Effective Date: July 1, 2025

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This Notice - by Elk Meadow Enduring Connections, Inc. (Elk) - describes how medical, mental health, and substance use disorder information about you may be used and disclosed, and how you can access this information. Please review it carefully.

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OUR LEGAL OBLIGATIONS & DUTIES

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Elk is required by law to:

1. Maintain the privacy of your Protected Health Information (PHI).

2. Provide you with this Notice explaining our legal duties and privacy practices.

3. Comply with the Health Insurance Portability and Accountability Act (HIPAA) and the Confidentiality of Substance Use Disorder (SUD) Patient Records regulations (42 CFR Part 2).

4. Notify you promptly if a breach occurs that may have compromised your information.

 

SPECIAL PROTECTIONS FOR SUD RECORDS

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Federal law (42 CFR Part 2) provides extra protections for information that identifies you as having a substance use disorder (SUD), receiving SUD services, or being evaluated for such services. We cannot disclose this information without your written consent (using a Release of Information - ROI - document) unless:

1. The disclosure is specifically allowed by law;

2. There is a valid court order; or

3. The disclosure is necessary to address a medical emergency, report child abuse or neglect, or to prevent an immediate threat to health or safety.

 

HOW WE MAY USE & DISCLOSE YOUR INFORMATION

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We may use or disclose your information for the following purposes:

1. Treatment:  to provide, coordinate, or manage your healthcare and related services.

Example: Sharing relevant information with another provider involved in your care, with your written consent.

2. Payment: to bill and receive payment for your healthcare services.

Example: Giving necessary information to your insurance company to process a claim.

3. Healthcare Operations: for administrative, management, training, and quality improvement purposes.

Example: Using information to assess the quality of services and improve care.

 

OTHER USES & DISCLOSURES ALLOWED BY LAW WITHOUT YOUR CONSENT

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We may share information if required or permitted by law, including:

1. In a medical emergency (limited information as needed to treat you);

2. To report child abuse or neglect to appropriate authorities;

3. To prevent or lessen a serious and imminent threat to your health or safety, or the health or safety of another person;

4. To comply with court orders that meet legal requirements.

 

USES & DISCLOSURES REQUIRING YOUR WRITTEN CONSENT 

 

Any other disclosure of your health or substance use disorder information will be made only with your signed written authorization.  You may revoke your consent in writing at any time, except to the extent we have already acted on it.

 

YOUR RIGHTS

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You have the right to:

1. Inspect and receive a copy of your records (some exceptions may apply).

2. Request amendments to your health information.

3. Request restrictions on certain uses or disclosures (we may not be able to agree to all requests).

4. Request confidential communications (e.g., use a specific phone number or mailing address).

5. Receive an accounting of disclosures made without your consent (excluding disclosures for treatment, payment, and operations).

6. Obtain a paper copy of this Notice at any time.

7. File a complaint with us or with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. You will not face retaliation for filing a complaint.

 

FILING A COMPLAINT and CONTACT INFORMATION

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If you have questions or wish to exercise your privacy rights, contact:

Privacy Officer:  Tammy Pope
Elk Meadow Enduring Connections
PO Box 62359, Colorado Springs, Colorado  80962
Phone:  719. 452. 0393
Email:  connect@enduringconnections.org

 

You may also contact:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Toll-Free: 1-877-696-6775
www.hhs.gov/ocr/privacy

 

For substance use disorder confidentiality violations:

• United States Attorney’s Office in the district where the violation occurred.

 

CHANGES TO THIS NOTICE

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Elk reserves the right to change our privacy practices and this Notice at any time.

Any changes will apply to all PHI we maintain, and the updated Notice

will be available on our website and at our office.

Your trust is important to us.

Elk is committed to protecting your privacy

and honoring your rights under HIPAA and 42 CFR Part 2.