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.

Your Rights

You have the right to:

• Get a copy of your medical record
  

• Correct your medical record
  

• Request confidential communication
  

• Ask us to limit the information we share
  

• Get a list of those with whom we’ve shared your information
  

• Get a copy of this privacy notice
  

• Choose someone to act for you
  

• File a complaint if you believe your privacy rights have been violated
  

Your Choices

You can tell us your choices about:

• Sharing information with your family, close friends, or others involved in your care
  

• Sharing information in a disaster relief situation
  

• Including your information in a facility directory
  

• Contacting you for fundraising efforts
  

• Marketing communications and the sale of your information
  

Our Uses and Disclosures

We typically use or share your health information to:

• Treat you (e.g., share with other professionals involved in your care)
  

• Run our organization (e.g., improve care quality, train staff)
  

• Bill for services (e.g., send claims to insurance)
  

We may also share your information when:

• Required by law
  

• For public health and safety
  

• For research (with conditions)
  

• With organ and tissue donation organizations
  

• With medical examiners or funeral directors
  

• For workers’ compensation claims
  

• For health oversight (audits, inspections)
  

• In response to legal proceedings or law enforcement
  

Our Responsibilities

We are required to:

• Maintain the privacy and security of your protected health information
  

• Notify you if a breach occurs that may have compromised your information
  

• Provide you with this notice and follow the terms within it
  

• Not use or share your information other than as described unless you give us written permission
  

Changes to This Notice

We reserve the right to change this notice and the revised version will apply to all information we have about you. We will post the new notice and make it available upon request.

Complaints

If you believe your rights have been violated, you can file a complaint with us at: [Clinic Contact Info] Or with the U.S. Department of Health and Human Services: Phone: 1-877-696-6775 Website: www.hhs.gov/ocr/privacy/hipaa/complaints

We will not retaliate against you for filing a complaint.

Harmony Mental Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
We provide free aids and services to people with disabilities to communicate effectively with us, and free language services to people whose primary language is not English.

Harmony Mental Health is committed to treating all patients with dignity, respect, and compassion. We believe informed patients are empowered partners in their care.

Patient Rights

As a patient, you have the right to:

1. Respectful and Non-Discriminatory Care

   • Receive care without discrimination based on race, color, religion, gender, sexual orientation, gender identity, age, disability, or source of payment.

2. Privacy and Confidentiality

   • Have your personal and health information protected, in accordance with HIPAA.

3. Informed Consent

   • Receive clear explanations about your diagnosis, treatment options, risks, and benefits before giving permission for care.

4. Access to Records

   • Review and request a copy of your medical records, and request corrections when needed.

5. Participation in Care

   • Be involved in decisions about your care and treatment, including the right to refuse or discontinue treatment.

6. Cultural and Language Access

   • Receive interpretation services or disability accommodations when needed.

7. Continuity of Care

   • Be referred to appropriate services or providers when needed for follow-up or specialty care.

8. Complaint and Feedback Process

   • Voice concerns or complaints about your care without fear of retaliation, and receive a timely response.

Patient Responsibilities

As a patient, you are expected to:

1. Provide Accurate Information

   • Share complete and accurate health and contact information with your care team.

2. Follow Agreed-Upon Treatment Plans

   • Work with your provider to follow recommended care plans or communicate any concerns.

3. Be Respectful

   • Treat staff, providers, and other patients with courtesy and respect.

4. Keep Appointments

   • Arrive on time, notify the clinic of cancellations as early as possible, and respect no-show policies.

5. Understand Financial Responsibilities

   • Provide insurance information and work with the clinic on any billing questions or payment plans.

6. Ask Questions

   • Speak up if you don’t understand something about your care, treatment, or responsibilities.