Notice of Privacy Practices

Livengrin Foundation, Inc. Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. 

Who We Are

We are Livengrin Foundation, Inc., a program that provides treatment for substance use disorders (SUD). We are required by law to maintain the privacy of your protected health information (PHI) and to provide you with this notice of our legal duties and privacy practices. We are also required to follow the terms of this notice currently in effect.

What is Protected Health Information?

PHI is any information that we create or receive that relates to your past, present, or future health or condition, the provision of health care to you, or the past, present, or future payment for your health care. PHI includes information that can be used to identify you, such as your name, address, phone number, email address, social security number, etc.

How We May Use and Disclose Your PHI

We may use and disclose your PHI for certain purposes without your written consent or authorization, as explained below. For any other purposes, we must obtain your written consent or authorization before we use or disclose your PHI.

Treatment: We may use and disclose your PHI to provide, coordinate, or manage your health care and related services. For example, we may share your PHI with other health care providers who are involved in your care, such as doctors, nurses, counselors, pharmacists, etc. We may also share your PHI with other SUD treatment programs or facilities that have a relationship with you for your treatment.

Payment: We may use and disclose your PHI to obtain payment for the health care services we provide to you. For example, we may submit claims to your health insurance plan or other payer for reimbursement of the services we provide to you. We may also share your PHI with other entities that are involved in the payment process, such as billing companies, collection agencies, etc.

Health Care Operations: We may use and disclose your PHI for our health care operations. These are activities that are necessary for us to run our program and ensure quality care for our patients. For example, we may use your PHI for quality assessment and improvement activities, training and supervision of staff, accreditation and licensing purposes, legal and compliance matters, etc. We may also share your PHI with our business associates who perform certain functions on our behalf, such as legal services, accounting services, etc. We require our business associates to protect the privacy of your PHI.

Other Permitted or Required Uses and Disclosures: We may also use or disclose your PHI for the following purposes without your consent or authorization:

• To comply with federal, state, or local laws that require us to report certain information. For example, we may report suspected child abuse or neglect, certain injuries, or diseases, etc.
• To comply with court orders or subpoenas that direct us to disclose your PHI.
• To communicate with law enforcement officials if you are involved in a crime or if we suspect that you have committed a crime on our premises.
• To communicate with emergency medical personnel if you have a medical emergency and are unable to give consent.
• To communicate with public health authorities or other government agencies that are authorized to receive information about public health threats or emergencies.
• To communicate with researchers who have obtained proper approval to conduct research that involves your PHI.
• To communicate with coroners, medical examiners, or funeral directors as necessary to carry out their duties.
• To communicate with organ procurement organizations or other entities involved in organ donation or transplantation if you are an organ donor or a potential recipient.
• To communicate with military authorities if you are a member of the armed forces or a veteran.
• To communicate with correctional institutions or law enforcement officials if you are an inmate or under their custody.
• To communicate with authorized federal officials for national security or intelligence purposes.
• To communicate with your family members or other persons involved in your care if you give us verbal agreement or if we infer from the circumstances that you do not object. For example, we may share relevant information about your condition or treatment with a friend who accompanies you to our facility. If you are unable to agree or object due to incapacity or emergency, we may share information that is in your best interest.

Your Rights Regarding Your PHI

If you wish to exercise your rights as described below, we will provide you with a form to complete and submit your specific request in writing. All requests will be reviewed and considered within the HIPAA required timeframes. Under certain circumstances, we may deny your request. If this occurs you may have the right to have the denial reviewed.

Right to Request a Copy: You have the right to request a copy of the PHI that we maintain about you, with limited exceptions. If you request a copy of the information we may charge a fee for the cost of copying, mailing, or other supplies associated with your request. Additionally, you have the right to ask us to send a copy of your PHI to other individuals that you designate. To do so, you must provide complete the appropriate consent form that clearly identifies the designated person and where to send the copy of your PHI. In most cases, we will provide access to the person you designate. This right applies to PHI used to make decisions about you or payment for your care, subject to limited exceptions.

Right to Request Restrictions: You have the right to request restrictions on how we use and disclose your PHI for treatment, payment, and health care operations. You also have the right to request restrictions on how we communicate with you about your PHI. For example, you may ask us to contact you only at a certain phone number or address. We are not required to agree to your requests unless they relate to disclosures to your health plan for payment or health care operations purposes and the PHI pertains solely to a health care item or service for which you have paid us in full. If we agree to your requests, we will comply with them unless we need to use or disclose your PHI for emergency treatment.

To request restrictions, you must submit a written request to our Privacy Officer. Your request must specify: (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.

Right to Request Confidential Communications: You have the right to request that we communicate with you about your PHI in a certain way or at a certain location. For example, you may ask us to call you only at your work number or to send mail to a different address. We will accommodate reasonable requests. We will not ask you the reason for your request.

To request confidential communications, you must submit a written request to our Privacy Officer. Your request must specify how or where you wish to be contacted.

Right to Amend: You have the right to request that we amend your PHI that we maintain in a designated record set if you believe it is incorrect or incomplete. To request an amendment, you must submit a written request to our Privacy Officer. Your request must provide a reason that supports your request. We may deny your request if: (1) the information was not created by us, unless the person or entity that created the information is no longer available; (2) the information is not part of the designated record set; (3) the information is not part of the information that you are permitted to inspect and copy; or (4) the information is accurate and complete as it is. If we deny your request, we will tell you why in writing and explain your right to submit a written statement of disagreement.

Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this notice at any time, even if you have agreed to receive this notice electronically. To obtain a paper copy of this notice, please contact our Privacy Officer.

How to Exercise Your Rights

To exercise any of your rights described in this notice, please contact our Privacy Officer using the contact information below. We may ask you to fill out a form or provide other documentation to process your request.

How to File a Complaint

If you believe that your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1/877/696/6775, or visiting https://www.hhs.gov/civil-rights/index.html. To file a complaint with us, please contact our Privacy Officer using the contact information below. You will not be penalized or retaliated against for filing a complaint.

Changes to This Notice

We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for PHI we already have about you as well as any information we receive in the future. We will post a copy of the current notice at our facility and on our website. The notice will contain the effective date on the first page.

SMS

You may receive SMS messages from Livengrin; reply STOP to opt out.

Contact Information

If you have any questions about this notice or want to exercise any of your rights, please submit these inquires via mail to:

Attention: Privacy Officer
Livengrin Foundation
4833 Hulmeville Road
Bensalem, Pa 19020

or via email at Quality@Livengrin.org, Attention: Privacy Officer