHMRCC may disclose your health information to an employee or agent of a doctor or other professional who is treating you, to comply with statutory, licensing, or accreditation requirements, as long as your information is protected and is not disclosed for any other reason
	For purposes relating to death.  If you die, BRMHMRCC may disclose health information about you to your personal representative and to coroners or medical examiners for the purpose of identifying you or determining the cause of death
	To a correctional institution.  If you are in the custody of a correctional institution, BRMHMRCC may disclose your health information to the institution in order to provide health care to you
	For continuity of care for special needs offenders.  If you have been convicted of a crime and are in custody or under any form of criminal justice supervision, or if criminal charges are pending against you.  BRMHMRCC may disclose your health information to agencies or persons involved in your treatment or supervision for the purpose of treatment, payment, or certain health care operations.
	To locate you if you are missing from a facility.  If you have been committed by a court to a mental health facility.  BRMHMRCC can disclose certain information about you law enforcement personnel in order to return you to the mental health facility
	For government benefit programs.  BRMHMRCC may use or disclose your health information as needed for the administration of a government benefit program, such as Medicaid.
	If you are receiving services for mental retardation, BRMHMRCC may disclose health information about your current physical and mental condition to your parent, guardian, relative, or friend.
	To the Secretary of Health and Human Services.  BRMHMRCC must disclose your health information to the United States Department of Health and Human Services when requested in order to enforce the privacy laws.

If you are being treated for chemical dependency, BRMHMRCC may not say to any person outside of BRMHMRCC that you have been admitted to a BRMHMRCC facility or that you are receiving chemical dependency treatment or services, and may not disclose any information identifying you as a alcohol or drug abuser.

BRMHMRCC may only disclose information about treatment for chemical dependency without your permission in the following circumstances:
 

	pursuant to a special court order that complies with 42 Code of Federal Regulations Part 2 Subpart E;
	to medical personnel in a medical emergency;
	to qualified personnel for research, audit, or program evaluation; or
	to report suspected child abuse or neglect.

Federal and State laws prohibit redisclosure of information about chemical dependency treatment without your permission.
 

COMPLAINT PROCESS

If you believe that BRMHMRCC has violated your privacy rights, you have the right to file a complaint.

If you believe that your rights have been violated, you can contact the Rights/Privacy Officer by telephone, fax, or by mail.  The Rights/Privacy Officer can be contacted by calling 1-956-794-3017; faxing 1-956-794-3575 or by mail Border Region MHMR Community Center, Attn: Rights/Privacy Officer, P. O. Box 1835, Laredo, Texas 78041-1835 or by e-mail jesush@borderregion.org .  You may complain by contacting the Consumer Services and Rights Protection/Ombudsman Office at 1-800-252-8145.  You may also complain by filing a complaint with the Secretary of the United States Department of Health and Human Services at the Hubert H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201.  You must file your complaint within 180 days of when you knew or should have known about the event that you think violated your privacy rights.  You may also contact the Texas Attorney General’s Office at P. O. Box 12548, Austin, Texas 78711 or www.oag.state.tx.us.   BRMHMRCC will not retaliate against you if you file a complaint