NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
PLEASE REVIEW IT CAREFULLY
LeChris must collect information about you to provide quality
services. We know that information we collect and your
health is confidential, and we are required to protect this
information by Federal and State law.
The Notice of Privacy Practices tells you how Le’Chris may
use or disclose information about you. As required by law,
only the minimum necessary information will be used and
If you have questions, please contact the Privacy Officer at
your office location.
WHO WILL FOLLOW THIS NOTICE
This notice describes LeChris practices at all locations and
Any independent health care professional who treats
or cares for consumers at LeChris and is authorized
to enter information into your medical record.
All departments and units of LeChris.
All employees of LeChris.
Any volunteers we allow to help you while you are in
Any vendors or independent contractors who have
access to protected health care information of
consumers at LeChris.
All students or trainees.
Any LeChris corporate office staff.
All of the above listed persons, entities, sites and locations
follow the terms of this notice. In addition, these persons,
entities, sites and locations may share medical information
with each other for your treatment or LeChris operations
purposes and the purposes described in this notice. The
independent health care professionals who provide care at
LeChris and have agreed to follow the terms of this notice are
not employees or agents of LeChris, and LeChris is not
responsible for how they fulfill their professional
LE’CHRIS MAY USE & DISCLOSE INFORMATION
WITHOUT YOUR AUTHORIZATION
For Treatment. LeChris may use or disclose
protected health care information with health care
providers who are involved in your health care to
create and carry out a plan of treatment.
For Payment. LeChris may use or disclose
protected information in order to get payment or to
pay for the health care services you receive. For
example, your protected information may be used
within our company for billing purposes.
For Health Care Operations. LeChris may use or
disclose your protected information in order to review
the quality of services you receive and for resolving
grievances and appeals.
For Appointments. LeChris may contact you to remind
you of an appointment.
For Public Health. LeChris is required by law to report
suspected communicable diseases.
As Required By Law. LeChris may use and disclose
protected health care information when required or
permitted by Federal or State law or if required by a court
For Abuse Reports and Investigations. LeChris is
required by law to report any suspected abuse, neglect, or
For Government Programs. LeChris may use and
disclose protected health care information for public
benefits under government programs. An example of this
would be for Medicaid benefits.
To Avoid Harm. LeChris may use and disclose
protected information in order to avoid a serious threat to
the health and safety of a person or the public.
In Case of Emergency. LeChris may use and disclose
protected health care information in emergency
situations. An example of this would be in the case of a
medical or psychiatric emergency or criminal behavior.
Another example would be a disaster relief organization
such as the Red Cross if we need to notify someone of your
location or condition.
For Minors. LeChris may use and disclose protected
health care information regarding a minor to a parent,
legal guardian, or others responsible for the minor except
in limited circumstances.
To Persons Involved in Your Care. LeChris may
use and disclose protected health care information
about you to a relative or any person that you identify
if that person is involved in your care and only if that
information is relevant to your care except as
mandated by State and Federal regulations.
You may ask us not to disclose protected health care
information to persons involved in your care, and we
will agree to your request and not disclose the
information except in circumstances such as an
emergency or if you are a minor. If you are a minor,
we may or may not be able to agree with your request.
USES AND DISCLOSURES THAT REQUIRE YOUR
For other situations, LeChris will ask for your written
authorization before using or disclosing information. You
may cancel this authorization at any time in writing. We
cannot take back any uses or disclosures already made with
YOUR PRIVACY RIGHTS
The Right To Request Restrictions On Uses And
Disclosures. You have the right to request that we limit the
use and disclosure of protected health care information about
you. We are not required to agree to your request. If we
agree to your request, we must follow your restrictions except
when the information is necessary for emergency treatment.
You may cancel these restrictions at any time, and we may
cancel a restriction at any time as long as we notify you of the
cancellation and continue to apply the restriction to
information collected before the cancellation.
The Right To Request An Alternative Method Of
Contact. You have the right to be contacted at a different
location or by an alternative method. For example, you may
request that written information be sent to your work address
or a post office box instead of your home address. Your
request for this alternative method of contact must be in
The Right To See And Get Copies Of Your Records. You
have the right to request to view or receive copies of your
records in most cases. This request must be in writing and
there may be a charge for the cost of copying your records.
The Right To Get A List Of Disclosures. You have the
right to ask Le’Chris for a list of certain disclosures. You
must make this request in writing, and the list will not
include the times that the information was disclosed for
treatment, payment, or health care operations. It will also
not include information provided directly to you or your
family or information that was sent with your authorization.
YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES
If you believe that your privacy rights have been violated, you
may file a complaint. We will not take any actions against
you or change our treatment of you in any way if you file a
To file a complaint with LeChris, you may bring your
complaint to our office or mail it to the office that provides