NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES
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 CARFULLY
If you have any question about this notice, please contact the National Veterans Wellness and Healing Center’s (“Center”) Privacy Officer.
This Notice Describes Our Practice and those of:
Any Center contracted provider or staff that provide services to you or any volunteer the Center allows to help you during your retreat. All of these people follow the terms of this notice. They may also share protected health information with each other for services provided or other retreat-related operations described in this notice.
Our Pledge Regarding Health Information:
We understand that health information about you and your health is personal. Your health information is contained in a record that is the physical property of the Center. We are committed to protecting health information about you. This notice will tell you about the ways in which we may use and disclose health information. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
The Center is required by law to:
Make sure that medical information that identifies you is private. Give you this notice of our legal duties and privacy practices with respect to health information about you. Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations. Follow the terms of the notice that is currently in effect.
How the Center may use or disclose your health information:
For Retreat Services. The Center may use your health information to provide you with services. For example, a provider, such as a counselor, may record information in your record that is necessary for your successful retreat experience. This information is necessary for the provider to determine what service you should receive. Providers may also record actions taken by them or other retreat providers in the course of the retreat and note how you respond to the actions. Your information may also be used for aftercare following the retreat.
For Retreat Operations. The Center may use and disclose health information for operational purposes. For example, your health information may be disclosed to members of the retreat staff or Center volunteers to assign counselors, evaluate the performance of our providers, assess the quality of service and outcomes, learn how to improve our facilities and services, and determine how to continually improve the quality and effectiveness of the retreats.
For Post Traumatic Stress related activities. The Center may use your information to contact you to provide reminders and information of your scheduled retreat. The Center may also contact you about services, activities, or health-related benefits that may be of interest to you.
Others involved in your care. The Center may release relevant health information to a family member, friend, or anyone else you designate in order for that person to be involved in your care or aftercare.
Outreach to other Veteran/First Responder Families. The Center will not release any health information for the purpose of informing and educating others in the military and veteran community about Post Traumatic Stress and the Center’s programs without you written authorization.
Fundraising: The Center will not release any health information for the purpose of fundraising without you written authorization.
Required by law. The Center may use and disclose information about you as required by law. For example, the Center may disclose information to report suspected abuse or neglect, or similar injuries or events.
Law enforcement purpose. Subject to certain restrictions we may disclose information required by law officials.
Judicial and administrative proceedings. We may disclose information in response to an appropriate subpoena, discovery request or court order.
Health ocersight activities. We may disclose your health information to a health oversight agency for activities authorized by law.
Research. We may use your health information for research purposes after a receipt of authorization from you.
Health and safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
Other uses and disclosures. Other uses and disclosures will be made only with your written authorization. You may revoke an authorization except to the extent that the Center has taken action reliant on it.
Your health information rights:
· Obtain a paper copy of this notice of information practice upon request.
· Inspect and obtain a copy of our health information practices upon request.
· Request an amendment to your health information that is maintained by the Center.
· Request confidential communications of your health information by alternative means or at alternative locations.
· Receive an accounting of disclosures made of your health information. Request a restriction on certain uses and disclosures of your information. The Center is not required to agree to a requested restriction.
Changes to this notice: The Center reserves the right to change the terms of this notice. The Center can make the new terms effective for all protected health information kept by the Center. You may also get a current copy by contacting the Center Privacy Officer.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with the Center Privacy Officer or with the Secretary for the Department of Health and Human Services. To file a complaint with the Center, submit your written complaint to our Privacy Officer. You will not be penalized for filling and complaint.
Contact information for questions or to file a complaint: If you have any question about this notice, want to exercise one of our rights that are described in the notice, or want to file a complaint, please contact the Center Privacy Officer at the National Veterans Wellness and Healing Center, PO Box 805, Angel Fire, NM 87710.
PARTICIPATION AGREEMENT
This Participation Agreement sets forth the terms and understanding between the National Veterans Wellness and Healing Center (NVWHC) and participants of the NVWHC seven-day PTS Couples Retreat Program.
Background
Our staff is whole-heartedly committed to providing you and your partner with a safe environment that promotes both healing and personal growth. Establishing and maintaining a safe and stable environment is one of the most critical parts of our program and is the foundation that our week-long program is built upon.
Purpose
The purpose of this Participation Agreement is to provide all retreat participants and staff members with some very basic rules or guidelines that must be acknowledged and followed as a condition of this program. The rules and guidelines laid out below have been established as critical to maintaining a safe and stable environment for both the participants as well as staff members.
Alcohol and Recreational Drugs
· Alcohol consumption and recreational drug usage are prohibited in our program and during the entire week of the program. This rule does not apply to drugs that have been medically prescribed by a licensed doctor or physician. If you believe that adhering to this rule could create a medical issue or raises concerns for you, please address this concern privately with Retreat Program Director or Facilitator.
· We ask that you commit to refraining from alcohol consumption and recreational drug use during this retreat.
· If you do choose to consume alcohol and/or drugs during the retreat week, NVWHC reserves the right to ask you to exit the program.
Cellphones, Tablets, Mobile Devices
· The use of cellphones during scheduled activities or appointments is prohibited. We ask that you keep your cellphone, tablets, and other mobile devices on silent mode and stored away during all activities and appointments.
· If you have a special circumstance that may require the use of your mobile device during activity or appointment periods, please privately notify the Retreat Program Director or Facilitator and inform them of your special circumstances. To prevent distractions from occurring, we all participants with special circumstances that require access to a cellphone or mobile devices to ensure that these devices remain on vibrate and that he or she steps out prior to using this device.
· We ask that you commit to following our cellphone & mobile device policy.
Firearms and Weapons
· We respect your 2nd amendment rights, however, the carrying or storing of any weapon or firearm in retreat facilities is strictly prohibited. Firearms and other weapons should be stored in your personally-owned vehicle for the duration of the retreat and are not permitted within retreat facilities for any reason. Retreat facilities include but are not limited to hotel, therapy rooms, conference rooms, equine facilities, dining facilities, etc.
· We ask you to commit to keeping weapons and firearms out of retreat programs and facilities.
Participation
· Our retreat program is voluntary and the only associated cost to you and your partner is your participation. It is one of the most important factors in whether or not you will find this experience beneficial and productive. Participants are expected to attend all scheduled activities outlined in his / her personal retreat schedule.
· We ask that you pay close attention to the schedule provided to you and that you are on time for all activities and appointments.
· As a courtesy, if a scheduled activity creates a conflict for you and you cannot attend an activity or appointment due to medical or personal reasons, please privately notify the Executive Director, Retreat Program Director or Facilitator prior to your scheduled appointment time or activity. By notifying one of above staff members in advance, we can notify staff of your absence and prevent timely searching for
individuals. Early notification can also create an opportunity for another individual to be treated during your absence. We ask that you commit to notifying our staff if you cannot be present for or participate in an activity / appointment and that you are on time.
Respect and Consideration
· We ask that you remain considerate of others this week and respectful towards every veteran, spouse, family member, friend or staff member who is also participating in this program. In addition to these individuals, we must also be considerate and respectful of the thoughts, opinions, emotions, or feelings of others as well.
· Articles of clothing that could be distracting for the group or viewed as derogative or offensive in nature are not permitted for wear during this retreat.
· Sharing or displaying of inappropriate materials such as pornography or other items that could be viewed as offensive in nature are not permitted during this retreat.
· We ask that you commit to being respectful and considerate while participating in this retreat.
As previously mentioned, the topics discussed in this Participation Agreement are critical to maintaining a safe and healthy environment and we greatly appreciate your willingness to comply with these terms. The National Veterans Wellness and Healing Center reserves the right to dismiss any participant who fails to comply with these terms and conditions.
Congratulations on your decision to join us for what we can only hope is a life-changing experience for you and your partner. We are humbled you have chosen The National Veterans Wellness and Healing Center to be a part of your healing and appreciate the opportunity of serving you.