About This Notice

This notice explains how health information about you may be used and shared, how you can get access to that information, and the responsibilities of The Ship Group Services (“TSG”). It applies to protected health information maintained by TSG programs that are subject to HIPAA and, when applicable, substance use disorder records protected by 42 CFR Part 2.

TSG programs and members of the TSG care team may share information with one another for treatment, payment, and health care operations when permitted by law. Additional protections may apply to certain behavioral health, substance use, HIV, genetic, minor, or other specially protected information.

Your Rights

Get a copy of your health record

You may ask to inspect or receive an electronic or paper copy of health information that we maintain about you, as allowed by law. We may charge a reasonable, cost-based fee when permitted.

Ask us to correct your record

You may ask us to correct health information you believe is incorrect or incomplete. We may deny the request in some circumstances, but we will explain the reason in writing when required.

Request confidential communications

You may ask us to contact you in a specific way or at a different address. We will accommodate reasonable requests as required by law.

Ask us to limit what we use or share

You may ask us not to use or share certain information for treatment, payment, or health care operations. We are not always required to agree. If you pay in full out of pocket for a service and ask us not to disclose information about that service to your health plan for payment or operations, we will honor the request when HIPAA requires it unless another law requires disclosure.

Get a list of certain disclosures

You may ask for an accounting of certain disclosures of your health information made during the time period allowed by law.

Get a copy of this notice

You may ask for a paper or electronic copy of this notice at any time, even if you agreed to receive it electronically.

Choose someone to act for you

If you have given someone medical power of attorney, a legal guardian has authority, or another person is legally authorized to act for you, we will recognize that person’s rights as required by law.

File a complaint

You may complain if you believe your privacy rights were violated. TSG will not retaliate against you for filing a complaint.

How We May Use and Share Your Information

Treatment

We may use and share your health information with doctors, nurses, therapists, behavioral health clinicians, care managers, peer support staff, pharmacies, laboratories, hospitals, specialists, and other people involved in your care when permitted by law.

Payment

We may use and share information to bill and collect payment from Medicaid, Medicare, an MCO or health plan, commercial insurance, another responsible payer, or you.

Health care operations

We may use and share information for quality improvement, care coordination, compliance, credentialing, supervision, auditing, training, business operations, and other activities allowed by law.

Public health, safety, and legal requirements

We may use or share information when law permits or requires it, including certain reports involving abuse or neglect, public health activities, health oversight, workers’ compensation, law enforcement, coroners or medical examiners, judicial or administrative proceedings, serious safety threats, and other lawful purposes. Special confidentiality rules may limit these disclosures for some records.

Business associates

We may share information with vendors that perform services for TSG when permitted by law. When required, those vendors must agree to protect the information through a Business Associate Agreement or other required privacy protections.

Uses That Usually Require Your Written Permission

We generally obtain your written authorization before using or disclosing health information for purposes not otherwise permitted by law. This can include certain disclosures to attorneys, employers, schools, family members or other outside parties; most uses of psychotherapy notes; certain marketing activities; and a sale of protected health information. You may revoke an authorization in writing, subject to actions already taken in reliance on it and other legal limits.

Substance Use Disorder Records — 42 CFR Part 2

When TSG creates, receives, or maintains records protected by 42 CFR Part 2, those records receive additional federal confidentiality protections. A valid consent may permit certain future uses and disclosures for treatment, payment, and health care operations as allowed by current Part 2 rules.

Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless the requirements of Part 2 and other applicable law are met. Certain SUD counseling notes and other specially protected information may require specific consent. A recipient of Part 2 information must handle it according to the rules that apply to that disclosure.

Our Responsibilities

TSG is required to protect the privacy and security of protected health information, provide you with this notice of our legal duties and privacy practices, notify affected individuals following a breach when required by law, and follow the notice currently in effect.

We may change this notice and apply the revised notice to information we already have as well as information received in the future. The current notice will be posted on our website and made available upon request.

Nondiscrimination, Language Assistance & Accessibility

TSG does not unlawfully discriminate in its health programs or activities. Free language assistance and appropriate auxiliary aids and services are available when required. If you need information in another language or format, or need a reasonable accommodation to communicate with us, call 704-553-5392.

Additional nondiscrimination, accessibility, and language-assistance notices required by federal or state law may be provided separately and remain part of your rights.

Questions or Privacy Complaints

The Ship Group Services — Privacy / Compliance Office
6636 E. W.T. Harris Blvd., Suite E
Charlotte, NC 28215
Phone: 704-553-5392
Fax: 980-333-4063
Email: admin@tsgbh.com

You may also file a HIPAA privacy complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. TSG will not retaliate against you for exercising your privacy rights or filing a complaint.