HIPAA Notice of Privacy

Notice of Privacy Practices of Serenity for Life

This notice describes:

  • How Protected Health Information (PHI) about you may be used and disclosed.

  • Your rights with respect to your PHI

  • How to file a complaint concerning a violation of the privacy or security of your PHI or of your rights concerning your information.

You have a right to a copy of this notice in paper or electronic form and to discuss it with the client advocate for Serenity For Life.

Uses and Disclosures

Purposes for which Serenity for Life is permitted or required to use or disclose records without the client's written consent:

  1. To Provide Care. We may use or disclose information between Serenity for Life personnel having a need for information in providing care or services.  The physician, nurse, therapist, and/or other professionals will use your information to diagnose and/or provide treatment.

  2. Payment. If applicable, your PHI will be used to check for eligibility and to prepare and file claims.  We may provide portions of your PHI to your payer to obtain payment or be reimbursed for healthcare services we provide. 

  3. Healthcare Operations. We may use or disclose your PHI in connection with our healthcare operations, including licensing and accreditation.  We may also use it to evaluate our performance and identify ways to improve our service and the care we provide. 

  4. Public Health.  We may disclose your PHI to a public health authority that is authorized by law to collect or receive such information, such as for the purpose of preventing or controlling disease, injury, or disability; reporting births, deaths or other vital statistics; reporting child abuse or neglect; notifying individuals of recalls of products they may be using; notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.

  5. Business Associates.  We may disclose your PHI to Business Associates that are contracted by us to perform services on our behalf.  We require business associates to enter into a written agreement to safeguard and protect your health information.

  6. Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, accreditation, licensure, and disciplinary actions.

  7. Judicial and Administrative Proceedings.  We may disclose your PHI in the course of judicial or administrative proceedings.  We may make a disclosure in response to your authorization or a court or administrative order.

  8. Crimes on Premises. We may disclose to law enforcement officers information that is directly related to the commission of a crime on the premises or against our personnel or related to a threat to commit such a crime.

  9. Reports of Suspected Abuse and Neglect. We may disclose information required to report under state law incidents of suspected child abuse and neglect to the appropriate state or local authorities.  We may also disclose information required to report an at-risk adult who may be experiencing mistreatment or is self-neglecting basic needs.

  10. To Avert a Serious Threat to Health or Safety.  We may use and disclose your PHI when necessary to prevent a serious and imminent threat to your health or safety or the health and safety of the public or a specific person. 

  11. Emergency Situations. We may disclose information to medical personnel for the purpose of treating you in an emergency.

  12. Court Order. We may disclose information required by a court order, provided certain regulatory requirements are met.

  13. Research. We may use and disclose your information for research if certain requirements are met, such as approval by an Institutional Review Board.

  14. Reporting of Death. We may disclose your information related to cause of death to a public health authority that is authorized to receive such information.

You may provide a single consent for all future uses or disclosures for treatment, payment, and health care operations purposes. 

Serenity For Life will make uses and disclosures not described in this notice only with the client’s written consent.

Revocation

If you or your representative authorize us to use or disclose your PHI for reasons other than treatment, payment, or healthcare operations, you may revoke your authorization in writing at any time to stop future uses or disclosures.  Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. 

Records, or testimony relaying the content of such records, shall not be used or disclosed in any civil, administrative, criminal, or legislative proceedings against the client unless based on specific written consent or a court order;

  1. Records shall only be used or disclosed based on a court order after notice and an opportunity to be heard is provided to the client or the holder of the record, where required by 42 U.S.C. 290dd-2 and this notice; and 

  2. A court order authorizing use or disclosure must be accompanied by a subpoena or other similar legal mandate compelling disclosure before the record is used or disclosed.

Separate statements for certain uses or disclosures. If the part 2 program intends to engage in any of the following activities, the description required by paragraph (b)(1)(ii)(D) of this section must include a separate statement as follows:

  1. Records that are disclosed to Serenity For Life, covered entity, or business associate pursuant to the client's written consent for treatment, payment, and health care operations may be further disclosed by that part 2 program, covered entity, or business associate, without the client’s written consent, to the extent the HIPAA regulations permit such disclosure.

  2. Serenity For Life may use or disclose records to fundraise for the benefit of Serenity For Life only if the client is first provided with a clear and conspicuous opportunity to elect not to receive fundraising communications.

Client rights

The notice must contain a statement of the client's rights with respect to their records and a brief description of how the client may exercise these rights, as follows:

  1. You have the right to request restrictions of disclosures made with prior consent for purposes of treatment, payment, and health care operations.

  2. You have the right to request and obtain restrictions of disclosures of records for those services for which you have paid in full. 

  3. You have the right to an accounting of disclosures of electronic records for the past 3 years, for all disclosures made with consent.

  4. You have the right to a list of disclosures by an intermediary for the past 3 years 

  5. You have the right to obtain a paper or electronic copy of this notice

  6. You have the right to discuss this notice with a designated contact person or office identified by Serenity for Life

  7. You have the right to elect not to receive fundraising communications.

Serenity For Life’s duties

Serenity For Life is required by law to maintain the privacy of records, to provide clients with notice of its legal duties and privacy practices with respect to records, and to notify affected clients following a breach of unsecured records;

Serenity For Life is required to abide by the terms of this notice currently in effect; and Serenity For Life will apply a change in a privacy practice that is described in the notice to records that Serenity for Life created or received prior to issuing a revised notice, Serenity for Life reserves the right to change the terms of its notice and to make the new notice provisions effective for records that it maintains. The statement must also describe how it will provide clients with a revised notice.

Complaints

Clients have a right to make a complaint to Serenity for Life if they believe their privacy rights have been violated, a brief description of how the client may file a complaint with the program, and a statement that the client will not be retaliated against for filing a complaint.

Contact  

For further information about this notice, contact:

Serenity For Life
Client Advocate
303.604.4060
support@serenityforlife.org

Effective date: May 5, 2025

 The notice must contain the date on which the notice is first in effect, which may not be earlier than the date on which the notice is printed or otherwise published.

Revisions to the notice 

Serenity for Life must promptly revise and distribute its notice whenever there is a material change to the uses or disclosures, the client’s rights, Serenity for Life’s legal duties, or other privacy practices stated in this notice. Except when required by law, a material change to any term of the notice may not be implemented prior to the effective date of the notice in which such material change is reflected.