Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

THIS NOTICE DESCRIBES:

  • HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
  • HOW YOU CAN GET ACCESS TO THIS INFORMATION
  • YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
  • HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION

PLEASE REVIEW IT CAREFULLY. YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH OUR PRIVACY OFFICER AT [email protected] OR 866-491-5196 IF YOU HAVE ANY QUESTIONS.

CH Medical CA, P.C., Charlie Health Medical, P.A., CH Medical NC NJ, P.C., Charlie Health, Inc., CH Medical NY, and Charlie Health Inc.’s wholly owned subsidiaries (collectively “Charlie Health”, “we”, “us” “our”) make up an organized health care arrangement.  Charlie Health is a clinically integrated care setting in which our members receive health care from more than one health care provider. In addition, we are an organized health care system that jointly participates in numerous activities including quality assessment and improvement activities.  The list of entities making up such organized health care arrangement may be updated from time to time.  Charlie Health respects and is committed to protecting the privacy of your medical information. In performing its services, Charlie Health will receive, create, and disclose your protected health information (“PHI”). Charlie Health is required by law to maintain the privacy and security of your PHI and to provide you with notice of our legal duties and privacy practices with respect to your PHI.

In the case of substance use disorder (“SUD”) records created or maintained by certain Charlie Health programs subject to federal SUD confidentiality law and regulations found at 42 U.S.C. § 290dd2 and 42 C.F.R. Part 2 (“Part 2”) or other applicable laws providing heightened protections for certain sensitive records, we may not use or disclose such records without your written authorization unless otherwise permitted or required by law, as detailed further below.


For information about our collection, use, and disclosure of personal information other than PHI and/or SUD records, please see our privacy policy at https://www.charliehealth.com/privacy-policy and the privacy policies posted on the websites of the affiliates listed above. 

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record:

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. You will have to submit this request in writing. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
  • Ask us to correct your medical record
  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications:

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share:

  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
  • We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out- of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
  • We will say “yes” unless a law requires us to share that information.
  • With respect to any of your SUD records, you can ask us to limit how we use or share such records for treatment, payment or operations, even if you have previously given consent.

 Get a list of those with whom we’ve shared information:

  • You can ask for a list (accounting) of the times we’ve shared your PHI for six years prior to the date you ask or your electronic SUD records for three years prior to the date you ask, who we shared it with, and why.
  • If you have given written consent to an intermediary (such as a health information exchange) to use or share your SUD records, you can ask the intermediary for a list of the times they have shared your SUD records for three years prior to the date you ask, who received the records and when, and what parts of your records were disclosed.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice and speak with our Privacy Officer:

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
  • You can ask to speak with our Privacy Officer regarding this notice by either emailing: [email protected] or calling: 866-491-5196.

 Choose someone to act for you:

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated:

  • You can complain if you feel we have violated your rights by contacting us using the contact information on the last page.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696- 6775, or visiting www.hhs.gov/ocr/privacy/hipaa/ complaints/.
  • We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can elect that we not send you fundraising communications.

OUR USES AND DISCLOSURES

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you:

  • We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks a Charlie Health provider about your overall health condition. In such cases, we may share your health information to the requesting doctor so that the doctor has all the information necessary to diagnose and treat you.

Run our organization:

  • We can use and share your health information to perform health care operations to manage and run our organization, improve your care, and contact you when necessary.

Example: We use health information about you to conduct quality assessment and improvement activities aimed at better managing your treatment and services.

Bill and get paid for services we provide you:

  • We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

Help with public health and safety issues:

  • We can share health information about you for certain situations such as:
  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

Do research:

  • We can use or share your information for health research.

Comply with the law:

  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

 Respond to organ and tissue donation requests:

  • We can share health information about you with organ procurement organizations.

 Work with a medical examiner or funeral director:

  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

 Address workers’ compensation, law enforcement, and other government requests:

We can use or share health information about you:

  • We can use or share health information about you:
  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

 Respond to lawsuits and legal actions:

  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Charlie Health shall grant access to records to patients who request them in compliance with established standards and state laws and when such access is in the best interest of the resident.

In order to request access to files:

1. Submit a written request to [email protected].

2. The request will be reviewed by the appropriate staff and the Clinical Director.

3. An appointment will be made with a counselor to review the record, whenever possible.

4. If appropriate and in compliance with established standards and state laws, a copy of the clinical record will be provided within the state required time frames (usually between 14 and 30 days) of the date of the approval of the written request.

5. This procedure may be subject to a small fee if copies are requested.  You will be informed of the exact fee prior to being charged.

SUBSTANCE USE DISORDER (SUD) RECORDS

Some of Charlie Health’s programs may be subject to the federal SUD confidentiality law and regulations found at 42 U.S.C. § 290dd2 and 42 C.F.R. Part 2 (“Part 2”) as a SUD treatment program (“Part 2 Programs”). In such instances, information regarding your SUD treatment, including your participation in a Part 2 Program, and payment for those services, is protected by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and its corresponding regulations, and may have additional privacy protections under Part 2.

In general, we cannot disclose information which would identify you as a Part 2 Program client without your written consent; however, we may do so under the following circumstances:

  • To a medical personnel during a medical emergency, if we cannot obtain your consent.
  • To Food and Drug Administration (“FDA”) medical personnel so that they can notify you or your physician that your health may have been compromised by an error in the manufacturing, labeling, or sale of a product regulated under the FDA.
  • For research purposes, if the recipient has met certain requirements or exceptions under HIPAA.
  • For certain management audits, financial audits, and program evaluations. The individuals perform such audits or evaluations will be subject to Part 2’s restrictions on redisclosures of your information.
  • To a public health authority, if your information has been de-identified so that the information cannot be used to identify you.
  • To the Department of Veterans Affairs.
  • For communication within a Part 2 program or between a Part 2 Program and an entity having direct administrative control over that Part 2 Program.
  • To a qualified service program who is providing services to the Part 2 Program.
  • To report crimes to law enforcement agencies or officials regarding crimes which occurred on Part 2 Program premises or against Part 2 Program personnel or a threat to commit a crime.
  • To state or local authorities to report child abuse and neglect (this exception does not apply to actual patient records regarding your substance abuse or neglect).
  • As permitted by a valid court order.

Before a Part 2 Program can use or share any covered SUD records in a manner which is not described above, we must first obtain your specific written consent allowing it to make the disclosure. Any such written consent may be revoked by you in writing in accordance with 42 C.F.R. Sections 2.31 and 2.35, except to the extent that the Part 2 Program or others have relied on the consent. If you signed the written consent because you are participating in the Part 2 Program as a condition of a criminal justice proceeding, such as probation or parole, your consent can be revoked upon the conclusion of certain events, such as the end of your probation or parole.

Under Part 2, you generally must give written consent before information identifying you as a patient of a Part 2 Program is disclosed, including to entities or individuals who are paying your insurance claims. We may ask that you help us care for you and support your treatment goals by providing a written consent that allows a Part 2 Program’s providers to receive from and disclose to other treating providers your identity and information in order to provide you the care you need, to obtain payment for care and treatment, and to allow for communication with other professionals, friends and advocates involved in your treatment or recovery.

You may also execute a single written consent for all future uses or disclosures by a Part 2 Program of your SUD records for treatment, payment, and health care operations purposes (as detailed above under “Our Uses and Disclosures”). Records that are disclosed to another Part 2 program, covered entity, or business associate pursuant to your written consent for treatment, payment, and health care operations may be further disclosed by that other Part 2 program, covered entity, or business associate, without additional written consent from you, to the extent the HIPAA regulations permit such disclosure.

Your SUD records, or testimony about those records, cannot be used or disclosed in legal proceedings against you unless (a) you have given written consent or (b) there is a court order authorizing such use or disclosure and a subpoena compelling such use or disclosure. Courts can only issue such an order if you have been provided notice and an opportunity to object to the proposed use or disclosure.

We may only use or disclose your SUD records to fundraise for the benefit of a Part 2 Program so long as we first provide you with a clear and conspicuous opportunity to elect not to receive fundraising communications, as we note above.

In the case of SUD counseling notes (meaning notes recorded in any medium by a Part 2 Program provider who is a SUD or mental health professional documenting or analyzing the contents of conversation during a private SUD counseling session or a group, joint, or family SUD counseling session and that are separated from the rest of the patient’s SUD and medical record, but excluding medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date):

  • We may not use or disclose SUD counseling notes without your written authorization unless otherwise permitted or required by law.

OUR RESPONSIBILITIES

  • We are required by law to maintain the privacy and security of your protected health information and to provide you with this notice of our legal duties and privacy practices with respect to PHI and SUD records.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

CHANGES TO THE TERMS OF THIS NOTICE

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web-site at www.charliehealth.com.

This Notice of Privacy Practices applies to the following organizations:

Charlie Health 

Headquarters:

233 E. Main St. #401

Bozeman, MT 59715

Privacy Officer:

Ellen Broxmeyer 

[email protected] 

ph.: 866-491-5196

Effective date: June 20, 2023

Updated: December 22, 2025