Chelan-Douglas Regional Support Network/
Prepaid Health Plan

For Mental Health

1. Right to Inspect and Copy. You have the right to request an opportunity to inspect or copy health information used to make decisions about your care – whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes. You must submit your request in writing to our Privacy Officer at Chelan-Douglas Regional Support Network/Prepaid Health Plan, 636 Valley Mall Parkway, Suite 200, East Wenatchee WA 98802. If you request a copy of the information, we may charge a fee for the cost of copying, mailing and supplies associated with your request. We may deny your request to inspect or copy your health information in certain limited circumstances. In some cases, you will have the right to have the denial reviewed by a licensed health care professional not directly involved in the original decision to deny access. We will inform you in writing if the denial of your request may be reviewed. Once the review is completed, we will honor the decision made by the licensed health care professional reviewer.

2. Right to Amend. For as long as we keep records about you, you have the right to request us to amend any health information used to make decisions about your care – whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes. To request an amendment, you must submit a written document to our Privacy Officer at Chelan-Douglas Regional Support Network/Prepaid Health Plan, 636 Valley Mall Parkway, Suite 200, East Wenatchee WA 98802, and tell us why you believe the information is incorrect or inaccurate. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend health information that:

   	was not created by us, unless the person or entity that created the health information is no longer available to make the amendment;
   	is not part of the health information we maintain to make decisions about your care;
   	is not part of the health information that you would be permitted to inspect or copy; or
   	is accurate and complete.

   If we deny your request to amend, we will send you a written notice of the denial stating the basis for the denial and offering you the opportunity to provide a written statement disagreeing with the denial. If you do not wish to prepare a written statement of disagreement, you may ask that the requested amendment and our denial be attached to all future disclosures of the health information that is the subject of your request. If you choose to submit a written statement of disagreement, we have the right to prepare a written rebuttal to your statement of disagreement. In this case, we will attach the written request and the rebuttal (as well as the original request and denial) to all future disclosures of the health information that is the subject of your request.

3. Right to an Accounting of Disclosures. You have the right to request that we provide you with an accounting of disclosures we have made of your health information. An accounting is a list of disclosures. But this list will not include certain disclosures of your health information, by way of example, those we have made for purposes of treatment, payment, and health care operations. To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer at Chelan-Douglas Regional Support Network/Prepaid Health Plan, 636 Valley Mall Parkway, Suite 200, East Wenatchee WA 98802. For your convenience, you may submit your request on a form called a “Request For Accounting,” which you may obtain from our Privacy Officer. The request should state the time period for which you wish to receive an accounting. This time period should not be longer than six years and not include dates before April 14, 2003. The first accounting you request within a twelve month period will be free. For additional requests during the same 12 month period, we will charge you for the costs of providing the accounting. We will notify you of the amount we will charge and you may choose to withdraw or modify your request before we incur any costs.

4. Right to Request Restrictions. You have the right to request a restriction on the health information we use or disclose about you for treatment, payment or health care operations. You may also ask that any part (or all) of your health information not be disclosed to family members or friends who may be involved in your care. To request a restriction you must request the restriction in writing addressed to the Privacy Officer at Chelan-Douglas Regional Support Network/Prepaid Health Plan, 636 Valley Mall Parkway, Suite 200, East Wenatchee WA 98802. We are not required to agree to a restriction that you may request. If we do agree, we will honor your request unless the restricted health information is needed to provide you with emergency treatment.

5. Right to Request Confidential Communications. You have the right to request that we communicate with you about your health care only in a certain location or through a certain method. For example, you may request that we contact you only at work or by e-mail. To request such a confidential communication, you must make your request in writing to the Privacy Officer at Chelan-Douglas Regional Support Network/Prepaid Health Plan, 636 Valley Mall Parkway, Suite 200, East Wenatchee WA 98802. We will accommodate all reasonable requests. You do not need to give us a reason for the request; but your request must specify how or where you wish to be contacted.

6. Right to a Paper Copy of this Notice. You have the right to obtain a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this Notice of Privacy Practices electronically, you may still obtain a paper copy. To obtain a paper copy, contact our Privacy Officer at Chelan-Douglas Regional Support Network/Prepaid Health Plan, 636 Valley Mall Parkway, Suite 200, East Wenatchee WA 98802.

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