HIPAA Notice of Privacy Practices
Your health information is protected by federal law. Learn about your rights and our responsibilities under HIPAA.
Effective Date: August 2, 2025
Important Notice
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.
Serenity Behavioral Health Services is committed to protecting your health information. We are required by the Health Insurance Portability and Accountability Act (HIPAA) to maintain the privacy of your protected health information (PHI) and to provide you with this notice of our legal duties and privacy practices.
We Are Required To:
- • Maintain the privacy of your health information
- • Provide you with this notice of our duties and privacy practices
- • Follow the terms of this notice
- • Notify you of any breaches of your information
We Reserve the Right To:
- • Change our privacy practices
- • Make changes effective for all PHI we maintain
- • Provide you with a revised notice
We may use and disclose your health information for the following purposes:
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your health care and related services.
Examples include:
- • Sharing information with other healthcare providers involved in your care
- • Coordinating care between our staff members
- • Consulting with specialists about your treatment
- • Referring you to other healthcare providers
Payment
We may use and disclose your PHI to obtain payment for services provided to you.
Examples include:
- • Submitting claims to your insurance company
- • Verifying insurance coverage and benefits
- • Collection activities for outstanding balances
- • Determining eligibility for financial assistance programs
Healthcare Operations
We may use and disclose your PHI for healthcare operations necessary to run our practice.
Examples include:
- • Quality assessment and improvement activities
- • Staff training and education
- • Accreditation and licensing activities
- • Business planning and development
We may also use or disclose your health information in the following situations:
Public Health Activities
Disease prevention, injury reporting, vital statistics
Abuse or Neglect
Reporting suspected abuse, neglect, or domestic violence
Legal Proceedings
Court orders, subpoenas, and legal investigations
Emergency Situations
Serious threats to health or safety
Government Functions
Military, national security, and correctional institutions
Workers' Compensation
Work-related injury or illness claims
You have the following rights regarding your protected health information:
Right to Inspect and Copy
You have the right to inspect and copy your health information used to make decisions about your care.
We may charge a reasonable fee for copying costs. We may deny your request in certain limited circumstances.
Right to Amend
You have the right to request that we amend your health information if you believe it is incorrect or incomplete.
We may deny your request if the information was not created by us, is not part of our records, or is accurate and complete.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your health information.
We are not required to agree to your request, but if we do, we will comply with your request unless the information is needed for emergency treatment.
Right to Request Confidential Communications
You have the right to request that we communicate with you about your health information in a certain way or at a certain location.
We will accommodate reasonable requests that do not interfere with our ability to provide quality care.
Right to an Accounting of Disclosures
You have the right to receive a list of disclosures we have made of your health information.
This list will not include disclosures for treatment, payment, healthcare operations, or disclosures made with your authorization.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this notice at any time, even if you have agreed to receive it electronically.
Filing a Complaint
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
Contact Our Privacy Officer
Privacy Officer
Serenity Behavioral Health Services
125 S Main St
Fostoria, OH 44830
Phone: (567) 429-1000
Email: privacy@serenitybhs.com
U.S. Department of Health and Human Services
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy
Changes to This Notice
We reserve the right to change this notice and make the new notice apply to health information we already have as well as any information we receive in the future. We will post a copy of the current notice in our facility and on our website. The notice will contain the effective date.