The Montcalm Center for Behavioral Health

611 N. State Street – Stanton, MI 48888

1-800-377-0974

HIPAA Privacy Rights

HIPAA is a law that protects your privacy. We are required to inform you of your rights under this law. This document is a short summary of your rights. A longer version with more information is attached. If you have questions you may ask to speak to our Privacy Officer.

Ø We will use or share your private information with others as necessary for treatment. We may also use or share your information to get paid for our services and to run our agency.

Ø We may remind you of your appointment by sending a postcard or leaving a message on your answering machine. You may ask us not to do these things.

Ø If we need to share your information for other reasons, we will ask you to sign a special form. If you change your mind and tell us, we will stop sharing the information.

Ø You have the right to see the information we have about you and to get copies of that information. If we refuse your request we must tell you the reason.

Ø If you think that the information you saw is wrong, you can write to us and ask us to change it. We do not have to agree to change the information. If we do not agree we have to tell you why.

Ø You can get a list of the people we have shared your information with. If we shared the information to treat you, to receive payment, or to run our agency, it will not be on the list.

Ø You can ask us not to use your information in a certain way. You may also ask us not to share your private information with certain people. We do not have to agree to these requests.

Ø You can ask that we send your mail to a certain address or that we only call you at a certain time or place.

Ø You have the right to complain to our Privacy Officer if you think that we did not follow these rules.