Bonfire Behavioral Health Privacy Policy – HIPAA Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU AND YOUR TREATMENT MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Bonfire Behavioral Health is required by law to maintain the privacy and confidentiality of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. Please also respect the privacy of others you encounter in treatment.

Bonfire Behavioral Health collects health information about you and stores it in an electronic health record. This is your medical record. The medical record is the property of Bonfire Behavioral Health, but the information in the medical record belongs to you. The Health Insurance Portability and Accountability Act (HIPAA) requires Bonfire Behavioral Health to maintain the privacy of your medical record. HIPAA generally requires that any uses or disclosures of information in your medical record be limited to the minimum necessary to the purposes of the uses or disclosures. HIPAA also provides you certain rights with respect to the information in your medical record which are described below.

Information relating to your treatment at Bonfire Behavioral Health is protected by federal regulations specific to drug and alcohol treatment, which are known as 42 CFR Part 2. These regulations protect the confidentiality of information relating to the identity, diagnosis, prognosis, or treatment of any patient in a drug or alcohol treatment program. Bonfire Behavioral Health may not disclose records relating to your treatment without your written consent, except in narrowly limited circumstances. Under 42 CFR Part 2, the terms of a written consent to disclose information must specify the scope and types of information to be disclosed, the parties to whom the information may be disclosed, the purpose of the disclosure and the timeframe of the consent. You may revoke a consent to disclose information relating to drug and alcohol verbally or in writing at any time.

Bonfire Behavioral Health may ask for your written consent to disclose treatment information for certain purposes, including releasing treatment information to or obtaining information from your other medical providers, obtaining payment from insurance or other payers, contacting your family either for treatment purposes or in the case of a medical or other emergency. Bonfire Behavioral Health will not disclose your treatment information for these purposes without your consent.

Bonfire Behavioral Health may disclose treatment information without your written consent under certain narrow circumstances as permitted by 42 CFR Part 2. For treatment purposes, Bonfire Behavioral Health is permitted to use and disclose treatment information internally and to entities with which it shares administrative control. Bonfire Behavioral Health is permitted to share treatment information as necessary with qualified service organizations that agree to maintain the confidentiality of the information. Bonfire Behavioral Health also may disclose treatment information to outside auditors, regulatory agencies, and evaluators and for certain research purposes. Bonfire Behavioral Health may disclose treatment information without your written consent when necessary in a life-threatening medical emergency and may disclose to report a crime on the premises or against Bonfire Behavioral Health personnel. Bonfire Behavioral Health also may disclose patient information without consent where the state mandates child abuse and neglect reporting; when cause of death is being reported; or when required by a valid court order that contains specific required findings. Bonfire Behavioral Health may contact you to share information about Bonfire Behavioral Health’s treatment services or to send you reminder notices of future appointments for your treatment.

1. Your Health Information Rights
   In addition to protecting privacy and confidentiality, HIPAA and 42 CFR Part 2 afford you the following rights with respect to your medical record and drug or alcohol treatment information:
   1. You have the right to a paper copy of this written notice of Bonfire Behavioral Health’s privacy practices.
      You have a right to request a copy of your treatment record or to receive your health information through a reasonable alternative means or at an alternative location. Bonfire Behavioral Health requires that all such requests be put in writing. A reasonable fee will be charged for copying your health information.
   2. You have a right to request that Bonfire Behavioral Health amend health information that is incorrect or incomplete. If Bonfire Behavioral Health determines not to amend the health information, it will provide you with an explanation of the reason for the denial and your rights to disagree with the denial.
   3. You have a right to request restrictions on otherwise permitted uses and disclosures of your health information. Bonfire Behavioral Health is not obligated to comply with such requests.
   4. You may request that Bonfire Behavioral Health provide you with a written accounting of all disclosures made by Bonfire Behavioral Health during a specific time period (not to exceed 6 years). Bonfire Behavioral Health asks that such requests be made in writing on a form provided by our facility. Please note that an accounting will not apply to any of the following types of disclosures: disclosures made with your written consent for reasons of treatment, payment or health care operations; disclosures made to you or your legal representative, or any other individual involved with your care. You will not be charged for your first accounting request in any 12-month period. However, for any requests that you make thereafter, you will be charged a reasonable, cost-based fee.
2. Changes to this Notice of Privacy Practices
   1. Bonfire Behavioral Health reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment. Until amendment is made, Bonfire Behavioral Health is required by law to comply with this Notice. Should our privacy practices change, we will provide all current and future patients with a copy of the revised Notice of Privacy Practices. Effective November 24, 2020

Complaints Regarding Privacy Practices:

Complaints about this Notice of Privacy Practices or how Bonfire Behavioral Health handles your health information should be directed to:

Bonfire Behavioral Health
10 Grove Street
Dover, NH 03820

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to one of the following:

Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, SW Room 509F, HHH Building
Washington, DC 20201

New Hampshire Department of Health and Human Services
Bureau of Drug and Alcohol Services
129 Pleasant Street
Concord, NH 03301

You may also address your complaint to one of the regional U.S Department of Health and Human Services Offices for Civil Rights. A list of these offices can be found online at: https://www2.ed.gov/about/offices/list/ocr/addresses.html