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.

The new federal Health Insurance Portability and Accountability Act (HIPAA) regulates the use and disclosure of "Personal Health Information" (PHI). This is information about you that may identify you and that relates to your medical condition, the health care services you receive, any plan for future care to you, or the payment for health care services provided to you.

This Privacy Notice describes how Namaqua Center protects the PHI that we have about you related to the health care services that you receive from us and how we may use and disclose this information. It also describes your rights with respect to your PHI that we maintain or create and how you can exercise those rights.

Our Pledge Regarding Your Health Information

We understand that your health information is personal, and we are committed to protecting your privacy. We create a record of the services you receive at Namaqua Center to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records relating to your health that we maintain, whether created by us or another provider.

We are required by law to:

• follow the terms of the Privacy Notice;
• give you this notice of our legal duties and privacy practices with respect to your personal health information (PHI)
• maintain the privacy of your PHI.

Changes to This Notice

We may change the terms of our Notice at any time. The new notice will be effective for all PHI that we maintain at that time. If we make changes to this Notice, you may obtain a copy of the revised Notice by contacting the Privacy Officer at the address and phone number listed below. The revised Notice will be made available at our reception desk and on our website www.namaqua.com.

Uses and Disclosures of PHI

Namaqua Center uses and discloses PHI for Treatment, Payment, and Health Care Operations. This includes providing and billing for services to you, maintaining records, consulting with Namaqua therapists, and our Quality Improvement measures.

Colorado state law and professional mental health standards about confidentiality are more stringent than the new HIPAA laws. We will continue to follow these higher standards. Unless otherwise specified below, we will not release PHI about you without written authorization from you or your legal representative. You may revoke your authorization, in writing, at any time. Such revocation will be effective except to the extent that we have taken action in reliance on the original authorization.

Exceptions to Confidentiality

State and federal laws require that we share information even without your authorization in the following situations:

• Reporting known or suspected child abuse or neglect.
• If a client presents a serious threat to themselves or others, such as suicide, homicide or grave disability.
• Court ordered evaluation or treatment may also limit the confidentiality of our work together. We will discuss this with you.

We may also use and disclose the minimum necessary PHI for the following purposes under limited circumstances:

• To contact you about appointments.
• To business associates if they need to receive PHI to provide services (such as billing companies, collection agencies, accountants, or attorneys). Our business associates are also required by law to keep your PHI confidential.
• To law enforcement officials in response to a request made through a court order, subpoena, warrant, or summons.
• To respond to any complaint, grievance or lawsuit brought by you.

Obtain a Copy of this NoticeYou have the right to have a copy of this Notice provided to you at your request.

Inspect and Copy Your PHI

In most cases, you have the right to inspect and obtain a copy of your PHI that we maintain for as long as we maintain it. You will be charged for the costs of copying and mailing the information. In limited circumstances, we may deny your request. We will advise you in writing of the reasons for denial and your right to have the denial reviewed.

Amend Your PHI

You have the right to request that we amend PHI you believe to be incorrect or missing. We will not alter the original record, but will include your amendments when possible. We may deny your request under certain circumstances. We will advise you in writing of the reason for the denial and your right to submit a statement disagreeing with the denial.

Obtain a List of the Disclosures

You have the right to obtain a list of disclosures of your PHI for purposes other than treatment, payment, health care operations, disclosures made directly to you, or where you have specifically authorized a disclosure. The first request within a 12-month period will be free. We will charge you for costs of any additional requests.

Request Restrictions on the Use and Disclosure of Your PHI

You have the right to request that we limit the way we use or disclose any part of your PHI. We are not required to agree to a requested restriction. If we do agree, we will comply with your request except when you require emergency treatment.

Request Confidential Communications

You have the right to request that we communicate with you about PHI in a certain way or at a certain location. We will accommodate all reasonable requests.

The Right to File a Complaint

If you believe your privacy rights have been violated, you may file a written complaint with our Privacy Officer or with the Secretary of the Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.If you believe your privacy rights have been violated, you wish to exercise any of the rights outlined above, you have any questions or comments about our privacy practices, or would like a copy of this notice, you may contact our Privacy Officer:

Karen McMahon, Operations Coordinator
404 East 7th Street
Loveland, CO. 80537
970.669.7550 x17
karen.mcmahon@larimercenter.org