Rogers Behavioral Health Joint Notice of Privacy Practices

YOUR INFORMATION.

YOUR RIGHTS.

OUR RESPONSIBILITIES.

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. 

This Notice is effective January 2025, unless and until it is revised.

Rogers Behavioral Health, Inc., Rogers Memorial Hospital, Inc., and all subsidiaries and affiliates of both corporations (“Rogers”) is required by law to maintain the privacy of your health information and to provide you with a Notice of Privacy Practices (“Notice”) that describes Rogers’ legal duties and privacy practices concerning your health information. Health information is information that we have created and/or received about you that may identify you (such as your name, address, phone number), as well as your symptoms, examinations, test results, diagnosis, treatment and plans for future care or treatment. We are required to follow the privacy practices described in this Notice.

We reserve the right to change the privacy practices described in this Notice. We reserve the right to apply any changes to this Notice to the health information that is already in our possession as well as any future information. You may review our Notice at any time on our website at https://rogersbh.org. You may also obtain a current copy of our Notice at each of our health care locations, by contacting our Privacy Officer, or on Rogers’ website, https://rogersbh.org.

Rogers participates in an organized health care arrangement for compliance with the Health Insurance Portability and Accountability Act (“HIPAA”) and other privacy related regulations. Rogers is a clinically integrated care setting in which patients receive care from Rogers staff and from independent health care providers who participate in your care (“Integrated Care Team”). As part of this arrangement, we share your health information with each other as necessary for your treatment, to get paid for our services, and to carry out other healthcare operational activities of the Integrated Care Team. This Joint Notice of Privacy Practices (“Notice”) provided to you by any one of the Integrated Care Team participants will also satisfy the HIPAA requirement for providing notice for all others covered by this Notice. This Notice applies to services provided by Rogers’ clinics, facilities, programs, and affiliated clinical practices. Additional state-specific privacy protections, if applicable, are included in state-specific addendums at the end of this Notice. This Notice will be followed by:

• All employees of Rogers.
• All members of the medical staff and other health care providers who provide treatment to you while you are a patient of Rogers.
• Any student, volunteer or other person authorized to assist with your care while you are a patient of Rogers.
• The Notice does not cover the privacy practices of independent health care providers at other settings and locations not covered by this Notice or part of the Integrated Care Team.

How Rogers May Use and Disclosure Your Health Information

Federal laws restrict the use or disclosure of your health information relating to treatment for mental health, development disabilities, alcoholism, drug dependence or information concerning HIV status, without obtaining your authorization. Certain state laws may also restrict the use or disclosure of such information. If your health information involves such information, the information will be handled, used and disclosed only as permitted by law or with your authorization. In several instances, Federal SUD Regulations in 42 CFR Part 2 are more restrictive and we will comply with the more restrictive laws as set forth in this Notice.

The following categories describe different ways we may use and disclose health information about you without your authorization. For each category of uses or disclosures we will give examples to help you understand what we mean. Not every use or disclosure in a category will be listed. We will make reasonable efforts to use and disclose only the minimum amount of health information needed to accomplish the intended purpose of the task.

Treatment. We may use or disclose your health information to other health providers for your continuity of care. We may disclose your health information to physicians, psychologists, nurses or other health care personnel who provide you with health care services or who are involved in your care. For example, a physician may review your health information to determine if a medication is appropriate for your care.

Payment. We may use or disclose health information about you so that the treatment services you receive may be billed to, and payment may be collected from you, an insurance company or another third-party payer. For example, we may provide portions of your health information such as your name, diagnosis and the specific treatment that you are receiving to our billing department and your health plan to get paid for services provided to you. In certain situations, we may disclose your health information to a collection agency if a bill is not paid.

Health Care Operations. We may use your health care information as necessary for our individual and permitted joint health care operations which may include quality assurance and improvement activities, evaluation of the performance of health care providers, legal services, risk management business planning and compliance with law. For example, we may use your information to look at the care you received from doctors, nurses, or other health care providers. We may use your health information for our accreditation activities.

Fundraising.  We may use or disclose to the Rogers Memorial Hospital Foundation certain limited information from your record (excluding any alcohol and other drug abuse records) for fundraising purposes in accordance with applicable privacy laws, which information shall be limited to the following: limited demographic information, including your name, address, and/or other contact information (or that of your personal representative, as applicable); dates of health care provided to you, and names of your treating physician(s). The Foundation has no access to your health information and, if applicable, will be provided only the limited information noted above from Rogers for fundraising purposes.  In each fundraising communication received, either from Rogers directly or from the Foundation, you will be provided the opportunity to opt-out of receiving further fundraising communications in the future. If the information is from your substance use treatment, you will first be provided with a clear and conspicuous opportunity to elect not to receive fundraising communications.

Additional Ways Rogers May Use and Disclosure Your Health Information Without Your Authorization

Family and Care Givers for Care. We may disclose limited health information about you to your family members, other relatives, or a close personal friend, or any other person you identified the protected health information directly relevant to their involvement with your health care or payment.   If you are able and available to agree or object, we will give you the opportunity to agree or object to such uses and disclosures. If you are not available or in the event of your incapacity or emergency circumstances, we will disclose health information using professional judgment disclosing only information that is directly relevant to person’s involvement in your health care.

Required by Law. We may use and disclose your health information when that use or disclosure is required by local, state or federal law. For example, we are required to report actual and suspected abuse, neglect or violence relating to children and the elderly. We are also required to respond to a court order.

Public Health. We may disclose your health information to local, state or federal public health agencies, subject to the provisions of applicable law, to help prevent or control disease, injury, or disability. For example, we are required to report certain diseases, injuries, and problems with products and reactions to medications to the Food and Drug Administration.

Health Oversight Activities. We may disclose your health information to authorities and agencies designated by the government or as required by law, for purposes such as management audits, financial audits or program monitoring and evaluation.

Judicial and Administrative Proceedings. We may disclose your health information in the course of an administrative or judicial proceeding for such purposes as response to a court order or associated with a petition filed in court related to treatment.

Law Enforcement. We may disclose your health information to a law enforcement official as required or permitted by law. For example, we may disclose health information to report an apparent crime committed on the premises, assist with identifying and locating a missing patient, or comply with a court order.

Coroners and Medical Examiners. We may disclose your health information to coroners, medical examiners, law enforcement, and other authorities as required or permitted by law so they can carry out their duties related to your death, such as determining cause of death.

Research. Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research. The researchers agree not to disclose information that would allow you to be identified, except as allowed by law. For example, the research study may measure the success of a treatment or medication in treating an illness or condition.

Avert Serious Threats to Health or Safety. We may disclose your health information in a very limited manner to appropriate persons to prevent a serious threat to the health and safety of a particular person or the general public. Disclosure is usually limited to law enforcement personnel who are involved in protecting the public safety or others in a position to prevent the threat.

For Workers’ Compensation. We may disclose your health information to the appropriate persons to comply with the laws related to workers’ compensation or other similar programs. These programs may provide benefits for work-related injuries or illness.

Health Information. We may use or disclose your health information to provide information to you or about treatment alternatives or other health-related benefits and services that may be of interest to you.

Facility Directory. We may use your health information, such as your name, location in our facility, and your religious affiliation for our directory. Unless there is a specific written request from you to the contrary, we can disclose this directory information, except for your religious affiliation, to people who ask for you by name.

Your religious affiliation may be given to the members of the clergy even if they do not ask for you by name.

Correctional Facility, Probation or Parole. If you are an inmate of a correctional facility, we may disclose your health information to the correctional facility and other authorized authorities for your health and the health and safety of others.

Business Associates.  We may disclose your information to contractors (business associates) who provide certain services to us. We will require these business associates to appropriately safeguard your information.

Note that, although we do not need your written authorization for these disclosures, any uses or disclosures for health oversight activities, judicial and administrative proceedings, law enforcement purposes, and disclosures to coroners and medical examiners that involves information potentially related to reproductive health care requires an attestation from the individual or entity requesting the information. The attestation must clearly state that the protected health information used or disclosed will not be used (1) in an investigation into or imposition of liability against any person in connection with reproductive healthcare where such health care is lawful under the circumstances, or (2) to identify any person for the purpose of initiating such investigations or imposing such liability. For example, if a law enforcement agency requests your protected health information, which includes information potentially related to reproductive health care, the agency would be required to provide an affidavit.

Special Requirements for Substance Use Disorder Patient Records

Federal law protects the confidentiality of your substance use disorder (“SUD”) records.  Any use or disclosure of your SUD records will be limited to that information which is necessary to carry out the purpose of the use or disclosure. We will only use your SUD records without your consent for:

Medical Emergencies. We may disclose your SUD records to meet a bona fide medical emergency in which your prior written consent cannot be obtained, or we are unable to provide services or obtain your consent due to closures caused by a declared state of emergency due to a natural or major disaster.  For example, you have a medical emergency that prohibits your ability to communicate or otherwise give consent.

Scientific Research.  We may disclose your SUD records to help conduct research after confirming the recipient is a HIPAA covered entity or business associate that has obtained and documented your authorization, or a waiver or alteration of authorization to receive the information, and the use or disclosure is made in accordance with HIPAA.  For example, the research study may measure the success of a treatment or medication in treating an illness or condition.

Management Audits, Financial Audits, and Program Evaluation.  We may disclose your SUD records to qualified individuals or entities that perform audits or evaluations on behalf of a governmental agency, third-party payers or health plans, quality improvement organizations, or having direct administrative control us.  For example, we may be evaluated for compliance with health care licensing laws.

Public Health.  We may disclose your SUD records for public health purposes without patient consent so long as the disclosure is made to a public health authority and your information has been deidentified so there is no reasonable basis to believe you can be identified from the information.  For example, we are required to report certain diseases and injuries to government agencies.

Crimes on Our Premises.  The prohibitions on uses and disclosures of your SUD records do not apply to our communications with law enforcement agencies or officials which are directly related to a patient’s commission of a crime on our property, against our staff, or constitute a threat to commit such a crime so long as the communications are limited to the circumstances of the incident.

Child Abuse and Neglect. The prohibitions on uses and disclosures of your SUD records do not apply to reports required by law of incidents of suspected child abuse and neglect.  However, your original SUD records remain subject to the restrictions on use and disclosure.

Court Orders.  Your SUD records, or testimony relaying their content, cannot be used or disclosed in any civil, administrative, criminal, or legislative proceedings against you unless based on your specific written consent or a court order.  Your SUD records can only be used or disclosed based on a court order after you or we have received a notice and an opportunity to be heard when required by Federal law.  A court order authorizing the use or disclosure must be accompanied by a subpoena or other similar legal mandate compelling disclosure before your SUD records are used or disclosed.

Requirement to Obtain an Authorization for Use or Disclosure of Your Health Information

Except as described in this Notice, we will not use or disclose your health information without your written authorization. For example, your authorization is required for most uses and disclosures of health information for marketing purposes and the sale of health information.

Your authorization is required for most uses and disclosures of psychotherapy notes which are notes recorded by a mental health provider documenting or analyzing the contents of conversation with you during counseling sessions that are kept separate from the rest of your health information. If you authorize us to use or disclose your health information, you may revoke that authorization, in writing, at any time to stop any future uses and disclosures to the extent that we have not taken any action relying on the authorization.

If you wish to withdraw your authorization, you may contact Rogers’ Health Information Department at 833-984-3366 or via email at releaseofinformation@rogersbh.org. For treatment, payment, and health care operations purposes, you may provide a single consent for all future uses or disclosures of your SUD records.

Disclosures of your SUD records made with your consent to Part 2 programs, covered entities, or business associates for purposes of treatment, payment, and health care operations may be further disclosed by those entities without your written consent to the extent permitted by HIPAA.

Your Right to Refuse Authorization for Use or Disclosure of Your Health Information

Your protected health information may not be used or disclosed without your authorization, and you may refuse to authorize the use or disclosure of your protected health information, for the following purposes:

A criminal, civil, or administrative investigation into, or imposition of criminal, civil, or administrative liability against, any person in connection with seeking, obtaining, providing, or facilitating reproductive healthcare, where such health care is lawful under the circumstances in which it is provided and any of the following conditions exist:

The investigation or imposition of liability is in connection with any person seeking, obtaining, providing, or facilitating reproductive health care where such health care is lawful.  For example, if a resident of one state traveled to another state to receive reproductive health care, such as an abortion, it is lawful in the state where such health care was provided.

The investigation or imposition of liability is in connection with a person seeking reproductive health care that is protected, required, or expressly authorized by federal law.  For example, if the reproductive health care, such as miscarriage management, is required under the Emergency Medical Treatment and Labor Act (“EMTALA”) to stabilize the health of the pregnant individual.

The identification of any person for the purpose of initiating such investigations or proceedings listed above.  For example, the protected health information is sought to obtain the name of an individual who has received reproductive health care in connection with a civil lawsuit under the conditions described above.

Other Rights Regarding Your Health Information and This Notice

As a patient, you have several rights regarding your health information.

Right to be Notified of a Breach. You have the right to be notified in the event there is any breach of your unsecured health information.

Right to Inspect and Copy. With a few exceptions, you have the right to inspect and obtain a copy of your health information. If you request copies of your health information, although we may charge for the costs of providing the copies, such charges are limited and, in some instances, you may obtain copies free of charge.  For example, if you request an electronic copy and the health information you are requesting is maintained electronically, we will provide the copy electronically in the form you request if it is readily producible, or if not, in an agreed upon readable electronic form. You have the right to request, in writing, that we transmit a copy of your health information directly to another individual. This right to access does not apply to psychotherapy notes, which are maintained for personal use of a mental health professional.

Right to Amendment. You have a right to request that we amend your health information that you believe is incorrect or incomplete. You must also provide a reason for your request. We are not required to change your health information and may deny your request in writing if the health information is correct and complete, not created by us, or not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you do not file one, you have the right to request that your request and our denial be attached to all future disclosures of your health information. If we approve your request to amend, we will make the changes to your health information and make reasonable efforts to inform others about the change to your health information. Changes to non-clinical information such as changes of address and insurance information are not amendments and may be routinely processed.

Right to Request Restrictions. You have the right to request restrictions on the use and disclosure of your health information for treatment, payment, or health care operations activities.

Additionally, you have the right to request restrictions on disclosure of information to individuals involved in your care. We are not required to agree to your requested restrictions in most cases. If we do agree, we will comply with your restriction unless the information is needed to provide you emergency treatment or until the agreement is terminated. We must, however, agree to your request to restrict disclosure of your health information, to a health plan for the purpose of carrying out payment or health care operations, if it is not otherwise required by law, and, the health information pertains solely to a health care item or service for which you, or a third party other than the health plan, have paid us for in full. We will inform you if we cannot carry out your request.

Right to Receive Confidential Communications. You have the right to request that we communicate your health information to you in a certain way or at a certain location. For example, you may ask that we only contact you at work or by U.S. Mail. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.

Right to Receive an Accounting. You have the right to request, in writing, a record of certain types of disclosures we made of your health information to individuals or organizations for the six (6) years prior to the date on which the accounting is requested, or a shorter time period if requested. We are not required to provide a record of the following disclosures:

• To carry out treatment, payment, and health care operations.
• To individuals regarding information about themselves.
• Incident to a use or disclosure otherwise permitted by applicable law.
• To persons involved in the individual’s care, or for other notification purposes as permitted by applicable law.
• For the facility’s directory.
• That occurred pursuant to an authorization.
• For national security or intelligence purposes.
• To correctional institutions or law enforcement officials regarding patients in their custody.
• As part of a limited data set which excludes your name, date of birth, and other key identifiers.

The record of disclosures will include the date of each disclosure, who received the disclosed health information along with the address, if known, a brief description of the health information disclosed, and why the disclosure was made. We will provide the first list you request within a 12-month period at no charge. For additional lists, we may charge for the cost for providing the list.

For SUD records, you may request an accounting of disclosures made with your consent for the three (3) years prior to the date on which the accounting is requested, or a shorter time period if requested. The accounting of disclosures will meet the requirements of 45 CFR 164.528(a)(2) and (b) through (d). You may also obtain an accounting of disclosures of such records for treatment, payment, and health care operations where such disclosures were made through an electronic health record. Additionally, you have the right to a list of disclosures by an intermediary for the past three (3) years.

Right to Receive a Paper Copy. Upon your request, you may at any time receive a paper copy of this Notice, even if you earlier agreed to receive this Notice electronically. This Notice is available at all Rogers locations, as well as on our website, https://rogersbh.org.

Right to Opt-Out. You have the right to opt-out of fundraising communications.

Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with Rogers. You also have the right to complain to the Secretary of the Department of Health and Human Services, Office for Civil Rights, 233 N Michigan Avenue, Suite 240, Chicago, IL 60601, or by calling 800-368-1019. If your complaint relates to your privacy rights while you were receiving treatment, you may also file a complaint with a Rogers staff member. There will be no retaliation against you in any way for filing a complaint.

How to Contact Us:

• Privacy Officer, 833-221-0991, compliance@rogersbh.org, rogersbh.ethicspoint.com
• Medical Records, Release of Information, 833-984-3366, releaseofinformation@rogersbh.org
• Rogers Behavioral Health, 36700 Valley Road, Oconomowoc, WI 53066, https://rogersbh.org

State Addendums

The following states have protections for your health information that are in some instances more restrictive than the disclosures permitted under Federal law.  If you are receiving services in one of the following states, we will follow the more stringent protection under the applicable state’s law as provided here.

California: For patients in California, the Rogers Memorial Notice of Privacy Practices are modified to the extent provided in this addendum.

Except in limited circumstances authorized by law, we will not disclose your participation in outpatient treatment with a psychotherapist unless the person or entity requesting information is otherwise authorized to receive it and submits to you and us a written and signed request that includes: (a) the specific information sought and their intended uses; (b) the length of time the information will be kept before being destroyed or disposed of; (c) a statement that the information will not be used for any purpose other than its intended use; and (d) a statement that the information will be destroy or returned before or immediately after the specified length of time expires.

Except in limited circumstances authorized by law, we will also not disclose your medical information related to you seeking or obtaining an abortion to law enforcement or in response to a subpoena or request if the subpoena or request is based on (1) another state’s laws that interferes with your reproductive privacy rights under California law or (2) a lawsuit authorized by another state to punish an offense against the laws of that state.

Additionally, under California law we are prohibited from releasing medical information related to a person allowing a child to receive gender affirming care in response to any lawsuit based on another state’s law that authorizes a person to bring a lawsuit against a person that allows a child to receive gender affirming care.

You also have additional rights in your health information under California law.  If you signed an authorization for the disclosure or release of your health information you are entitled to a copy of the signed authorization.  With limited exceptions, if we have disclosed your health information with a third-party for purposes of the third-party’s own direct marketing, you are entitled to, upon written request, a list of the types of personal information released and third parties who have received it.

Colorado:  For patients in Colorado, the Rogers Memorial Notice of Privacy Practices are modified to the extent provided in this addendum.

We may disclose your mental health information to your family or other individuals participating in your care.  Under federal law, you will be given the opportunity to object to such disclosures.  If you are unavailable, the disclosures will be limited to one or more of the following to the extent that they are directly relevant to their involvement in your care: your diagnosis, your prognosis, the need for hospitalization and anticipated length of stay, the discharge plan, the medication administered and side effects of the medication, and the short-term and long-term treatment goals.  Additionally, information disclosed to your family solely for purposes of notification will be limited to the location and fact of admission to inpatient or residential care.

Your mental health information will be disclosed pursuant to a court order only if you and Rogers have been notified and provided an opportunity for a hearing.

Florida: For patients in Florida, the Rogers Memorial Notice of Privacy Practices are modified to the extent provided in this addendum.

Under Florida law your information will be used for research purposes only after measures have been taken to protect your identity.  If your records include substance abuse information, we will also obtain assurances in writing that your identifying information will not be used.

Georgia:  For patients in Georgia, the Rogers Memorial Notice of Privacy Practices are modified to the extent provided in this addendum.

Under Georgia law, absent your written authorization, we will not disclose your mental health information that is privileged under Georgia law to coroners, the legal representative of your estate (if you are deceased), the disability service ombudsman, or in response to a subpoena or court order.

Illinois:  For patients in Illinois, the Rogers Memorial Notice of Privacy Practices are modified to the extent provided in this addendum.

If you are an inpatient of a mental health facility, information will only be disclosed to individuals involved in your care, such as family members, after their identity is confirmed, we receive assurances there are no protection orders or divorce proceedings between you and the individual, the disclosure does not create a risk of neglect or abuse, and the disclosure is in your best interest.  The information disclosed will be no more than necessary for the individual’s involvement in your care or payment and limited to whether you are at our facility and your discharge plans.  Additionally, you will be notified in writing of such disclosures.

You have additional rights under Illinois law.  If we deny your request to amend your medical record You have the right to submit a written statement about any disputed or new information in your record which will be included in future disclosures and, if we deny your request to amend your record, you have the right to seek a court order compelling us to do so.

You also have the right to refuse to disclose and to prevent the disclosure of your mental health records in civil, criminal, administrative, or legislative proceedings. This right does not apply, and your mental health information may be disclosed to the extent necessary  (1) when your mental condition or related treatment is introduced as part of a claim and the court makes certain findings; (2) for information from a court-ordered examination and the court makes certain findings; (3) for competency proceedings and your fitness to stand trial; (4) for investigations of and trials for homicide when the disclosure relates directly to the fact or immediate circumstances of the homicide; (5) child abuse proceedings; (6) collection of payments; (7) proceedings involving the validity of or benefits under insurance claims; (8) death investigations; and (9) actions under the “Mental Health and Developmental Disabilities Confidentiality Act.”.  Before any such disclosures are made, you may request the court privately review the record or communications to be disclosed prior to making a decision regarding the disclosure.

Minnesota:  For patients in Minnesota, the Rogers Memorial Notice of Privacy Practices are modified to the extent provided in this addendum.

Your records relating to your reproductive care will not be released under the laws of other states, or related court orders, which restrict or punish accessing reproductive health care services.

Your medical records will also not be released to an individual involved in your health care, such as a family member, unless the request is in writing by an individual, verified by another, who lives with, provides care for, or is directly involved in monitoring your treatment, you have been  informed in writing of the request and do not or are unable to object, and the disclosure is necessary to assist in providing your care or monitoring your treatment.  The information disclosed will be limited to that which is relevant and consist of only your diagnosis, admission or discharge, the name and dosage of your medications, side effects of your medication, consequences of your failure to take the medication, and a summary of the discharge plan.

Your records will not be disclosed for research purpose unless we first disclose to you in writing that your health records may be released and have the right to object.  If you object the records will not be released. We will also notify you how you may contact the researcher and the date of the disclosure, and we will use reasonable efforts to obtain your written authorization for any release for research purposes. We will also make reasonable effort to determine that the disclosure of your records does not violate any limitations under which we acquired the record, the disclosure of individually identifiable information is necessary to accomplish the research purpose, the researcher maintains adequate safeguards to protect your records, and further use or release of your records without your authorization is prohibited.

Pennsylvania:  For patients in Pennsylvania, the Rogers Memorial Notice of Privacy Practices are modified to the extent provided in this addendum.

For purposes of judicial proceedings, if your mental health treatment is being provided on an involuntary basis or you are an inpatient, we will only disclose your mental health treatment records in accordance with proceedings authorized by The Mental Health Procedures Act and related regulations or pursuant to a court order. For purposes of payment, we will only disclose the staff names, the dates, types and costs of therapies or services, and a short description of the general purpose of each treatment session or service.  In addition to your rights under Federal law, you have the right to include a written statement qualifying or rebutting information in your mental health records if you believe information is erroneous or misleading.  Your written statement will accompany all released records.

Tennessee:  For patients in Tennessee, the Rogers Memorial Notice of Privacy Practices are modified to the extent provided in this addendum.

Under Tennessee law, your name and addresses will not be sold for any reason.  Absent your written authorization, your confidential information will only be disclosed pursuant to a court order after a hearing and a finding the information is necessary for the conduct of the proceedings and that failure to make the disclosure would be contrary to public interest or to the detriment of a party to the proceedings.

Disclosures of your mental health records for law enforcement purposes will be limited to instances when the agency has jurisdiction over serious felonious acts of bodily harm or sexual offenses that appear to have been committed on our property or in our facilities.  Such disclosures to law enforcement are limited to: (1) The names of, and providing access to, witnesses or potential witnesses of the offense; (2) The names of, and providing access to, suspects or potential suspects of the offense; and (3) The scene of, and providing access to, where the offense occurred.

If the felonious act involves a sexual abuse of a child or sexual exploitation of an elderly person or disabled adult in a locality having a sex abuse crime unit, we will only disclose your information to that unit of the law enforcement agency.  However, Tennessee law does permit the disclosure of your information for investigative purposes to other types of state and local agencies.  For example, your information may be disclosed for purposes of reporting elderly abuse.

Washington:  For patients in Washington, the Rogers Memorial Notice of Privacy Practices are modified to the extent provided in this addendum.

We keep a record of the health care services we provide you. You may ask us to see and copy that record.  You may also ask us to correct that record. We will not disclose your record to others unless you direct us to do so or unless the law authorizes or compels us to do so. You may see or get more information about your record by contacting Rogers’ Health Information Department at 833-984-3366 or via email at releaseofinformation@rogersbh.org.

Any of your mental health information that we disclose to individuals involved in your care, without your authorization, will be limited to the relevant minimum amount necessary and include only: (a) your diagnoses and treatment recommendations; (b) issues concerning your safety; (c) information about resources that are available to you in the community; and (d) the process to ensure that you safely transitions to a different of care.

Unless we are otherwise required by law, we will only disclose your information to law enforcement when it is evidence of criminal conduct on our premises and when you are being transported by law enforcement.   We may also disclose your mental health records in connection with a prohibition on firearms ownership and for the protection of others.  If you are a minor, your mental health records may also be disclosed if you have violated your conditions of treatment, there is an emergency that poses a significant and imminent risk to the public, and when the health and safety of an individual has been threatened.

Your information will only be disclosed for research purposes if an institutional review board has made certain determinations regarding the protection of your information and the importance of the research.

Wisconsin:  For patients in Wisconsin, the Rogers Behavioral Health Joint Notice of Privacy Practices are modified to the extent provided in this addendum. Absent your written authorization, we will release only the following to your family members or caregivers, who have been verified by another to be involved in your care, only to the extent it is directly relevant to such person’s involvement with your care:

• A summary of your diagnosis and prognosis.
• A listing of the medications you have received and are receiving.
• A description of your treatment plan.