Personal Health Information Disclosure and Use (PHI) / Patient Privacy/ Express Relief,LLC) Your PHI will not be used or disclosed for any purpose not listed below, without your specific written authorization. You must give written authorization to disclose your health information to anyone for any reason you want. Any specific written authorization you provide may be revoked at any time by your written request.

• Health Care Provider - PHI may be used and disclosed to your physician or other healthcare provider who is also treating you.
• Payment - Your PHI may be used and disclosed for submission of your claim to your insurance carrier for payment and / or your legal representative for payment or by any of your legal representative's requests.
• Care Operations - Your PHI may be used and disclosed to staff members for the purpose of providing service.
• As Law Requires - Your PHI may be used and disclosed to any person required by federal, state, or local laws to have lawful access to your treatment program.
• Court Orders, Judicial and Administrative Proceedings, and Law Enforcement - Your PHI may be disclosed as part of a court proceeding, in response to a subpoena, or in other situations as required by law.
• Appointment Reminder - You may be contacted by phone or email for an appointment reminder. If contact is by phone, a recorded message may be left on your answering machine.
• Victims of Abuse, Neglect, or Domestic Violence - Your PHI may be used or disclosed to authorized persons from state agencies in cases of disclosures required by applicable state laws governing abuse, neglect, criminal activities, threats to the health/safety of the client and others, domestic violence, etc. In the case of minor children, the law requires such information to be disclosed.
• Event of an Emergency - Your PHI may be disclosed to a family member, a person responsible for your care, or your personal representative in the event of an emergency. If you are present in such a case, you will be given an opportunity to object. If you object or are not present or are incapable of responding, your PHI will be used or disclosed in your best interest at that time. In so doing, only the aspects of your PHI that are necessary for response to the emergency will be used or disclosed.
• With limited exceptions, you can make a written request to inspect your PHI that is maintained by us for our use. Your PHI includes basic information about your diagnosis, treatment dates, treatment plans, intake and termination summaries.
• Requested copies of any PHI information will be provided per request in conjuction with local, state and Federal rules and regulations.
• You must make a written request to have your PHI communicated with you by alternative means at an alternative location. (An example would be if your primary language is not spoken and a child for whom you have lawful custody is being treated.) Your written request must specify the alternative means and location.
• You can make a written request that restrictions be placed on other ways we use or disclose your health information. Any or all of your requested restrictions may be denied. If these restrictions are agreed to, they will be abided by in all situations except those in which professional judgment constitutes an emergency.
• You can make a written request that your PHI be amended.

If approved, your records will be changed accordingly. Notification will also be made to anyone else who may have received this information and anyone else of your choosing.

If denied, you can place a written statement in your records disagreeing with the denial of your request.