Notice of Privacy Practices

Right to Inspect and Copy

You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records. To inspect and copy medical information, you must submit your request in writing to the Privacy Officer at Adapt of Missouri, LLC. If you request a copy, we may charge a reasonable fee for copying, mailing, or other supplies. We may deny your request in certain limited circumstances. If denied, you may request a review by another licensed professional.

Right to Amend

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information by contacting the Privacy Officer. The request may be denied if the information:

• Was not created by us
• Is not part of the medical information kept by Compass Health Network
• Is not part of information you would be permitted to inspect and copy
• Is accurate and complete

Right to an Accounting of Disclosures

You have the right to request an "accounting of disclosures" — a list of disclosures we made of medical information about you. Submit your request in writing to the Privacy Officer. Your request must state a time period (not longer than six years, not before April 14, 2003). The first list within a 12-month period is free; additional lists may incur a cost.

Right to Request Restrictions

You have the right to request restrictions on the medical information we use or disclose for treatment, payment, or health care operations. We are not required to agree to your request. To request restrictions, submit your request in writing to the Privacy Officer, specifying what information you want to limit, whether you want to limit use, disclosure, or both, and to whom the limits should apply.

Right to Request Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location (e.g., only at work or by mail). Submit your request in writing to the Privacy Officer, specifying how or where you wish to be contacted. We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice at any time, even if you have agreed to receive it electronically. You may obtain a copy at our website: https://compasshealthnetwork.org/

For Treatment

We may use medical information about you to provide you with medical treatment or services. We may disclose medical information to doctors, nurses, clinicians, counselors, interns, pharmacists, or personnel involved in your care. Different programs may share information to coordinate prescriptions, case management, psychotherapy, etc.

For Payment

We may use and disclose medical information so that treatment and services may be billed to and payment collected from you, an insurance company, or a third party. We may also tell your health plan about upcoming treatment to obtain prior approval or determine coverage.

For Health Care Operations

We may use and disclose medical information for agency operations necessary to run Adapt of Missouri, LLC and ensure quality care. This includes reviewing treatment, evaluating staff performance, deciding on additional services, and training personnel. We may remove identifying information so others may study health care delivery.

Note: Substance abuse treatment records are protected under Federal Regulations (42 CFR Part 2) and HIPAA (45 CFR Parts 160 and 164) and cannot be disclosed without written authorization unless otherwise provided by regulations.

Appointment Reminders

We may use and disclose medical information to contact you as a reminder about appointments.

Research/Program Evaluation

Under certain circumstances, we may use and disclose medical information for research purposes. All research projects are subject to a special approval process. We will ask for your specific permission if the researcher will have access to identifying information or if you are to participate in experimental treatments.

Patient Photography

Photographs, videotapes, or other images may be recorded to document your care. Adapt of Missouri, LLC retains ownership rights, but you may view or obtain copies. Images will be stored securely and released only with your written authorization.

As Required By Law

We will disclose medical information when required by federal, state, or local law.

To Avert a Serious Threat to Health or Safety

We may use and disclose medical information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Children's Mercy Integrated Care Solutions (CMICS)

We participate in a clinically integrated network (CIN) called Children's Mercy Integrated Care Solutions (CMICS) and may share your child's data with the CIN to support coordination, communication, and delivery of the highest level care.

Health Information Exchange (HIE)

Adapt of Missouri, LLC may participate in health information exchanges (HIEs) and may electronically share your medical information for treatment, payment, and other authorized purposes. Information shared may include diagnoses, medications, allergies, lab results, radiology reports, and sensitive health information including mental health, HIV/AIDS, genetic, STD, and family planning information.

The inclusion of your medical information in an HIE is voluntary and subject to your right to opt-out. To exercise your right to opt-out, please call 660.890.8116.

More information: https://velatura.org/velatura-hie/#resources

Privacy Officer

Adapt of Missouri, LLC

2301 Hampton Ave

St. Louis, MO 63139

Phone: (660) 890-8141

Client Rights Monitor

Missouri Department of Mental Health

1706 East Elm Street

Jefferson City, MO 65102

Phone: (573) 751-4942

U.S. Department of Health and Human Services

Office for Civil Rights

200 Independence Avenue, S.W.

Room 509F, HHH Building

Washington, D.C. 20201