This notice describes how medical information regarding your health care, including payment for health care is protected by two federal laws: The Health Insurance Portability and Accountability Act of 1966 (“HIPAA”), 42 U.S.C. & 1320d et seq., 45 C.R.F. Part 160 & 164, and the Confidentiality Law, 42 U.S.C. & 290dd-2, 42 C.F.R. Part 2. Under these laws, My Time Recovery LLC may not say to a person outside of My Time Recovery LLC that you attend the program, nor may My Time Recovery LLC disclose information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
This Notice Describes Our Practices and Those of:
My Time Recovery LLC uses health information about you for treatment, to obtain payment for treatment for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of My Time Recovery LLC.
My Time Recovery LLC may use your health information to provide you with medical treatment for services. For Example, information obtained by a health care provider, such as a physician, nurse, or other person providing health care services to you, will need record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.
My Time Recovery LLC may use and disclose your health information to others for purposes of receiving payments for treatment and services that you receive. For example, a bill may be sent to you or a third party, such as an insurance company, HMO, or health plan. The information of the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
My Time Recovery LLC may use and disclose health care information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk, or quality improvement personnel, and others to:
My Time Recovery LLC may use your information to contact you to provide appointment reminders. My Time Recovery LLC may also contact you to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you.
My Time Recovery LLC may release relevant health information to a family member, friend, or anyone else you designate in order for that person to be involved in your case or payment related to your case. My Time Recovery LLC may also disclose health information to those assisting in disaster relief efforts so that others can be notified about your condition, status, and location.
My Time Recovery LLC does not use the information for fundraising unless authorized, in writing, by you.
My Time Recovery LLC may use and disclose information about you as required by law. For example, My Time Recovery LLC may disclose information for the following purposes:
For judicial and administrative proceedings pursuant to a court order.
Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities (State Health Department, Center for Disease Control, Etc.) to prevent or control disease, injury, or disability, or for other public health activities.
My Time Recovery LLC may disclose your health information to a health oversight agency for activities authorized by law. Examples of these activities include audits, investigations, and inspections to monitor the health care system and compliance with laws and regulations.
Decedents: Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
Your health information may be disclosed to avert a serious threat to the health and safety of you and any person pursuant to applicable law.
Your health information may be used or disclosed in order to comply with laws and regulations related to Worker’s Compensation.
Other uses and disclosures will be made only with your written authorization. You may revoke an authorization except to the extent My Time Recovery LLC has taken action in reliance to it.
Under HIPAA you have the right to:
My Time Recovery LLC reserves the right to change the terms of this notice and make the new terms effective for all protected health information kept by My Time Recovery LLC. The administration will post a copy of the current notice in the facility. You may also get a current copy by contacting our Human Resources Department. (address at the end of this statement). The effective date of the notice is in the top right-hand corner of each page.
If you believe your privacy rights have been violated, you may file a complaint, at any time, with My Time Recovery LLC or at any time with the:
Department of Health Care Services, Quality Assurance Branch
Licensing and Certification section
1700 K Street, Sacramento, CA 95814-3279
Attention: Complaint Coordinator phone # (916) 322-2911
The U.S Department of Health and Human Services
200 Independence Avenue SW
Washington, DC, 20201
Phone # 202-619-0257 or toll free at (877) 696-6775, and
Commission on Accreditation of Rehabilitation Facilities (CARF)
Phone # (520) 325-1044 or toll-free at (888) 281-6531.
To file a complaint with My Time Recovery LLC, submit your written complaint to our Administrator (address at the end of this notice). You will not be penalized for filing a complaint.
Contact Information for Questions or To File a Complaint:
If you have any questions about this notice, want to exercise one of your rights that are described in this notice, or want to file a complaint, please contact My Time Recovery LLC at:
My Time Recovery LLC
83 E. Shaw Ave., Ste. 202, Fresno, CA 93710 Phone: (559)293-4387
By reading this document, I acknowledge that I have received a copy of My Time Recovery LLC Notice of Privacy Practices.