Privacy Practices

Notice of 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 CAREFULLY!

Effective date: April 2026

This Notice of Privacy Practices pertains to HealthSource Integrated Solutions, Inc. HealthSource is a covered entity that has both direct and indirect treatment relationships with our clients. Direct treatment relationships are where the HealthSource provider treats the client directly and has the capability of sharing any results or records directly with the client, while an indirect treatment relationship is where the provision of services is based on the orders of another provider, and any records or results are shared with the client’s direct treatment provider instead of directly with the client. Examples of when HealthSource has direct treatment relationships include Olmstead Navigation Case Management services and the provision of eligibility assessments to provide Autism Waiver Services in the state of Kansas. HealthSource Integrated Solutions, Inc. also has formal arrangements with multiple community partners to provide indirect treatment services on their behalf, including, but not limited to, mental health crisis services such as behavioral health assessments and crisis line calls. Any of your other health care providers that are not a member of our organization may have different practices or notices about the ways they use and share protected health information, and we advise you to review them.

YOUR RIGHTS

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

Ask us how to request the following:

GET AN ELECTRONIC OR PAPER COPY OF YOUR MEDICAL RECORD

• You can ask, in writing, to see or get an electronic or paper copy of your medical record and other health information we have about you. For records related to Olmstead Navigator Case Management or Autism Waiver Services, you may reach out to HealthSource directly. For services provided on behalf of a hospital, community mental health center (CMHC), certified community behavioral health clinic (CCBHC), or other contracted partner, HealthSource provides services as a contractor and business associate of that organization. In these situations, the partner organization maintains the designated medical record. If you would like to access records related to those services, please contact the hospital, CMHC, CCBHC, or other entity where you directly received services. HealthSource will coordinate with the partner organization as required by law.
• You can also direct us to send records related to a direct treatment relationship with HealthSource to a third party. This request must be made in writing and clearly tell us to whom and where to send the copy of the medical record.
• We can provide the appropriate form to assist in requesting a copy of your medical records and/or directing us to send the records to a third party. However, alternative arrangements may be made for individuals unable to make a request in writing. 
• We will provide a copy or a summary of your health information, usually within 30 days of your request.
• You may request that your information be provided in an electronic format and we will provide the information to you in the form and format you request, if it is readily producible.  If we cannot readily produce the records in the form and format you request, we can work together to agree on an appropriate electronic format.  
• We may charge a reasonable, cost-based fee and will not withhold a copy of your medical record because of an unpaid medical bill.
• We may deny your request to inspect or obtain a copy in certain limited circumstances.  If we refuse access, we will tell you in writing within 30 days of your request, and in some circumstances, you may ask that a neutral person review the refusal. 
• For records that relate to Autism Waiver Assessments, please contact AutismWaiverAssessment@healthsrc.org. 
• For records that relate to Olmstead Navigation Case Management, please contact OlmsteadNavigationServices@healthsrc.org
• If you have questions about receiving records related to mental health crisis services, please contact CRCCompliance@healthsrc.org. 

REQUEST A CORRECTION TO YOUR MEDICAL RECORD

• You can ask us, in writing, to correct health information about you that you think is incorrect or incomplete.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
  • Denial reasons could include, but are not limited to, the following:
    • The information was not created by any member of HealthSource, unless the person or entity that created the information is no longer available to make the amendment.
    • The medical record is not part of the designated record set.
    • The request is related to information which you are not permitted to inspect and/or receive a copy.
    • The information is determined to be accurate and complete information.

REQUEST ALTERNATIVE COMMUNICATIONS

• You can ask us, in writing, to contact you in a specific way (for example, home or office phone) or to send mail to a different address, or you may prefer that we communicate with you via unencrypted email or text messaging. There are risks associated with communications via unencrypted email or text messaging, for example, a third party could intercept the email or text message in transmission.
• We will say “yes” to all reasonable requests.

REQUEST 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 and for other limited purposes. These requests must be made in writing, but we are not required to agree to your request (except as described below) and we may say “no” if it would affect your care.
• If you pay for a service or healthcare item out-of-pocket in full at the time of service, we are required to agree to your request not to share that information with your insurer if the purpose of the disclosure is for payment or operations. We will say “yes” unless a law requires us to share that information.

GET A LIST OF THOSE WITH WHOM WE’VE SHARED INFORMATION

• You can ask, in writing, for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, with whom we shared it, and why.
• We will include all the disclosures except for those that were made for purposes of treatment, payment, and/or healthcare 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

The Notice will be available upon request, and on our website. 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.

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

• We are committed to protecting the privacy and confidentiality of your personal health information. If you believe that your privacy rights have been violated, you may contact HIPAA@healthsrc.org. 
• You can also 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 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
  • We will only disclose the health information directly related to their involvement in your care or payment.
  • 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:

Most sharing of psychotherapy notes

IN THE CASE OF FUNDRAISING, MARKETING, AND SELLING YOUR INFORMATION:

• We do not use your personal information for fundraising or marketing purposes.
• We do not sell your personal information.

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 another doctor about your overall health condition.

• We may use your health information to tell you about or recommend new treatment alternatives or other health-related services that may be of interest to you.

BILL FOR SERVICES

• We can use and share your health information to bill and get payment from health plans or other entities.
  • Example: If relevant, we give information about you to your health insurance plan so it will pay for services you received.

RUN OUR ORGANIZATION

• We can use and share your health information to run our organization, improve your care, and/or contact you when necessary.
• We may contact you by phone, mail, or electronic means:
  • As a reminder that you have an appointment for treatment and services
  • Regarding treatment information
  • Requesting you to complete a short survey about the care and service you received.

• By providing us with your contact information, you give your consent that we may use it.  We may contact you by the following means (even if we initiate contact using an automated telephone dialing system (ATDS) and/or an artificial or prerecorded voice): (1) paging system; (2) cellular telephone service; (3) landline; (4) text message; (5) email message; or (6) facsimile. For your convenience, email and text messages may be sent unencrypted.  Before using or agreeing to use of any unsecure electronic communication to communicate with us, note that there are certain risks, such as interception by others, misaddressed/misdirected messages, shared accounts, messages forwarded to others, or messages stored on unsecured potable electronic devices.  If you want to limit these communications to a specific telephone number or numbers, you need to request that only a designated number or numbers be used for these purposes.  If you inform us that you do not want to receive such communications, we will stop sending these communications to you.
  • Example: We use health information about you to manage your treatment and 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 must meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

DO RESEARCH

We can share your information for health research as long as it meets requirements as described in 45 CFR 164.512(i).

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 they want 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.

HELP WITH PUBLIC HEALTH AND SAFETY ISSUES

We can share health information about you for certain situations such as:

• Preventing or controlling disease, injury, or disability (such as disease or trauma registries)
• Notifying a person who may have been exposed to a disease or condition
• To report births and deaths
• Helping medical device manufacturers who may need to contact you about a medical device that is required for your care and/or for product recalls
• Reporting adverse reactions to medications
• Reporting certain types of suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

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.

RESPOND TO LAWSUITS AND LEGAL ACTIONS

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

ADDRESS WORKERS’ COMPENSATION, LAW ENFORCEMENT, INMATES AND OTHER GOVERNMENT REQUESTS

We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• If you are an inmate of a correctional institution or under the custody of 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

OTHER USES AND DISCLOSURES

• Once protected health information (PHI) is disclosed based on your authorization or as legally permitted under state and federal law as described in this Notice, the disclosed PHI may no longer be protected and may be redisclosed without your knowledge or authorization. 
• Other uses and disclosures of your health information not covered in the previous sections of this Notice will only be made with your written authorization.
• In some instances, state or federal law may provide privacy protections in addition to HIPAA for certain diagnoses. This includes information related to alcohol and substance use, genetics, mental health, HIV/AIDS, or minors’ information. We will follow the more stringent law where it applies to us.

SUBSTANCE USE DISORDER RECORDS

• Federal law (42 C.F.R. Part 2) protects the confidentiality of substance use disorder information, and these protections are now more consistent with HIPAA. Although HealthSource is not a substance use treatment program (SUD Program operating under the 42 C.F.R. Part 2 regulations), we may receive information from a SUD Program about your treatment.
• We may not use or disclose your health information contained in substance use disorder treatment records we have received from substance use disorder programs subject to 42 C.F.R. Part 2 (Part 2), including information contained in communications we have received from such programs relaying the content of such records, in response to a request for the records associated with a civil, criminal, administrative, or legislative proceeding against you, unless we first have received your prior written consent or a court order accompanied by a subpoena that was obtained in accordance with the requirements of Part 2 that compels our disclosure of such information. 
• Substance use disorder counseling notes have enhanced confidentiality protections similar to psychotherapy notes under HIPAA and generally require specific written authorization for disclosure unless the law permits otherwise. In all other situations, we will follow our privacy practices regarding the disclosure of substance use disorder information as stated in this Notice.
• We are not allowed to use or disclose any health information that is contained in Part 2 substance use disorder records for fundraising purposes, unless we first provide you with a clear and conspicuous opportunity to elect not to receive any such fundraising communications.

OUR RESPONSIBILITIES

• We are required by law to maintain the privacy and security of your protected health information.
• 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 have copies available to you upon request.
• We will not use or disclose your health information other than as described herein without your authorization.  If you tell us we can, you may change your mind at any time.  Let us know in writing if you change your mind.  If you revoke your authorization, it will not be effective for any uses and disclosures we have already made in reliance on your prior authorization.  

For more information regarding your rights under the Health Insurance Portability and Accountability Act (HIPAA), please visit HHS.gov.

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 and on our website.

For information on how to submit your written requests or if you have any questions about this Notice or our privacy practices, please contact HIPAA@healthsrc.org or call us at 785.575.9393 ext. 117. 

DISCRIMINATION IS AGAINST THE LAW

HealthSource complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. HealthSource does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.  

HealthSource:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

• If you have any accessibility or language needs, language assistance services are available to you free of charge. Please contact HIPAA@healthsrc.org and we will set up a call using our translation services.

• If you believe that HealthSource has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Section 1557 Coordinator. You can file a grievance in person or by mail or email.  If you need help filing a grievance, our Section 1557 Coordinator is available to help you.

Section 1557 Coordinator 
HealthSource Integrated Solutions
2121 SW Chelsea Drive
Topeka, KS  66614
785.575.9393 ext. 117.
HIPAA@healthsrc.org

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf, or by mail or phone at:  

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html