Goshawk Behavioral Health Services
Effective Date: September 1, 2018


Who Will Follow These Practices:

  • Anyone who enters information into your Goshawk chart
  • Any volunteer at Goshawk
  • All staff of Goshawk

Our Pledge:

We are committed to protecting your psychiatric information.  We are required by State and Federal law to do the following:

  • Keep your personal health information private
  • Give you this Notice
  • Follow the terms of the Notice currently in effect
  • Notify you if a breach of unsecure patient health information affecting you occurs

We May Use and Disclose Your Psychiatric Information as follows:

  • To provide psychiatric treatment to doctors nurses and therapists who will share information about you in order to provide you better care
  • For coordination of care with outside organizations where you have provided authorization
  • To receive payment for services provided to you (ex: your insurance company)
  • For quality improvement (reviewing of charts to make sure quality care is given to you)
  • On a census list if you are receiving services on an inpatient basis
  • To remind you of an appointment if you are receiving services on an outpatient basis
  • When required by law (information to Child Protective Services for example)

Special Situations

If one of the following situations applies to you, your information may be disclosed without your permission to the following organizations:

  • An organ donation center if you are a donor
  • Community health, safety, and law enforcement officials, and those who may be at risk in order to prevent a serious threat to the health and safety of you and others
  • Health oversight agencies if your psychiatric is selected for audit or inspection
  • Law enforcement officials, but only under a judge’s order or a search warrant, when we have your permission or as necessary to fulfill our obligations as described in #2 above

In situations not outlined above, we will ask you for written authorization before disclosing your psychiatric information.  Your signed authorization can be revoked in writing to stop future disclosures.

Uses and Disclosures Requiring Your Authorization

  • Your psychiatric information will not be used for marketing, sale, or fundraising unless you have signed a written authorization to do so.

Your Rights Regarding Your Psychiatric Information:

  • Right to Inspect and Copy. Under the Privacy Rule, patients do nothave the right to:
  • Inspect or obtain a copy of psychotherapy notes
  • Inspect information compiled in “reasonable anticipation” of, or for use in a civil, criminal, or administrative action
  • Records may also be withheld if there is a safety concern—example: when it is determined in the exercise of professional judgment that giving access to records is reasonably likely to endanger the life or physical safety of the patient or another person.

In most cases of denial, you may send a written request to have our decision reviewed.

  • Right to Request Restrictions. You have the right to request restrictions on how we use your psychiatric information for purposes of treatment, payment or health care operations. We do not have to agree to those restrictions. If you wish to request restrictions to a health plan please notify the staff at the location where you receive services.
  • Right to Request Restriction to Health Plan. You have the right to restrict certain disclosures of your information to a health plan (for purposes of payment or health care operations) when you pay out of pocket, in full, for the services rendered. If you wish to request restrictions to a health plan please notify the staff at the location where you receive services.
  • Right to Confidential Communications. You have the right to request that we communicate with you in a confidential manner. For example you may request that we contact you only at work.
  • Right to Amend. You have the right to amend your psychiatric information for as long as we maintain it.  We may deny your request if we did not create the psychiatric information that you wish to amend. If we deny your request, we will tell you why in writing and you will have the right to disagree with the denial in writing.
  • Right to Accounting. You have a right to receive a list of the persons or organizations with whom your psychiatric information has been shared. This list will not include allowable disclosures that have been made for treatment, payment, or health care operations purposes.  It also will not include disclosures made to you, or family members or friends involved in your care. Nor will it include disclosures you approved in writing.
  • Right to Receive a Copy of this Notice. You have a right to receive a paper copy of this Notice of Privacy Practices.


More Stringent State and Federal Laws

  • Certain federal and state laws are more stringent than HIPAA. We will abide by the more stringent state and federal laws. For example, the Michigan Mental Health Code is more stringent than HIPAA, thus we will follow the Mental Health Code.
  • We are required by law to maintain the privacy of your psychiatric information, provide you with this Notice of our legal duties and privacy practices, and to abide by the terms of the version of this Notice currently in effect.
  • We reserve the right to change this Notice at any time and these changes will apply to your information that we already have at the time of the change. The Notice currently in force is always posted and available at our service locations.
  • If you believe your privacy rights have been violated, you may file a written complaint with the office or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.