This notice applies to health information created or maintained by Solace Grove Behavioral Health, Inc. and its workforce. We are committed to protecting the privacy and security of your health information.
Your rights
When it comes to your health information, you have certain rights. Contact us using the information at the end of this notice to exercise these rights.
Get an electronic or paper copy of your record
You may ask to inspect or obtain an electronic or paper copy of your medical record and other health information we maintain about you, other than information excluded by law, such as most psychotherapy notes. We will generally provide a copy or summary within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your record
You may ask us to correct health information that you believe is incorrect or incomplete. We may deny the request in circumstances permitted by law, but we will explain the reason in writing, generally within 60 days.
Request confidential communications
You may ask us to contact you in a specific way or at a different address. We will agree to 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 health care operations. We are not always required to agree. If you pay for a service out of pocket in full, you may ask us not to disclose information about that service to your health plan for payment or health care operations, and we will agree unless disclosure is required by law.
Get an accounting of disclosures
You may ask for a list of certain disclosures of your health information made during the six years before your request. The accounting will not include certain disclosures, such as those made for treatment, payment, health care operations, or at your direction. One accounting in a 12-month period is free; we may charge a reasonable, cost-based fee for additional requests.
Get a copy of this notice
You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
Choose someone to act for you
If a person has legal authority to act for you, such as a health care agent or legal guardian, that person may exercise your rights. We will verify the person's authority before acting.
File a complaint
You may complain if you believe your privacy rights have been violated. Instructions for filing a complaint with Solace Grove and with the U.S. Department of Health and Human Services Office for Civil Rights appear at the end of this notice. We will not retaliate against you for filing a complaint.
Your choices
In certain situations, you may tell us your preferences about sharing information. These may include sharing information with family, close friends, or others involved in your care or payment for your care, and sharing information during disaster relief. If you cannot tell us your preference, we may share information when we believe it is in your best interest or when needed to lessen a serious and imminent threat to health or safety, as permitted by law.
We will obtain your written authorization before using or disclosing your information for purposes that are not described in this notice or otherwise permitted by law. Written authorization is generally required for marketing, the sale of health information, and most uses and disclosures of psychotherapy notes. You may revoke an authorization in writing at any time, except to the extent we have already relied on it.
How we may use and disclose your health information
Treatment
We may use your health information and share it with other professionals who are treating you. For example, a clinician may consult with another treating health care provider to coordinate your care.
Health care operations
We may use and disclose your health information to operate our practice, improve the quality of care, supervise and train our workforce, conduct compliance activities, and contact you when necessary.
Payment
We may use and disclose your health information to bill for services and obtain payment from health plans or other responsible payers.
Other uses and disclosures permitted or required by law
Subject to applicable legal limits, we may use or disclose health information for public health and safety activities; reporting suspected abuse or neglect; health oversight; research meeting legal requirements; workers' compensation; certain law-enforcement and government functions; organ and tissue donation; coroners, medical examiners, or funeral directors; and judicial or administrative proceedings. We may disclose information when state or federal law requires it, including to the U.S. Department of Health and Human Services to demonstrate our compliance with federal privacy law.
We may also use your information to provide appointment reminders and information about treatment alternatives or health-related services. More protective federal or Wisconsin confidentiality rules will control when they apply.
Special protection for substance use disorder records
Records that identify a person as having or having had a substance use disorder and that are created or maintained by a federally assisted substance use disorder program may receive additional protection under 42 CFR Part 2.
In general, Part 2 records will not be used or disclosed unless you provide written consent or Part 2 otherwise permits the use or disclosure. Part 2 permits a patient to provide a single consent for future uses and disclosures for treatment, payment, and health care operations. Other limited uses or disclosures may be permitted, including for a medical emergency; qualifying research, audit, or evaluation activities; reporting crimes on program premises or against program personnel; or under a qualifying court order.
Part 2 records will not be used or disclosed in a civil, criminal, administrative, or legislative investigation or proceeding against you without your written consent or a court order and subpoena, or similar legal mandate, that satisfy Part 2 requirements. Recipients of Part 2 records must comply with applicable limits on use and redisclosure.
Our responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information, as required by law.
- We must follow the duties and privacy practices described in the notice currently in effect and provide you with a copy upon request.
- We will not use or disclose your information other than as described in this notice unless you authorize us in writing or the law permits or requires it.
Changes to this notice
We may change the terms of this notice, and changes may apply to all information we maintain about you. A revised notice will be available upon request, at our office, and on this website. The effective date will appear at the beginning of the notice.
Questions or complaints
To ask a privacy question, exercise a right, request a copy, or file a complaint with Solace Grove, call 414-200-0180 or write to:
Privacy Contact
Solace Grove Behavioral Health, Inc.
9235 W Capitol Drive, Suite 200
Milwaukee, WI 53222
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201; calling 1-877-696-6775; or visiting the HHS complaint page. Solace Grove will not retaliate against you for filing a complaint.