R.I.S.E. Integrated Mental Health Notice of Privacy Practices (NPP)*
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
This medical practice (the “Practice”) is committed to preserving the privacy and confidentiality of your health information, including any information regarding health treatment you may have received. We are required by law, including federal regulations, to provide you with this notice of the Practice’s legal duties, your rights, and the Practice’s privacy practices, with respect to using and disclosing your health care information that is created or retained by the Practice.
I. Summary of Rights and Obligations Concerning Health Information
Each time you receive treatment or services from this Practice, we make a record of your visit. Typically, this record contains the reason for the services or treatment, any symptoms or complaints, information regarding any examination, findings, observations, diagnoses and treatment, and a plan for future care or recommendations. We have an ethical and legal obligation to protect the privacy of your health information, and we will only use or disclose this information in limited circumstances. In general, we may use and disclose your health information to:
plan your care and treatment;
provide treatment by us or others;
communicate with other providers such as referring physicians;
receive payment from you, your health plan, or your health insurer including MaineCare (if applicable);
make quality assessments and work to improve the care we render and the outcomes we achieve, known as health care operations;
make you aware of services and treatments that may be of interest to you; and
comply with state and federal laws that require us to disclose your health information.
We may also use or disclose your health information where you have authorized us to do so. You have certain rights to your health information. You have the right to:
ensure the accuracy of your health record;
request confidential communications between you and your physician and request limits on the use and disclosure of your health information; and
request an accounting of certain uses and disclosures of health information we have made about you.
We are required to:
maintain the privacy of your health information;
provide you with notice, such as this Notice of Privacy Practices, as to our legal duties and privacy practices with respect to information we collect and maintain about you;
abide by the terms of the Practice’s most current Notice of Privacy Practices;
notify you if we are unable to agree to a requested restriction; and,
accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. We reserve the right to change the Practice’s protocols and to make the new provisions effective for all your health information that we maintain. Should the Practice’s information practices change, a revised Notice of Privacy Practices will be available upon request. If there is a material change, a revised Notice of Privacy Practices will be distributed to the extent required by law. We will not use or disclose your health information without your authorization, except as described in the Practice’s most current Notice of Privacy Practices.
II. How We May Use or Disclose Your Health Information
A. Treatment. We may use and disclose your health care information to provide you with health treatment or services. For example, we may use your
health information to recommend a certain plan of care. We will record your current healthcare information in a record so that in the future, we can see your health history to help in diagnosing and treating, or to determine how well you are responding to a particular plan of care. Your counseling records, or any other health records may be shared with staff within the Practice for your health and safety and to facilitate the continuity of your care. Otherwise, we may share your health information with health care providers outside of this Practice only with your permission, or in very limited circumstances as allowed or required by law, such as but not necessarily limited to an emergency related to your care, to report abuse or neglect, or in response to a legitimate government subpoena.
B. Payment. We may use and disclose your health information so that we may bill and collect payment for the services that we provided to you. For example, we may contact your health insurer (including MaineCare) to verify your eligibility for benefits, and may need to disclose to it some details of your health condition or expected course of treatment. We may use or disclose your information so that a bill may be sent to you, MaineCare or a family member. The information on or accompanying the bill may include information that identifies you and your diagnosis, as well as services rendered, any procedures performed, and supplies used. We also may provide information about you to other health care providers that have treated you or provided services to you to assist them in obtaining payment.
C. Health Care Operations. We may use and disclose your health care information to assist in the Practice’s business operations. For example, members of the Practice’s staff may use information in your health record to assess the care and outcomes in your case and others like it as part of a continuous effort to improve the quality and effectiveness of the health services we provide. We may use and disclose your health information to conduct cost-management and business planning activities for the Practice. We may provide information to MaineCare, if the Practice contracts with MaineCare, for quality review and billing purposes.
D. Business Associates. This Practice sometimes contracts with third party business associates for services. Examples include answering services, transcriptionists, billing services, consultants, and legal counsel. We may disclose your health information to the Practice’s business associates as may be necessary so that they can perform the job we have asked them to do. To protect your health information, however, we require the Practice’s business associates to appropriately safeguard your information as well.
E. Appointment Reminders. We may use and disclose information in your health record to contact you as a reminder that you have an appointment with an employee of this Practice. Our standard approach is to call you and leave a message with whatever phone number you have provided for this purpose or with an individual who answers or responds to the Practice’s call. However, you may request that we provide such reminders only in a certain way or only at a certain place, such as by text or e-mail. We will endeavor to accommodate all reasonable requests.
F. Treatment Options. We may use and disclose your health information in order to inform you of alternative treatments.
G. Release to Family/Friends. Our employees, using their professional judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, your health information to the extent it is relevant to that person’s involvement in your care or payment related to your care. We will provide you with an opportunity to object to such a disclosure whenever we practicably can do so. We may disclose the health information of minor children to their parents or guardians unless such disclosure is otherwise prohibited by law.
H. Solicitations and Health-Related Benefits and Services. We may use and disclose health information to tell you about health-related benefits, products or services that may be of interest to you. In any fund-raising types of communications, or similar solicitations, you will have the opportunity to opt out of receiving such information. The opt-out procedures will be made available to you at such time, if ever, that we undertake any such solicitations.
I. Newsletters and Other Communications. We may use your personal information in order to communicate to you via newsletters, mailings, or
other means regarding treatment options, health related information, disease management programs, wellness programs, or other community-based
initiatives or activities in which the Practice is participating.
J. Disaster Relief. We may disclose your health information in disaster relief situations where it is necessary to coordinate your care or notify family and friends of your location and condition. We will provide you with an opportunity to agree or object to such a disclosure whenever we practicably can do so.
K. Marketing. We are required by law to receive your written authorization before we use or disclose your health information for marketing purposes. However, we may provide you with promotional gifts of nominal value. Under no circumstances will we sell your health information to a third party without your written authorization.
L. Public Health Activities. We may disclose health care information about you for public health activities. These activities generally include the following:
licensing and certification carried out by public health authorities;
prevention or control of disease, injury, or disability;
reports of births and deaths;
reports of child abuse or neglect;
notifications to people who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
organ or tissue donation; and
notifications to appropriate government authorities if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will make this disclosure when required by law, or if you agree to the disclosure, or when authorized by law and in the Practice’s professional judgment disclosure is required to prevent serious harm.
M. Funeral Directors. We may disclose health information to funeral directors upon request and as may be necessary so that they may carry out their duties.
N. Food and Drug Administration (FDA). We may disclose information, upon request, and as may be necessary, to the FDA and other federal and state regulatory agencies, relating to adverse events with respect to food, supplements, products and product defects, or post-marketing monitoring information to enable product recalls, repairs, or replacement.
O. Psychotherapy Notes. We may not disclose psychotherapy notes as defined under HIPAA without your written authorization, except for treatment and payment purposes, for state and federal oversight of the mental health professional, for the purposes of medical examiners and coroners, to avert a serious threat to health or safety, or as may otherwise be authorized or required by law.
P. Research. We may disclose your health information to researchers when the information does not directly identify you as the source of the information or when a waiver has been issued by an institutional review board or a privacy board that has reviewed the research proposal and protocols for compliance with standards to ensure the privacy of your health information.
Q. Workers Compensation. We may disclose your health information to the extent authorized by and to the extent necessary to comply with laws
relating to workers compensation or other similar programs established by law.
R. Law Enforcement. We may release your health information:
in response to a court order, subpoena, warrant, summons, or similar process if authorized under state or federal law;
to identify or locate a suspect, fugitive, material witness, or similar person;
about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
about a death we believe may be the result of criminal conduct;
about criminal conduct at this location;
to coroners or medical examiners;
in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime;
to authorized federal officials for intelligence, counterintelligence, and other national security authorized by law; and
to authorized federal officials so they may conduct special investigations or provide protection to the President, other authorized persons, or foreign heads of state.
S. De-identified Information. We may use your health information to create "de-identified" information or we may disclose your information to a business associate so that the business associate can create de-identified information on the Practice’s behalf. When we "de-identify" health information, we remove information that identifies you as the source of the information. Health information is considered "de-identified" if there is no reasonable basis to believe that the health information could be used to identify you.
T. Personal Representative. If you have a personal representative, such as a legal guardian, we will treat that person as if that person is you with
respect to disclosures of your health information. If you become deceased, we may disclose health information to an executor or administrator of your
estate to the extent that person is acting as your personal representative.
U. HLTV-III Test. If we perform, or obtain or maintain information in the Practice’s records regarding, an HLTV-III test on you (to determine if you have
been exposed to HIV), we will not disclose the results of the test to anyone but you without your written consent unless otherwise required by law. We
also will not disclose the fact that you have taken the test to anyone without your written consent unless otherwise required by law.
V. Limited Data Set. We may use and disclose a limited data set that does not contain specific readily identifiable information about you for research, public health, and health care operations. We may not disseminate the limited data set unless we enter into a data use agreement with the recipient in which the recipient agrees to limit the use of that data set to the purposes for which it was provided, ensure the security of the data, and not identify the information or use it to contact any individual.
III. Authorization for Other Uses of Health care information
Uses of health care information not covered by this Practice’s most current Notice of Privacy Practices or the laws that apply to us will be made only with your written authorization. If you provide us with authorization to use or disclose health care information about you, you may revoke that authorization, in writing, at any
time. If you revoke your authorization, we will no longer use or disclose health care information about you for the reasons covered by your written authorization, except to the extent that we have already taken action in reliance on your authorization or, if the authorization was obtained as a condition of obtaining insurance coverage and the insurer has the right to contest a claim or the insurance coverage itself. We are unable to take back any disclosures we have already made with your authorization, and we are required to retain the Practice’s records of the care that we provided to you.
IV. Your Health Information Rights
You have the following rights regarding health care information we gather about you:
A. Right to Obtain a Paper Copy of This Notice. You have the right to a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.
B. Right to Inspect and Copy. You have the right to inspect and copy health care information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy health care information, you must submit a written request to the Practice’s privacy officer. We will supply you with a form for such a request. If you request a copy of your health care information, we may charge a reasonable fee for the costs of labor, postage, and supplies associated with your request. We may not charge you a fee if you require your health care information for a claim for benefits under the Social Security Act (such as claims for Social Security, or Supplemental Security Income or any other state or federal needs-based benefit program). We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to health care information, you may request that the denial be reviewed. A licensed healthcare professional who was not directly involved in the denial of your request will conduct the review. We will comply with the outcome of the review. If your health care information is maintained in an electronic health record, you also have the right to request that an electronic copy of your record be sent to you or to another individual or entity. We may charge you a reasonable cost-based fee limited to the labor costs associated with transmitting the electronic health record.
C. Right to Amend. If you feel that health care information we have about you in your health care record is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we retain the information. To request an amendment, your request must be made in writing and submitted to the Practice’s privacy officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that is: 1) correct and complete; 2) not created by us or not part of the Practice’s records, unless there is a reasonable basis to believe that the originator of the PHI is no longer available to act on the requested amendment; or 3) not allowed to be disclosed. If you do submit a proposed amendment, we are required to indicate whether we agree with the proposed amendment, or disagree, and take such actions as required under the federal regulations with respect to notifications about the same.
D. Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures of your health information made by us. In your accounting, we are not required to list certain disclosures, including:
disclosures made for treatment, payment, and health care operations purposes or disclosures made incidental to treatment, payment, and health care operations, however, if the
disclosures were made through an electronic health record, you have the right to request an accounting for such disclosures that were made during the previous 3 years;
disclosures made pursuant to your authorization;
disclosures made to create a limited data set;
disclosures made directly to you. ction to the President, other authorized persons, or foreign heads of state.
To request an accounting of disclosures, you must submit your request in writing to the Practice’s privacy officer. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you would like the accounting of disclosures (for example, on paper or electronically by e-mail). The first accounting of disclosures you request within any 12-month period will be free. For additional requests within the same period, we may charge you for the reasonable costs of providing the accounting of disclosures. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time, before any costs are incurred. Under limited circumstances mandated by federal and state law, we may temporarily deny your request for an accounting of disclosures.
E. Right to Request Restrictions. You have the right to request a restriction or limitation on the health care information we use or disclose about you for treatment, payment, or health care operations. If you paid out-of-pocket for a specific item or service, you have the right to request that health care information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we are required to honor that request. You also have the right to request a limit on the health care information we communicate about you to someone who is involved in your care or the payment for your care. Except as noted above, we are not required to agree to your request. If we do agree, we will comply with your request unless the restricted information is needed to provide you with emergency treatment. To request restrictions, you must make your request in writing to the Practice’s privacy officer. In your request, you must tell us:
what information you want to limit;
whether you want to limit the Practice’s use, disclosure, or both; and,
to whom you want the limitations to apply.
F. Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by e-mail. To request confidential communications, you must make your request in writing to our privacy officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
G. Right to Receive Notice of a Breach. We are required to notify you by first class mail or by e-mail (if you have indicated a preference to receive information by e-mail), of any breach, as defined under the HIPAA regulations, of Unsecured Protected Health Information as soon as possible, but in any event, no later than 60 days following the discovery of the breach. “Unsecured Protected Health Information” is information that is not secured through the use of a technology or methodology identified by the Secretary of the U.S. Department of Health and Human Services to render the Protected Health Information unusable, unreadable, and undecipherable to unauthorized users. The notice is required to include the following information:
a brief description of the breach, including the date of the breach and the date of its discovery, if known;
a description of the type of Unsecured Protected Health Information involved in the breach;
steps you should take to protect yourself from potential harm resulting from the breach;
a brief description of actions we are taking to investigate the breach, mitigate losses, and protect against further breaches;
contact information, including a toll-free telephone number, email address, Web site or postal address to permit you to ask questions or obtain additional information
In the event the breach involves 10 or more patients whose contact information is out of date we will post a notice of the breach on the home
page of the Practice’s Web site or in a major print or broadcast media. We will undertake such other notifications or reporting as may be applicable and
required by the HIPAA regulations.
V. Complaints
If you believe your privacy rights have been violated by this Practice, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave, S.W., Washington, D.C. 20201. To file a complaint with us, contact the Practice’s privacy officer at the address listed below. All complaints must be submitted in writing and should be submitted within 180 days of when you knew or should have known that the alleged violation occurred. See the Office for Civil Rights website, www.hhs.gov/ocr/hipaa/ for more information. You will not be penalized by the Practice in any way, for filing a complaint. If your complaint involves a breach of confidentiality regarding substance abuse treatment, you may also contact the Office of Substance Abuse Services Maine Office of Substance Abuse, 41 Anthony Ave. #11 State House Station, Augusta, ME 04333-0011, 207-287-2595.
If you have any questions about this Notice, or wish to report directly to the Practice any complaint or concern you may have, please contact the Practice’s privacy officer:
Name: Michael Beale, MBA
Address: 4 Market Place Drive, Suite 1-2, York, ME 03909
Phone: 207.630.2922
Effective Date: May 1, 2024
*This NPP is current as of April 1, 2024. It does not include the updated provisions required as a result of the HIPAA 2024 Final Rule, effective June 25, 2024 with a compliance deadline of February 16, 2026.
Copyright © 2024 R.I.S.E.ise Integrated Mental Health.
All Rights Reserved.
Call Us: 207-630-2922
R.I.S.E. Integrated Mental Health Privacy Policy
Your privacy is important to us. It is R.I.S.E Integrated Mental Health's policy to respect your privacy and comply with applicable laws regarding any personal information we collect about you across our website, www.riseimh.com
Information that can be used to identify you, such as your name, address, date of birth, payment details, and usage information regarding our website.
In the event our site contains links to third-party sites, please be aware that those sites have their own privacy policies. This Privacy Policy does not apply to any activities after you leave our site. Effective Date: September 15, 2024
Last Updated: September, 15, 2024
Information We Collect
We collect two types of information: “voluntarily provided” and “automatically collected” information. Voluntarily Provided Information includes any information you actively provide us while using our services, such as: Name, Email, Phone number. Automatically Collected Information refers to data sent by your devices while accessing our services, such as: Device IP address Browser type and version Pages visited
Log Data
When you visit our website, our servers may automatically log standard data provided by your browser, including your IP address, browser type, pages visited, and the date and time of your visit.
Device Data
We may also automatically collect data about your device, including: Device type, Operating system, Geo-location data
Use of Personal Information
We collect personal information for the following purposes: To provide our core services, To customize your experience, To communicate with you, For marketing and advertising purposes
Security of Your Personal Information
We protect your personal information using commercially acceptable means to prevent loss, theft, and unauthorized access. However, no method of electronic transmission or storage is 100% secure.
Children’s Privacy
We do not knowingly collect personal information from children under 13.
Disclosure of Personal Information
We may disclose personal information to: Affiliates and subsidiaries, Third-party service providers, Regulatory authorities, if required by law
Your Rights
By providing personal information, you agree to the collection and use of your information as outlined in this policy. If you have any questions, please contact us at [email protected]
Copyright © 2024 R.I.S.E. Integrated Mental Health. All Rights Reserved.
Phone 207-630-2922 Fax 207-805-7970