Effective Date: March 1, 2025
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. Our Commitment to Privacy
Serenity Lodge is committed to maintaining the privacy of your protected health information (PHI). We are required by law to protect the confidentiality of your PHI and to provide you with this notice of our legal duties and privacy practices.

2. Uses and Disclosures of Protected Health Information
We may use or disclose your PHI for the following purposes, without your written authorization:

a. Treatment
We may use and share your PHI to provide, coordinate, or manage your health care and related services. For example, we may share your information with a hospital if you become ill or require emergency medical care. We may also disclose information to a psychiatrist or other healthcare provider involved in your treatment.

b. Payment
We may use and disclose PHI to bill and collect payment for the treatment and services you receive from us. This may include contacting your insurance company to verify benefits or submit claims.

c. Health Care Operations
We may use or disclose PHI in connection with our healthcare operations, such as quality assessment, training, accreditation, licensing, and audit functions.

d. Required or Permitted by Law
We may disclose your PHI without your authorization if required or permitted by federal or state law, including for:
– Reporting suspected abuse, neglect, or domestic violence;
– Health oversight activities;
– Judicial or administrative proceedings;
– Law enforcement purposes;
– Public health activities.

e. Serious Threat to Health or Safety
We may use or disclose PHI if we believe it is necessary to prevent a serious threat to your health or safety or the health or safety of others.

f. Emergencies
If you are unable to provide consent due to an emergency, we may disclose your information as necessary until you are able to participate in your care decisions.

g. Others Involved in Your Care
With your consent, we may disclose PHI to a family member or other person involved in your care or payment for your care.

3. Your Rights Regarding Your Protected Health Information
a. Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI, with limited exceptions. Requests must be made in writing.

b. Right to Amend
If you believe your health information is incorrect or incomplete, you may request an amendment. Requests must be made in writing and must include a reason for the amendment.

c. Right to an Accounting of Disclosures
You may request a list of disclosures of your PHI made by us, except for those made for treatment, payment, or health care operations, or where you provided written authorization.

d. Right to Request Restrictions
You may request a restriction or limitation on the use or disclosure of your PHI. While we will consider your request, we are not required to agree to it.

e. Right to Request Confidential Communications
You may request that we communicate with you about medical matters in a specific way or at a specific location. We will accommodate reasonable requests.

f. Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with Serenity Lodge or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

4. Our Legal Duties
– Serenity Lodge is required by law to maintain the privacy of your PHI.
– We are required to provide you with this notice of our privacy practices.
– We must follow the terms of the privacy notice currently in effect.

We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI we maintain. If we make a material change, we will post the revised notice on our website and make copies available upon request.

5. Contact Information
If you have any questions about this notice, or if you want to exercise any of your rights, you may contact:

Privacy Officer
Serenity Lodge
21 Weida Court, Nicholson, PA 18466
Phone: 570.222.3449
Email: [email protected]