NOTICE OF PRIVACY PRACTICES (HIPAA & 42 CFR PART 2)

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.

Covered Entity

Northwest Addiction Treatment LLC, doing business as Recover Together Bend (“RTB”), is a covered entity under the Health Insurance Portability and Accountability Act (HIPAA) and a federally assisted substance use disorder treatment program subject to 42 CFR Part 2. RTB is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices.

Our Legal Duties

RTB is required by law to: - Maintain the privacy of your protected health information (“PHI”); - Provide you with this Notice of Privacy Practices; - Follow the terms of the Notice currently in effect; and - Notify you following a breach of unsecured PHI.

Medical Records

RTB collects health information about you and stores it in an electronic health record. This medical record is the property of RTB; however, the information contained in the record belongs to you. Uses and disclosures of your health information are limited to the minimum necessary as required by law.

Special Protections for Substance Use Disorder Records (42 CFR Part 2)

Information relating to your identity, diagnosis, prognosis, or treatment for substance use disorder is protected by federal confidentiality regulations at 42 CFR Part 2. RTB may not disclose Part 2–protected information without your written consent except as expressly permitted by law.

Any written consent must specify: - The information to be disclosed; - The name of the person or organization to receive the information; - The purpose of the disclosure; and - An expiration date or event.

You may revoke your consent verbally or in writing at any time, except to the extent action has already been taken in reliance on your consent.

Uses and Disclosures With Your Written Consent

With your valid written consent, RTB may disclose treatment information for purposes including, but not limited to: - Coordinating care with other healthcare providers; - Obtaining payment from insurers or other payers; - Communicating with family members or others involved in your care; - Care coordination, referrals, and continuity of care.

Uses and Disclosures Without Your Written Consent

RTB may use or disclose treatment information without your written consent only as permitted by 42 CFR Part 2, including: - Internal use within RTB; - Disclosures to qualified service organizations that have agreed in writing to protect confidentiality; - Medical emergencies; - Audits, evaluations, and certain research activities; - Reporting suspected child abuse or neglect as required by law; - Reporting cause of death; - Crimes committed on RTB premises or against RTB personnel; - Court orders that meet the specific requirements of 42 CFR Part 2.

Communications

RTB may contact you to provide appointment reminders or information about RTB services. Such communications may occur by phone, mail, or electronic means consistent with your preferences and applicable law.

Your Rights

You have the right to: - Receive a paper copy of this Notice; - Inspect or obtain a copy of your health information (requests must be in writing; reasonable fees may apply); - Request an amendment to your health information; - Request restrictions on certain uses or disclosures (RTB is not required to agree); - Request confidential communications; - Receive an accounting of certain disclosures; - Be notified of a breach of unsecured PHI; and - File a complaint without fear of retaliation.

Complaints and Contact Information

If you have questions or wish to file a complaint, contact:

Privacy Officer
Northwest Addiction Treatment LLC
61667 Somerset Dr.
Bend, OR 97702
Phone: (541) 241-3430

You may also file a complaint with the following agencies. You will not be retaliated against for filing a complaint.

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

Oregon Health Authority
Behavioral Health Division
500 Summer Street NE
Salem, OR 97301

Changes to This Notice

RTB reserves the right to change this Notice and make the revised Notice effective for all information it maintains. Updated notices will be made available.

Effective Date: January 1, 2025