Effective Date: February 16, 2026
Your Information. Your Rights. Our Responsibilities.
This notice explains how medical information about you may be used and disclosed, and how you can access this information. Please read it carefully.
Summary
Your Rights
You have the right to:
- Get a copy of your paper or electronic medical record
- Correct your paper or electronic medical record
- Request confidential communications
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in how we use and share your information when we:
- Tell family and friends about your condition
- Provide disaster relief
- Include you in a hospital directory
- Provide mental health care
- Market our services or sell your information
- Raise funds
Our Uses and Disclosures
We may use and share your information to:
- Treat you
- Run our organization
- Bill for your services
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
If we have substance use disorder patient records about you that are subject to 42 CFR Part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
Your Rights
When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities to help you use them.
Get an Electronic or Paper Copy of Your Medical Record
- You may ask to see or receive an electronic or paper copy of your medical record and other health information we have about you. Contact us to find out how.
- We will generally provide a copy or summary of your health information within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask Us to Correct Your Medical Record
- If you believe health information we have about you is incorrect or incomplete, you may ask us to correct it. Contact us to find out how.
- We may deny your request. If we do, we will explain why in writing within 60 days.
Request Confidential Communications
- You may ask us to contact you in a specific way (for example, at home, at work, or on your cell phone) or to send mail to a different address.
- We will agree to all reasonable requests.
Ask Us to Limit What We Use or Share
- You may ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may decline if, for example, it could affect your care. If we do agree, we may still share the information if you need emergency treatment.
- If you pay for a service or health care item out of pocket and in full, you may ask us not to share that information with your health insurer for payment or operations purposes. We will agree unless a law requires us to share it.
Get a List of Those With Whom We’ve Shared Information
- You may ask for a list (an “accounting”) of the times we have shared your health information during the six years before your request. The list will show who we shared it with and why.
- The list will include every disclosure except those for treatment, payment, and health care operations, and certain others (such as disclosures you asked us to make). We provide one accounting per year free of charge. We may charge a reasonable, cost-based fee if you ask for another within 12 months.
Get a Copy of This Privacy Notice
You may ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. We will provide one promptly.
Choose Someone to Act for You
- Someone may have legal authority to act as your personal representative, such as through a medical power of attorney or legal guardianship. If so, that person can exercise your rights and make choices about your health information.
- Before we take any action, we will confirm that the person has this authority and can act for you.
File a Complaint if You Feel Your Rights Are Violated
- If you believe we have violated your rights, you may file a complaint with us using the contact information at the end of this notice.
- You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You can mail a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, call 1-877-696-6775, or visit www.hhs.gov/hipaa/filing-a-complaint.
- We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us how you want it shared. If you have a clear preference in any of the situations below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and the choice to tell us whether to:
- Share information with your family, close friends, or others involved in your care or in paying for your care
- Share information in a disaster relief situation
- Include your information in a hospital directory
If you are unable to tell us your preference (for example, if you are unconscious), we may share your information if we believe it is in your best interest. We may also share it when needed to reduce a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
If we have substance use disorder patient records about you that are subject to 42 CFR Part 2, we will give you clear and obvious notice in advance. We will also give you a choice about whether to receive fundraising communications that use your Part 2 information.
Our Uses and Disclosures
How Do We Typically Use or Share Your Health Information?
We typically use or share your health information in the following ways.
Treat you
We may use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We may use and share your health information to run our hospital, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We may use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How Else Can We Use or Share Your Health Information?
We are allowed or required to share your information in other ways, usually ways that contribute to the public good, such as public health and research. We have to meet many legal conditions before we can share your information for these purposes.
Substance use disorder records: In all cases, including those listed below, if we have substance use disorder patient records about you that are subject to 42 CFR Part 2, we cannot use or share information from those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.
Help with public health and safety issues
We may share health information about you in certain situations, such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
Do research
We may use or share your information for health research.
Comply with the law
We will share information about you if state or federal law requires it. This includes sharing with the Department of Health and Human Services if it wants to confirm that we are complying with federal privacy law.
Respond to organ and tissue donation requests
We may share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We may share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We may use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We may share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described in this notice unless you give us written permission. If you give us permission, you may change your mind at any time. Please let us know in writing if you do.
For more information, visit HHS: Notice of Privacy Practices.
Changes to the Terms of This Notice
We may change the terms of this notice, and the changes will apply to all information we have about you. The updated notice will be available upon request, in our office, and on our website.
Contact Us
- Effective Date: February 16, 2026
- Mailing Address: Pleasant Point Behavioral Hospital, 17872 Lincoln Highway, Middle Point, OH 45863
- Pleasant Point Behavioral Hospital will never market or sell your personal information.