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 INFORMATION. PLEASE REVIEW IT CAREFULLY.

WHO WILL FOLLOW THIS NOTICE?

This Notice describes the practices of WOODHAVEN, (the "Agency") and the practices that will be followed by all Agency employees who handle your medical information.

OUR PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION

The Agency understands that medical information about you and your health is personal and recognizes that your medical information regarding substance disorders, and mental health issues is perhaps even more personal to you than other medical information. We are committed to protecting all medical information about you. We maintain our records and conduct our treatment environment with a goal of providing the highest level of protection for your medical information, while still providing you with the highest level of care. This Notice applies to all of the records of your medical care which are received or created by the Agency.

Your other medical treatment providers (e.g., doctors, hospitals, therapists, etc.) may have different policies or notices regarding the use and disclosure of your medical information. The Agency provides health care to you, as a client in partnership with area physicians, licensing organizations (such as the Ohio Department of Behavioral Health) and other organizations and professionals.

This Notice will tell you about the ways in which the Agency may use and disclose medical information about you. A signed release of information must be utilized if providing information to another physician, hospital, therapist or other outside agency. Your medical information, also referred to as protected health information (or "PHI"), is that information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health information and related health care services. In this Notice, we also describe your rights and certain obligations the Agency has regarding the use and disclosure of your protected health information so as to ensure that we do not violate any of your rights. We are required by law to:

*	Make sure that medical and other information that identifies you (protected health information) is kept private;

*	Give you this Notice of our legal duties and privacy practices with respect to protected health information about you; and

*	Follow the terms of the Notice that is currently in effect.

USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

By becoming a client of the Agency, you will be asked to provide consent (“Authorization”) for the Agency to use your protected health information for certain activities, including treatment, payment and other health care operations. As a client, you may provide a single consent for all future uses or disclosures for treatment, payment, and health care operations purposes. Consent for treatment and healthcare operations is not required to enroll in services and receive care.

First of all, we may use and disclose protected health information about you so that the Agency and its medical professionals can treat you. For example, we may disclose information about your symptoms, examination, test results, or diagnosis to consult with other medical professionals outside the Agency regarding the best course of treatment for you. We may also use and disclose protected health information about you so that we may be paid for the medical treatment we provide you. For example, we may send your protected health information to your insurance company, Medicaid, and other governmental bodies and agencies to obtain payment for services we render to you. We may also use and disclose protected health information about you for the Agency's health care operations, in other words, those other tasks that we need to perform to make sure that you are provided the highest quality of medical care. For example, we may submit information about you to others for purposes of assessing whether or not we have provided you quality care, determining what we can do to make sure that we continue to provide you quality care or improve the level of care we provide, and developing guidelines and training programs for our employees.

PERMITTED USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

The following uses of your protected health information may be made by the Agency without any additional authorization from you. (Not every use or disclosure is listed, but be assured that all uses and disclosures made by the Agency are only those which are permitted under the law):

1. USES AND DISCLOSURES FOR APPOINTMENT REMINDERS

We may use and disclose your medical information to contact you as a reminder that you have an appointment at our offices. If you request that such communications be made confidentially, please contact us at 1 Elizabeth Place, Dayton Ohio 45427. We will accommodate all reasonable requests.

2. USES AND DISCLOSURES TO OTHERS INVOLVED IN YOUR HEALTH CARE

We may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person’s involvement in your medical care. If you are unable to agree or object to this disclosure, we may disclose such information as necessary if we determine that it is in your best interests based on our professional judgment. We may also use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, of your location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

3. USES AND DISCLOSURES IN EMERGENCY SITUATIONS

We may use or disclose your protected health information in an emergency treatment situation. If this happens, the Agency will attempt to obtain your acknowledgment of this Notice as soon as reasonably practicable after the delivery of treatment.

4. USES AND DISCLOSURES FOR HEALTH-RELATED BENEFITS OR SERVICES

From time to time, the Agency may use and disclose protected health information to tell you about certain health-related benefits and services or treatment alternatives that may be of interest to you.

5. USES AND DISCLOSURES REQUIRED BY LAW

We will use or disclose protected health information about you when required to do so by federal, state, or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if the law requires us to do so, of any such uses or disclosures. We must make disclosures to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the law.

6. USES AND DISCLOSURES FOR PUBLIC HEALTH ACTIVITIES

We may disclose your protected health information for public health activities and disclosure for such purposes will be to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for purposes such as controlling disease, injury or disability. Disclosures to public health authorities may include disclosure to a foreign authority that is working with the public health authority.

7. USES AND DISCLOSURES RELATED TO COMMUNICABLE DISEASES

We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

8. DISCLOSURES FOR HEALTH OVERSIGHT ACTIVITIES

We may disclose protected health information to a health oversight agency for activities authorized by law. These activities include, for example, audits, investigations, and inspections. These activities are necessary for the government to monitor the health care system, the delivery of health care, government benefit programs, other government regulatory programs and civil rights laws.

9. DISCLOSURES OF ABUSE OR NEGLECT

We may disclose your protected health information to a public health authority or other governmental agency authorized by law to receive reports of child abuse or neglect, as required or permitted by applicable federal and Ohio law. We may also disclose your protected health information to a governmental authority authorized by law to receive reports of abuse, neglect, or domestic violence when such disclosure is required by law, authorized by law, or when otherwise permitted under applicable federal and Ohio law. Any such disclosure will be made in accordance with applicable legal requirements. Additionally, some disclosures are subject to Part 2 restrictions and exceptions.

10. DISCLOSURES TO THE FOOD AND DRUG ADMINISTRATION

We may disclose your protected health information to a person or company required by the Food and Drug Administration (FDA) to report adverse events, product defects or other problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements; or to conduct post-market surveillance, as required.

11. DISCLOSURES FOR LAWSUITS AND DISPUTES

If you are involved in a lawsuit or a dispute, we may disclose protected health information about you in response to a court order or administrative order. We may also disclose protected health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested, or any other such efforts as are required by Ohio law.

12. DISCLOSURES TO LAW ENFORCEMENT

We may release protected health information if asked to do so by a law enforcement official, in response to a court order, subpoena, warrant, summons, or similar process. Records shall only be used or disclosed based on a court order after notice and an opportunity to be heard is provided to you or the holder of the record, where required by 42 U.S.C. 290dd-2 and this part; and (3) 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. Other related disclosures may include disclosures relating to individuals who are Armed Forces personnel, to national security and intelligence agencies, as well as disclosures to authorized federal officials for the protection of the President of the United States or other authorized persons or foreign heads of state.

13. DISCLOSURES TO CORONERS, FUNERAL DIRECTORS, AND ORGAN DONATION

We may disclose protected health information about you to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties required by law. We may also disclose protected health information about you to a funeral director in order to permit the funeral director to carry out legal duties; and may do so if death is reasonably anticipated. Your protected health information may also be disclosed for certain organ donations to which you may have agreed.

14. DISCLOSURES FOR RESEARCH

We may disclose your protected health information to researchers when their research has been approved and protocols have been established to ensure the privacy of your information. We may also disclose a limited set of your information, as allowed under the law, for research purposes.

15. DISCLOSURES RELATED TO CRIMINAL ACTIVITY

We may disclose your protected health information, consistent with federal and Ohio laws, if we believe that the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public, or if it is necessary for law enforcement authorities to identify or apprehend an individual.

16. DISCLOSURES FOR WORKERS’ COMPENSATION

We may release protected health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

17. FUNDRAISING

We may, from time to time, contact you regarding our fundraising efforts. The services we have provided to you and our ability to continue to provide similar services in the future is largely dependent upon the generosity of individuals just like you. If you wish to not be contacted by us for this purpose, you have the right to opt out by contacting the Director of the Development Department.

18. TESTIMONIALS

We may contact any Woodhaven client to discuss and inquire if they would like to provide written or oral testimony
regarding services received at Woodhaven for purposes of media and advertising. If any Woodhaven client agrees, they
will need to sign a written authorization consent form for testimonials. This form authorizes the disclosure of the
testimonial.

19. CONSENT FOR USE AND DISCLOSURE OF RECORDS IN CIVIL, CRIMINAL, ADMINISTRATIVE, OR LEGISLATIVE PROCEEDINGS

Patient consent for use and disclosure of records (or testimony relaying information contained in a record) in a civil,
criminal, administrative, or legislative investigation or proceeding cannot be combined with a consent to use and
disclose a record for any other purpose.
20. COUNSELING NOTES
We require your written consent to use or disclose your SUD counseling notes, except for limited purposes such as
use by the creating provider for treatment, internal training, legal defense, or as otherwise permitted/required by law.
This consent must be separate from other consents, and you are not required to sign it to receive treatment,
payment, enrollment, or benefits.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU

Right to Inspect and Copy. You have the right to inspect and copy protected health information that may be used to make decisions about your medical care. Usually this right includes both medical and billing records. You must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. These fees comply with the Department of Health. Your request to inspect and copy your information may only be denied in very limited circumstances and you have a right to request that any such denial be reviewed.

One free copy of a patient's medical record is provided, on receipt of appropriate request, to:

The Bureau of Workers' Compensation, the Industrial Commission, or the Ohio Department of Job and Family Services;

Patient or patient's representative if the record is necessary to support a claim for Social Security disability benefits and the request is accompanied by documentation that the claim has been filed.

Right to Request Restrictions. You have the right to request that we restrict the use and disclosure of your protected health information for treatment, payment, and health care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to Woodhaven’s Privacy Officer, Michael Brakeall, 1 Elizabeth Place, Dayton, Ohio 45417. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.

Right to Confidential Communications. You also have the right to request to receive private health information communications (such as appointment reminders, test results, etc.) by alternative means or at alternative locations. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to Amend. If you feel that the protected health information about you, we have is incorrect or incomplete, you have the right to request that your protected health information be amended. Only the health care entity (e.g., doctor, hospital, clinic, etc.) that created your protected health information is responsible for amending it. For more information regarding the procedures for submitting such a request, contact us.

Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures we have made of your protected health information (PHI). An accounting is a list of disclosures made by Woodhaven that are not otherwise excluded by law.

Under HIPAA, an accounting is not required for the following disclosures:

Made for treatment, payment, or health care operations;

Made directly to you or your personal representative;

Made pursuant to your written authorization;

Made to persons involved in your care or payment for your care;

Made for disaster relief purposes;

Made as part of a facility directory;

Made from a limited data set;

Made for national security or intelligence purposes;

Made to correctional institutions or law enforcement officials regarding individuals in lawful custody, as permitted by law; or

That are incidental to otherwise permitted or required uses or disclosures.

In certain circumstances, disclosures to health oversight agencies or law enforcement officials may be temporarily excluded from an accounting if those agencies provide a written statement that providing the accounting would likely impede their activities.

To request an accounting of certain disclosures, you must submit a written request to:

Privacy Officer

Woodhaven

Michael Brakeall

michael.brakeall@woodhavenohio.com

(937) 813-1737 ext. 377

1 Elizabeth Place

Dayton, Ohio 45417

Your request must specify the time period covered by the accounting. The requested period may not exceed six (6) years prior to the date of your request and may not include dates before April 14, 2014.

Please indicate whether you would like the accounting provided in paper or electronic format. For additional information, please contact us.

Right to a Paper Copy or Electronic Copy of this Notice. You have the right to a paper copy or electronic copy of this Notice. You may ask us to give you a copy of this notice at any time.

*	You may obtain a copy of this Notice at our website: www.woodhavenohio.com

*	To obtain a paper copy of this Notice, contact our Privacy Office at:

Privacy Officer

Woodhaven

Michael Brakeall

michael.brakeall@woodhavenohio.com

(937) 813-1737 ext. 377

1 Elizabeth Place

Dayton, Ohio 45417

To learn more about these procedures, or to make any of these requests, you should contact us.

CHANGES TO THIS NOTICE

The Agency reserves the right to change this notice. We reserve the right to make the revised or changed Notice effective for protected health information we already have about you, as well as any information we create or receive in the future. The revised Notice is available upon request and is posted on Woodhaven’s website at Woodhavenohio.com.

COMPLAINTS

If you believe your privacy rights have been violated and/or that the Agency has not followed this policy, you may file a complaint. All complaints must be submitted in writing. You will not be penalized for filing a complaint. You may contact:

Privacy Officer

Woodhaven

Michael Brakeall

michael.brakeall@woodhavenohio.com

(937) 813-1737 ext. 377

1 Elizabeth Place

Dayton, Ohio 45417

You may also contact the Secretary of the Department of Health and Human Services at:

U.S. Department of Health and Human Services (HHS)

Region V- Chicago (Illinois, Indiana, Michigan, Ohio, Wisconsin)

Celeste Davis, Regional Manager

Office of Civil Rights

233 N. Michigan Ave., Suite 240

Chicago, IL 60601

Phone: (800) 368-1019

Fax: (312) 886-1807

TDD: (800) 537-7697

OTHER USES OF PROTECTED HEALTH INFORMATION AND AUTHORIZATION REVOCATION

Other uses and disclosures of your protected health information not covered by this notice or the laws that apply to the Agency will be made only with your written permission (“authorization”). If you provide us permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time, unless you are receiving treatment as a condition of probation, parole or rehabilitation. If you revoke your permission, we will no longer use or disclose protected health information about you for the reasons covered by your authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the medical treatment or other services that we have provided to you. You may revoke authorization by contacting a clinical staff member, such as a member of medical staff or clinical staff and identifying that you wish to revoke authorization. In addition, if you have already been discharged from the program, you may contact the Records Department at (937) 813-1737 ext. 370 and request to revoke your authorization. You will be asked to complete a “Revocation of Authorization for Release of Information” form.

QUESTIONS?

If you have any questions regarding this notice, please contact our Privacy Officer at:

Privacy Officer

Woodhaven

Michael Brakeall

michael.brakeall@woodhavenohio.com

(937) 813-1737 ext. 377

1 Elizabeth Place

Dayton, Ohio 45417

Approved by: Kyle Zink, Executive Director

Approval Date: 6/22/2017

Revision Date: 11/7/2017; 6/2018; 7/17/2019; 11/14/2019; 4/20/2021; 9/21/2023; 7/18/2024, 4/1/2025; 5/12/2026; 6/4/2026

Review Date: 3/16/2020; 10/21/2021; 9/15/2022; 5/18/2023; 10/1/2024; 7/1/2025

PATIENT ACKNOWLEDGMENT FORM

Our Notice of Privacy Practices (Notice) provides information about how we may use and disclose protected health information about you. You have the right to receive and review our Notice before signing this acknowledgment. As provided in our Notice, the terms of our Notice may change. If we change our Notice, you may obtain a revised copy.

By signing this form, you acknowledge that you have been informed of our uses and disclosures of protected health information about you for all of the purposes set out in our Notice.

By signing this form, you also acknowledge that a copy of our Notice has been provided to you, that you understand the contents of our Notice and how it applies to you, and that all of your questions regarding the contents of our Notice have been answered.

__________________________	______________________________________________

Date	Client Signature

__________________________	______________________________________________

Date	Staff Signature