Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Association for Multicultural Behavioral Health (AMBH) is committed to protecting and preserving your privacy. We understand that health information about you is personal and that you are concerned over how it is used. This Notice of Privacy Practices describes how the health care professionals and staff may use and disclose your Protected Health Information (PHI) to carry out your treatment, payment, and health care operations and for other purposes that are required by law and your rights as our client to access and control your protected health information.

AMBH must use and give out your PHI to provide information:

• To you or someone who has the legal right to act for you (your personal representative),
• To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected, and
• Where required by law.

AMBH has the right to use and give out your PHI to receive payment for treatment services provided to you and to operate the AMBH program. For example:

• AMBH use your PHI to collect your medical insurance benefits or health coverage from other third party payer.
• AMBH may use your PHI to make sure you and other AMBH clients get quality care, to provide customer services to you, to resolve any complaints you have, or to contact you about research studies.

AMBH may use or give out your PHI for the following purposes under limited circumstances:

• To State and other Federal agencies that have the legal right to receive AMBH data (such as to make sure AMBH is making proper payment claims and reporting for billed services, and to assist Federal/State programs),
• For public health activities (such as reporting disease outbreaks),
• For government health care oversight activities (such as fraud and abuse investigations),
• For judicial and administrative proceedings (such as in response to a court order),
• For law enforcement purposes (such as child abuse or neglect  to make the initial mandated report; criminal activity on program premises or against program personnel committed by you),
• For research studies that meet all privacy law requirements (such as research related to the prevention of disease or disability),
• To avoid a serious and imminent threat to health or safety inflicted on you or someone else,
• To create a collection of information that can no longer be traced back to you.

By law, AMBH must have your written permission (an "authorization") to use or give out your PHI for any purpose that isn't set out in this notice. You may take back ("revoke") your written permission at any time, except if AMBH has already acted based on your permission.

By law, you have the right to:

• See and get a copy of your PHI held by AMBH.
• Have your PHI amended if you believe that it is wrong or if information is missing, and AMBH agrees. If AMBH disagrees, you may have a statement of your disagreement added to your PHI.
• Get a listing of those getting your PHI from AMBH. The listing won't cover your PHI that was given to you or your personal representative, that was given out to pay for your treatment or for AMBH operations, or that was given out for law enforcement purposes.
• Ask AMBH to communicate with you in a different manner or at a different place (for example, by sending materials to a P.O. Box instead of your home address).
• Ask AMBH to limit how your PHI is used and given out to obtain payment for your treatment and run the AMBH program. Please note that AMBH may not be able to agree to your request.
• Get a separate paper copy of this notice.

Look at AMBH’s HIPAA Privacy & Security Plan for more information on:

• Exercising your rights set out in this notice.
• Filing a complaint, if you believe the AMBH has violated these privacy rights. Filing a complaint won't affect your services AMBH.

If you have any questions about this Notice of Privacy Practices, you can contact AMBH Privacy Officer at: ATTN.: Privacy Officer, Association for Multicultural Behavioral Health, LLC 6650 N. Northwest Highway, Suite 215, Chicago, IL 60631, (773) 313-3757. 

You may file a complaint with the Secretary of the Department of Health and Human Services (HHS). Visit the HHS Health Information Privacy website, or contact the Office for Civil Rights if you believe your privacy rights were violated.

By law, AMBH is required to follow the terms in this privacy notice. AMBH has the right to change the way your PHI is used and given out. If AMBH makes any changes to the way your PHI is used and given out, you will get a new notice by mail within 60 days of the change.

You have the right to obtain a paper copy of this notice from us upon request.