Notice of Privacy Practices
This privacy practices 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.
Privacy Practices: Use and Disclosure of Protected Health Information (PHI)
Rawhide may use your Protected Health Information for the purpose of providing treatment obtaining payment for care and other related health care operations. We have established specific policies to further protect your health information against unnecessary disclosure.
Circumstances Involving Use and Disclosure of Protected Health Information
- To Provide Treatment
Rawhide may use your Protected Health Information to consult with Rawhide employees or designated treatment providers to provide the best quality of care. (For example, a coordinating physician may need to know additional information about your symptoms to prescribe appropriate medications.)
Rawhide may use your Protected Health Information to other parties involved in paying for your treatment or care.
We may use the minimum required Protected Health Information for quality assessment activities, licensing, statistical, and accreditation purpose. For example, Rawhide’s Outpatient Program Director is required to review charts for formatting and signatures in order to remain licensed through the State of Wisconsin.
Note: Psychotherapy notes are never released to anyone internally or externally for treatment, payment, or operations.
When Required by Law
Rawhide will disclose your Protected Health Information when it is required to do so by Federal, State, County, or local law. This includes responding to a subpoena.
To Report Abuse or Neglect
Rawhide and its employees are mandated by law to report suspected child abuse, either physical or sexual, and child neglect.
To Report a Serious Threat to Health or Safety
If an employee of Rawhide has good reason to believe that your safety is in jeopardy (for example, because of a suicide threat) or that another person’s safety is in jeopardy (for example, because of a threat to harm another), we are mandated by law to disclose Protected Health Information for the purpose of preventing harm to yourself or to someone else.
Use and disclosure for any purpose described above is limited to the minimum necessary information needed by a third party to carry out services that are in the best interest of the customer. The customer will be notified by Rawhide when a disclosure must be made in the above instances.
Authorization and Rights Regarding Your Health Information
Other than stated above, Rawhide will not disclose your Protected Health Information other than with your written authorization. If you authorize the agency to use or disclose your Protected Health Information, you may revoke the authorization in writing at any time.
You have the following rights regarding your health information:
- Right to request restrictions on disclosure of your health information. We will respectfully consider your request, but there may be times when we are not required to agree to your request, such as; if disclosing information would jeopardize the customer or if the law requires disclosure.
- Right to inspect and copy your health information. You must request your health information in writing, sign your request, and allow the agency 72 business hours to process your request.
- Right to amend Protected Health Information. If you believe that your health care information is incorrect or incomplete, you may request to amend your record. Your request must be made in writing and be signed. We will respectfully consider your request, but there may be times when we are not required to abide by your request.
- Right to an accounting of disclosures. You have the right to request an accounting of the disclosures that Rawhide makes of your health information.
If you believe Rawhide has violated your privacy rights, you have the right to file a complaint in writing with:
Rawhide Boys Ranch
E7475 Rawhide Road
New London, Wisconsin 54961
(920) 982-6100, Ext. 2645
Office for Civil Rights
U.S. Department of Health & Human Services
233 N. Michigan Ave. Suite 240
Chicago, IL 60601
(312) 353-5693 (TDD)
(312) 886-1807 FAX
This notice is effective April 9, 2008, and replaces any previous notice of privacy practices issued by Rawhide.
If you have any questions regarding this notice, please contact your Program Manager.