At Tillmon Behavioral Health Services LLC, your privacy is important to us. We are committed to protecting your privacy. This Practice is required by federal law to maintain the privacy of your Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. Specifically, your PHI includes any health information, oral, written, or recorded, that is created or received by us, other healthcare providers, and health insurance companies or plans, that contains data, such as your name, address, date of birth or other information that could be used to identify you as the individual patient who is associated with that health information. This Practice is required to provide you with this Notice of Privacy Practices, which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.
Generally, we may not 'use' or 'disclose' your PHI without your permission, and must use or disclose your PHI in accordance with the terms of your permission. "Use" refers to activities within our practice generally. "Disclose" refers to activities involving parties outside of our practice generally. The following are the circumstances under which we are required to use or disclose your PHI.
Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.
To inspect and copy PHI.
You can ask for an electronic or paper copy of PHI. The Practice may charge you a reasonable fee.-
The Practice may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.
To amend PHI.
You can ask to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.
The Practice may deny your request. The Practice will send a written explanation for the denial and allow you to submit a written statement of disagreement.
To request confidential communications.
You can ask the Practice to contact you in a specific way.
To limit what is used or shared.
You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer.
You can ask for the Practice not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.
To obtain a list of those with whom your PHI has been shared.
You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.
To receive a copy of this Notice.
You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.
To choose someone to act for you.
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
To file a complaint if you feel your rights are violated.
You can file a complaint by contacting the Practice using the following information:
Tillmon Behavioral Health Services LLC
Telephone number: 646 423 8795
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
200 Independence Avenue
S.W., Washington, D.C. 20201
Or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
The Practice will not retaliate against you for filing a complaint.
Routine Uses and Disclosures of PHI
The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures when you are a harm to yourself and/or others, such as those made for treatment, payment, and the operation of our business.
To treat you.
The Practice can use and share PHI with other professionals who are treating you.
Example: Your primary care doctor asks about your mental health treatment.
To run the health care operations.
The Practice can use and share PHI to run the business, improve your care, and contact you.
Example: The Practice uses PHI to send you appointment reminders if you choose.
To bill for your services.
The Practice can use and share PHI to bill and get payment from health plans or other entities.
Example: The Practice gives PHI to your health insurance plan so it will pay for your services.
To help with public health and safety issues
Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.
Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
Serious threat to health or safety: To prevent a serious and imminent threat.
Abuse or Neglect: To report abuse, neglect, or domestic violence.
To comply with law, law enforcement, or other government requests
Required by law: If required by federal, state or local law.
Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.
Law enforcement: For law locate and identify you or disclose information about a victim of a crime.
Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
Workers' Compensation: To comply with workers' compensation laws or support claims.
To comply with other requests
Coroners and Funeral Directors: To perform their legally authorized duties.
Organ Donation: For organ donation or transplantation.
Research: For research that has been approved by an institutional review board.
Inmates: The Practice created or received your PHI in the course of providing care.
Business Associates: To organizations that perform functions, activities or services on our behalf.
The Practice must obtain your written authorization to use and/or disclose PHI for the following purposes
To medical providers, family, friends, or others if PHI directly relates to that person's involvement in your care.
You may revoke your authorization, at any time, by contacting the Practice in writing, using the information above. The Practice will not use or share PHI other than as described in Notice unless you give your permission in writing.
The Practice is required by law to maintain the privacy and security of PHI. The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law. The Practice reserves the right to amend Notice. All changes are applicable to PHI collected andmaintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing on this website. The Practice will inform you if PHI is compromised in a breach.
This Notice is effective on 3/15/2021, updated on 10/7/2022.