Notice of Privacy Practices

Wedgwood Christian Services Notice of Privacy Practices

Your information. Your rights. Our responsibilities.

VIEW Wedgwood Combined Notice of Privacy Practices

VER el Aviso Combinado de Prácticas de Privacidad de Wedgwood

This notice became effective April 1, 2023 and was most recently updated January 16, 2026.

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully!

ABOUT THIS COMBINED NOTICE

This Notice explains how Wedgwood Christian Services (“Wedgwood”) protects, uses, and shares your health information. It applies to all Protected Health Information (PHI) we create or maintain about you — whether it is written, spoken, or stored electronically. You will receive a copy of this Notice when you begin services, and you will be asked to sign an acknowledgment confirming that you received it. Copies of this Notice are also available
in facility common areas and posted on our website. You may request another copy at any time.

UNDERSTANDING YOUR PROTECTED HEALTH INFORMATION

Each time you receive care or services, your provider documents information about your visit. This documentation, called your Protected Health Information (PHI) or medical record, includes details about your diagnosis, treatment, and care. Your medical record serves several important purposes:

• It helps plan and coordinate your treatment and care.
• It allows communication among your healthcare providers.
• It provides a legal record of the care you received.
• It supports billing and payment for services.

Understanding how your health information is used helps you make informed decisions about your privacy and about when and how your information may be shared with others. We will only use or share your information as described in this Notice or as required by law. Any other use or disclosure will require your written authorization. When your health information is shared, we follow the “minimum necessary” standard, meaning we only share the smallest amount of information needed to fulfill the purpose, and nothing more.

OTHER USES OF YOUR HEALTH INFORMATION

Other uses and disclosures of your PHI that are not covered in this notice will be made only with your written authorization. If you provide us with your written authorization, you may revoke that authorization at any time in writing and we will no longer use or share any of your health information subject to the authorization. However, the revocation will not apply to disclosures previously made with your permission.

PARTICULARLY SENSITIVE CONDITIONS

Some types of health information receive extra protection under certain state and federal laws. For example, records related to mental health treatment, HIV/AIDS status, or genetic testing may be handled differently from other health information. When these additional laws apply, Wedgwood will obtain your written permission before sharing this information, except in situations where disclosure is required or allowed by law.

CONFIDENTIALITY OF SUBSTANCE USE DISORDER TREATMENT RECORDS

The “Notice of Privacy Practices for Substance Use Disorder Treatment,” supplements this HIPAA Notice and provides details on our privacy practices required by federal law (42 CFR Part 2). Federal law protects your health information in two ways:

• The HIPAA Privacy Rule protects all your medical records.
• 42 CFR Part 2 gives extra protection to information about substance use disorder treatment.

This notice explains your privacy rights and how we may use or share your information under both laws. In all cases, your information will only be shared as the law allows — and when the stricter rule applies, we will always follow the one that provides you with the most protection.

THE ROLE OF STATE AND FEDERAL LAWS IN SAFEGUARDING PRIVACY

Some states have additional privacy protections for substance abuse and mental health treatment records, HIV, and genetic information. We will use and share your health information only as allowed by federal and state law. These laws require us to maintain the privacy and security of your medical information and to explain clearly how we handle and protect it.

When both federal and state privacy laws apply, if Michigan law provides greater protection or broader rights regarding your information, we will follow the more protective state law.

I. YOUR RIGHTS CONCERNING YOUR HEALTH RECORDS

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 the portion of your PHI that is in a designated record set. “Designated record set” means medical and billing records and any other records that Wedgwood uses to make decisions about you.

We will make every attempt possible to provide you with access to your health information, or a summary of your health information, within 30 days of your request. We may charge a reasonable, cost-based fee.

In certain circumstances, we may deny your request to inspect or obtain a copy of parts of your record. If you are denied access to health information, you may request that our Privacy Officer review the denial. Under federal law, you may not see or copy the following that may be contained in your record: psychotherapy notes; information gathered for use in court or at hearings; PHI that is covered by a law that states you may not see it; and/or information assigned or developed as part of a peer review function.

How To Exercise This Right: During treatment, you can ask your primary therapist or the Medical Records staff to see your medical record. After discharge, you may request your records by contacting the Medical Records staff.

Ask Us to Correct You Medical Record

You can ask us to correct health information about you that you think is incorrect and incomplete. We may say “no” to your request, but we will tell you why in writing within 60 days. How To Exercise This Right: To request an amendment, your request must be made in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request.

Request Confidential Communications

You can ask us to contact you in a specific way or to send mail to a different address. For example, you can ask that we only contact your office phone or send information to a family member’s address. We will accommodate all reasonable requests.

How To Exercise This Right: To request confidential communications you must make your request in writing to the Privacy Officer and/or Medical Records staff. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted.

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 adversely affect your care.

If you pay out-of-pocket in full for a service or health care item, 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.

How To Exercise This Right: To request restrictions, discuss with your treatment professional and make your request in writing to the Privacy Officer. In your request, you must tell us what information you want to limit, whether you want to limit our use, disclosure, or both, and to whom you want the limits to apply.

Right to Receive an Accounting of Disclosures (Excludes SUD Treatment Records)

You can request a record of when, to whom, and why your health information was shared over the past six years, excluding disclosures for treatment, payment, healthcare operations, and certain other exceptions. One free report is provided annually; additional requests within 12 months incur a reasonable fee. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.

How To Exercise This Right: To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer.

Right to Revoke Your Authorization/Consent

You may revoke your authorization/consent for us to use and share your health information at any time, and we will immediately stop sharing your information, except to the extent that Wedgwood has already acted in reliance on it when we had your valid authorization/ consent.

How To Exercise This Right: During treatment, notify any staff member at the facility and they will help you process the revocation electronically. After discharging from treatment, you may revoke any consents that are still valid by contacting Medical Records staff

Right to Obtain a Copy of This Notice Upon Request

If you received this Notice electronically, you have the right to receive a paper copy upon request. You may request the copy in paper or electronic format.

How To Exercise This Right: Ask any staff member at the facility to provide you with a copy of this Notice in the format of your choice. You may also contact the Privacy Officer or Medical Records Department to obtain a copy

Right to Choose Someone to Act on Your Behalf

If you have appointed a medical power of attorney or legal guardian, that person can make decisions about your health information. We will verify their authority before acting on your behalf.

How To Exercise This Right: Provide the facility with your signed Advance Directive, Power of Attorney, Guardianship, or another legal form that complies with state and federal law.

Right to File a Complaint if You Feel Your Rights Are Violated

If you feel we have violated your rights, you may file a complaint. We will not retaliate
against you for doing so.

How To Exercise This Right: Contact the Wedgwood Privacy Officer, the Office of Recipient
Rights at your Community Mental Health organization, or the U.S. Department of Health and Human Services Office for Civil Rights using the contact information at the end of this Notice.

II. 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

If you cannot consent due to unconsciousness, psychosis, or a mental health crisis, we may
use our professional judgment to share your information if it is in your best interest or needed
to prevent an immediate health or safety threat.

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

• Uses and disclosures of PHI for marketing purposes;
• Disclosures that constitute a sale of your PHI;
• Disclosures of substance use disorder treatment records; and
• Uses and disclosures of psychotherapy notes other than to carry out the treatment,
  payment, and health care operations set forth at 45 CFR § 164.508(a)(2).

Other uses and disclosures of your PHI not covered by this notice or applicable laws will be
made only with your written permission. If you provide permission for us to use or disclose your
PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, we
will no longer use or disclose your PHI for the reasons covered by your written authorization.
You understand that we are unable to take back any disclosures we have already made with
your permission.

II. OUR USES AND DISCLOSURES

How do we typically share your health information? We may use and disclose PHI for a variety of reasons. We have
a limited right to use and/or disclose your PHI without your authorization for purposes of treatment, payment, or our health care operations. Other uses and disclosures require your written authorization unless the law permits or requires us to make the use or disclosure without your authorization. If we disclose your PHI to a third party in order for that party to perform a function on our behalf, the third party must agree that it will extend the same degree of privacy protection to your PHI that we do. Subject to the limitations of the Michigan Mental Health Code and 42 CFR Part 2, we may use or disclose your PHI without your authorization as follows:

Treatment

We can use your health information and share it with other professionals who are treating you. Example: We may disclose the needed parts of your PHI to another doctor or health care provider, such as a specialist or laboratory that helps us with your treatment.

Payment

We can use and share your health information to bill for services and get payment from your health plan. Example: We share needed parts of your records with your health insurance plan, when requested, to obtain authorization and/or payment for services.

Health Care Operations

We can use and share your health information to carry out activities necessary to operate the facility, improve your care, and contact you when necessary. Example: We may use your PHI relating to making sure we meet important goals and standards; judging how well our employees perform their work; training workers and volunteers; licensing or accreditation of our agency; fraud and abuse detection programs; business planning and development; and other general administrative activities.

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

Public Health and Safety Issues

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

• Preventing disease
• Helping with product recalls from the FDA
• Reporting adverse reactions to medications
• Reporting suspected abuse or neglect
• Preventing or reducing a serious threat to anyone’s health or safety

Contacting You (Calling, Texting, Emailing)

We may contact you for a variety of reasons, such as appointment reminders and wellness checks. By providing us with your mobile phone number, you agree to receive communications on your mobile device. You may contact the Medical Records staff to opt out of communications at any time. With your consent, we may contact you for certain other purposes.

Text and email messages are not encrypted, and there is a risk that someone could read or access these messages, so we limit the amount of protected health information they contain. If you do not wish to receive text or email messages, please let us know and we will honor your request.

Fundraising and Other Communications

We may use or disclose parts of your PHI to offer you information that may be of interest to you. For example, we may use your name and address to send you newsletters or other information about activities. If we contact you to raise funds, you can tell us to not contact you again.

Business Associates

We may contract with individuals and entities known as Business Associates to perform various functions or provide certain services. To perform these functions or provide these services, Business Associates may receive, create, maintain, use, and/or disclose your PHI, but only after they sign an agreement with us requiring them to implement appropriate safeguards regarding your PHI. Similarly, a Business Associate may hire a Subcontractor to assist in performing functions or providing your services. If a Subcontractor is hired, the Business Associate may not disclose your PHI to the Subcontractor until after the Subcontractor enters into a Subcontractor Agreement with the Business Associate that also requires the Subcontractor to safeguard your PHI.

To a Health Plan Sponsor

We may disclose your information to health plans for purposes of facilitating claims payments under that plan and/or to meet the requirements of a prepaid service. In addition, your PHI may be disclosed to a Plan Sponsor and its personnel to administer benefits under the Plan or as otherwise permitted by law and the Plan Sponsor’s HIPAA privacy policies and procedures. We must agree to a request to restrict disclosure of PHI to a health plan if the disclosure is for payment or health care operations and pertains to a health care item or service for which you
have paid out of pocket in full.

To a Health Plan Sponsor

We can use or share your information for health research only with your authorization.

As Required By 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.

Organ, Eye, and Tissue Donation Requests

We can share health information about you with organ procurement organizations only with your authorization.

To Medical Examiner or Funeral Director

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

Workers’ Compensation

We can use or share health information about you for workers’ compensation claims.

Health Oversight Activities

We may disclose your PHI to agencies that are responsible for making sure our services meet quality standards. They may need your PHI for activities such as audits, investigations, and inspections. Agencies that use this information include Center for Medicare and Medicaid Services, the Michigan Department of Health and Human Services, Disability Rights Michigan, Payors for services provided to you, PIHPs, accrediting bodies, and other regulating agencies.

Law Enforcement

We will disclose your PHI when required to do so by federal, state or local law. For example, we may disclose PHI in the course of any court or administrative proceeding, if we are ordered to do so, and/or to meet legal requirements. We may also disclose PHI for law enforcement purposes, such as investigation of a crime, but only if such disclosures comply with Michigan law.

Lawsuits and Legal Actions

We can share health information about you in response to a court or administrative order and only the health information authorized by the order will be disclosed. We can also share your health information in response to a subpoena, discovery request, or other lawful process, but only after reasonable efforts have been made to notify you of the request or to obtain an order from the court protecting the requested information.

Special Government Functions

We may use or share your health information if required for military and veterans activities, national security and intelligence activities, protective services for the President, and other special government functions.

Correctional Facilities

We may use or disclose your PHI if you are an inmate of a correctional facility and Wedgwood created or received your PHI while providing care to you.

Genetic Information

If we use or disclose PHI for underwriting purposes with respect to your services, we will not use or disclose PHI that contains your genetic information.

Photographs

Some programs may use a therapeutic photograph taken at the time of admission for the purposes of security, billing accuracy, and to help your treatment team accurately identify you. The image is part of your medical record and only disclosed in accordance with these privacy practices. Upon agency discharge, this photograph will be destroyed.

Community Electronic Health Record (CEHR) Portal

Wedgwood makes certain portions of the medical record available electronically through the CEHR Portal. If you wish to obtain a complete copy of your medical records, you may request a copy from the Medical Records staff. In order to access records through the patient portal, the patient (or patient’s representative) must provide their written authorization.

Laws Requiring Greater Limits on Disclosures

Substance Abuse Treatment Records

Substance abuse treatment records will only be disclosed with your written authorization or consent, except as otherwise permitted by law. When applicable, the more restrictive rule will be followed to provide the highest level of privacy protection.

IV. OUR RESPONSIBILITIES

• We are required by law to maintain the privacy and security of your protected health information (PHI).
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your PHI.
• 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 PHI 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.
• We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI we already have about you as well as any information we receive in the future. We will notify you in the event of a change

For more information visit: www.hhs.gov/hipaa/for-individuals/index.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 to facility staff, in physical locations where we deliver care, on each facility’s
website, and on Wedgwood’s website at www.wedgwood.org.

To receive a paper or electronic copy of the current Notice, you may also contact the Privacy Officer using the contact
information at the end of this Notice.

CONTACT INFORMATION (TO FILE A COMPLAINT, ASK QUESTIONS, & EXERCISE YOUR RIGHTS)

If you would like to file a complaint, ask questions, express concerns, or further inquire about the way your PHI is used and shared, please contact the Privacy Officer. Complaints may also be filed directly with the U.S. Department of Health and Human Services, Office for Civil Rights.

WEDGWOOD CHRISTIAN SERVICES PRIVACY OFFICER: PHONE: 616-831-5678 or
616-942-2110 ext. 472. EMAIL: privacyofficer@wedgwood.org. MAILING ADDRESS: Attn: Privacy Officer 3300 36th St. SE Grand Rapids, MI 49512

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES PRIVACY OFFICER: PHONE: 877-696-6775
WEBSITE: www.hhs.gov/ocr/privacy/hipaa/complaints MAILING ADDRESS: Attn: Office for Civil Rights 200 Independence Ave. S.W. Washington, D.C. 20201

NOTICE OF PRIVACY PRACTICES OF WEDGWOOD CHRISTIAN SERVICES ADDENDUM: Confidentiality of Substance Use Disorder Patient Records

EFFECTIVE DATE: This notice became effective April 1, 2023 and was most recently updated January 16, 2026.

FEDERAL LAW PROTECTS THE CONFIDENTIALITY OF SUBSTANCE USE DISORDER PATIENT RECORDS.

This notice describes:

• How health information about you may be used and disclosed
• 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 the Privacy Officer if you
have any questions. You can reach the Privacy Officer at 616-942-2110 ext. 472 or privacyofficer@wedgwood.org.

HOW WE USE YOUR PROTECTED HEALTH INFORMATION

Wedgwood will only use and disclose your protected health information as described in this Notice. Any other uses or disclosures of your protected health information not specifically mentioned or otherwise described in this Notice will made only with your expressed written consent.

I. OUR USES AND DISCLOSURES

A. Permissible Uses And Disclosures Without Your Written Consent

Under federal law, there are limited instances where we can share you Protected Health Information (PHI) without your consent, and these are explained in this Notice. Before your information can be used or shared, all legal conditions must be met. These instances are:

Medical Emergencies & Serious Threats to Health or Safety

We may use or share your health information with medical personnel to the extent necessary to treat you during a medical emergency or during a state/federal emergency declaration, when your consent cannot be obtained. We may also use or share your health information to lessen a serious and imminent threat to your health and safety or the health and safety of others. Any disclosure would be made to someone able to help prevent that threat only

Food and Drug Administration (FDA)

We may share your health information with FDA medical staff to alert you or your doctor of potential risks to your health.

Scientific Research

We may share your health information for scientific research if the program’s Chief Executive Officer or designee confirms the recipient meets all HIPAA and Part 2 requirements.

Management Audits, Financial Audits, and Program Evaluation

We may share your health information for audits and evaluations with authorized entities such as government agencies, accreditation bodies, insurers, and Wedgwood program administrators.

Public Health Authorities

We may disclose your records to the public health authority, however any records or information provided will be de-identified in accordance with 45 CFR 164.514(b), so that the information provided cannot be used to identify you.

Reporting of Crimes

We may disclose your health information to law enforcement or other agencies if you commit a crime, or threaten to commit such a crime, on our premises or against our employee(s); only limited details about the incident and involved individuals will be shared.

Reporting Suspected Child Abuse or Neglect to State or Local Authorities

We may share information with government or protective services agencies as required by law in cases of suspected child abuse or neglect, but your records will not be disclosed as part of any civil or criminal proceedings arising from such reports.

Vital Statistics, Medical Examiners

Your information may be provided under laws requiring reports of death or vital statistics, including sharing with medical examiners or coroners to determine causes of death.

Communication Within or Between Facilities

We may communicate and use your health information internally among staff and affiliated facilities to support treatment, payment, and healthcare operations.

Coordination of Care and Patient Portal

We may use your health information to send appointment reminders and other communications, such as messages, questionnaires, and document signing, through our CEHR Portal for telehealth clients. To access the portal, accept the invitation email and set up an account. You can opt out and disable your account at any time.

Qualified ServiceOrganizations/Business Associates

Health information may be used or shared with qualified service organizations or business associates who have agreed in writing to protect it and only use it when necessary to provide services.

As Required by Law

We may use or share your health information when required by state or federal law, including with the U.S. Department of Health and Human Services when the agency is assessing our compliance with federal privacy laws.

B. Uses And Disclosures Requiring Your Written Consent/Authorization

In all other cases, we require your written consent to use or share your Protected Health Information (PHI) outside our organization. We will not use or share your records without your written consent in these situations:

Treatment

When you consent, we can use or share your health information with other professionals who
are treating you. Example: The facility’s psychiatrist asks your primary care doctor for information about a
medical condition.

Payment

When you consent, we can use and share your health information to bill your health plan for
treatment services we’ve provided to you. Example: We share records with your health insurance plan, when needed to obtain an authorization for treatment/services.

Health Care Operations

When you consent, we can use and share your health information to carry out activities necessary to operate the facility, improve your care, and contact you when necessary. Example: We use health information about you to manage your care.

Future Uses and Disclosures for Treatment, Payment, and Healthcare Operations

You may sign a single authorization/consent for all future uses and disclosures of your health information for treatment, payment, and health care operations purposes.

Records that are disclosed to a Part 2 program, covered entity, or business associate pursuant to the patient’s written consent for treatment, payment, and health care operations may be further disclosed by that Part 2 program, covered entity, or business associate, without the patient’s written consent, to the extent the HIPAA regulations permit such disclosure.

All Other Uses and Disclosures Requiring Your Written Consent

To Individuals, a Category of Individuals, or an Entity You Choose

We may use or share your health information outside of our program when you ask us, in writing, to do so. The person or category or persons designated by you must be clearly identified in the consent and only information as described by you in the consent will be shared.

Substance Use Disorder Counseling Notes

Your SUD counseling notes, as defined by 45 CFR § 164.501 and 42 CFR § 2.11, are given extra protections under federal law. These are personal notes your counselors may keep to remember session details; these are not part of your official medical record. Your SUD counseling notes cannot be used or shared without your written consent, except when:

• The counselor uses them for your treatment
• The program uses them for training
• The program needs them in legal defense against your claim
• Law requires or specifically permits disclosure

Written consent must be on a separate, specific form and cannot be combined with other
authorizations.

Civil, Criminal, Administrative, and Legislative Proceedings

We will not share your records, or testimony relaying the content of such records, for use in any civil, criminal, administrative or legislative proceedings against you unless you have provided your specific written consent, or it is based on a court order after notice and an opportunity to be heard is provided to you and us as required by 42 U.S. Code § 290dd-2 and 42 CFR Part 2.

Any court order authorizing the use of disclosure of your health information must be accompanied by a subpoena or other similar legal document requiring disclosure before your health information is used or disclosed.

Marketing or Sale of Protected Health Information

We will not use or share your health information for certain marketing purposes without your consent. Unless otherwise permitted by law, we will not sell your health information to third parties without your consent.

Criminal Justice Referrals

If you were mandated to treatment through the criminal legal system (i.e., probation, parole, drug court), you must provide your written consent permitting us to use or share your health information with elements of the criminal legal system such as probation or parole officers, prosecutors, the court, and other law enforcement. Be advised that your right to revoke consent in these situations may be more limited and should be clearly explained on the consent you sign.

Prescription Drug Monitoring Program

With your prior written consent, we may report any substance use disorder medication prescribed or dispensed by the facility to the applicable state prescription drug monitoring program (PDMP) when reporting is required by state law.

II. YOUR RIGHTS CONCERNING YOUR SUBSTANCE ABUSE TREATMENT RECORDS

You have specific rights regarding your health records, which are described below along with instructions on how to exercise them. Contact information is provided at the end of this Notice. If you need assistance, a staff member can help direct your request.

Right to Request Restrictions on Disclosures

You have a right to request restrictions of disclosures, for purposes of treatment, payment, and healthcare operations, including when you have previously provided written consent. While we are not obligated to accept such restrictions, should we agree to them, we are required to comply with the terms of the restriction and safeguard your information accordingly.

You have the right to request and obtain restrictions of disclosures to your health plan for those services for which you have paid in full. We will honor this restriction unless required by law or contract to share that information.

How To Exercise This Right: Submit a written request for the restriction(s) to the Privacy Officer.

Right to Obtain a Copy of This Notice

You have a right to obtain a copy of this Notice in paper or electronic format from Wedgwood Christian
Services upon request.

How To Exercise This Right: Ask any staff member at the facility to provide you with a copy of this Notice in the format of your choice. You may also contact the Privacy Officer or Medical Records staff to obtain
a copy

Right to Discuss This Notice

You have a right to discuss this Notice with a contact person or the Privacy Officer described at the end of this Notice.

How To Exercise This Right: Contact the Privacy Officer using the contact information at the end of this Notice.

Right to Elect Not to Receive Communications for Fundraising

You have the right to elect not to receive communications from Wedgwood Christian Services to fundraise
on our own behalf.

How To Exercise This Right: You will be provided the opportunity to opt out of such communications at the time of intake or any time after by contacting the Privacy Officer.

Right to Revoke Consent/Authorizations

You have the right to revoke any consent/authorization you have provided, except to the extent that Wedgwood has already relied upon the authorization or request a reasonable accommodation for an alternative process.

How To Exercise This Right: During treatment, notify any staff member and they will help you process the revocation electronically. After discharging from treatment, you may revoke any consent(s) that are still valid by contacting the Medical Records staff. You may request a reasonable accommodation for an alternative revocation process by contacting the Medical Records staff.

Wedgwood Christian Services’ Duties

We are required by law to:

• Maintain the privacy of records.
• Provide patients with notice of its legal duties and Privacy Practices with respect to records.
• Notify affected patients following a breach of unsecured records.
• Abide by the terms of this Notice currently in effect.

We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for records that it maintains. The new Notice will be available upon request to facility staff, in physical locations where we deliver care, on each facility’s website and on Wedgwood Christian Services’ website at www.wedgwood.org.

Complaints

If you believe your privacy rights have been violated, you have the right to file a complaint with the Secretary of the U.S. Department of Health and Human Services and Haven Health Management. You may do so by contacting the HHS Office for Civil Rights or accessing https://www.hhs.gov/hipaa/filing-a-complaint/index.html. A client is not required to report an alleged violation either to the Secretary or part 2 program but may report to either or both.

In order to file a complaint with Wedgwood, you may contact the Privacy Officer. You may file a complaint using the
contact information below. Wedgwood will not retaliate against any client for filing a complaint.

Contact Information

For additional information, to file a complaint, or to exercise your rights, please contact:

WEDGWOOD CHRISTIAN SERVICES

PRIVACY OFFICER
PHONE: 616-831-5678 or 616-942-2110 ext. 472

EMAIL: privacyofficer@wedgwood.org

MAILING ADDRESS: Attn: Privacy Officer 3300 36th St. SE Grand Rapids, MI 49512

MEDICAL RECORDS DEPARTMENT PHONE: 616-942-2110
EMAIL: hello@wedgwood.org

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES PRIVACY OFFICER
PHONE: 877-696-6775

WEBSITE: www.hhs.gov/ocr/privacy/hipaa/complaints

MAILING ADDRESS: Attn: Office for Civil Rights 200 Independence Ave. S.W. Washington, D.C. 20201

NOTICE OF NONDISCRIMINATION

Our Commitment to Equal Care
Wedgwood Christian Services respects the rights and dignity of every person. In keeping with federal civil rights
laws, we do not discriminate or treat anyone differently based on race, color, religion, national origin, ancestry, age,
disability, sex, gender identity, sexual orientation, marital or family status, military service, political beliefs, or parental
status.

Accessible Communication and Language Support

To ensure that everyone can access and understand our services, Wedgwood Christian Services provides the
following free of charge:

• Assistance for individuals with disabilities, such as qualified sign language interpreters and written materials in
  alternative formats (large print, Braille, audio, or other formats as needed).
• Language assistance for individuals with limited English proficiency, including qualified interpreters and translated
  documents.

If you need any of these services, please contact Wedgwood at 616-942-2110 or by email at hello@wedgwood.org.

How to Report a Concern

If you believe Wedgwood Christian Services has discriminated against you or failed to provide necessary communication assistance, you can file a grievance with the Privacy Officer using the contact information below.

If you need help filing a grievance, the Privacy Officer can assist you throughout the process.

How to File a Civil Rights Complaint
You may also file a complaint directly with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) using the contact information below.

 

WEDGWOOD CHRISTIAN SERVICES
PRIVACY OFFICER PHONE: 616-831-5678 or 616-942-2110 ext. 472

EMAIL: privacyofficer@wedgwood.org | clientrights@wedgwood.org

MAILING ADDRESS: Attn: Privacy Officer 3300 36th St. SE Grand Rapids, MI 49512

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES OFFICE FOR CIVIL RIGHTS

PHONE: 1-800-368-1019

TDD: 1-800-537-7697

MAILING ADDRESS:
200 Independence Avenue, SW Room 509F, HHH BuildingWashington, DC 20201

ONLINE: ocrportal.hhs.gov/ocr/portal/lobby.jsf

COMPLAINT FORM:
www.hhs.gov/ocr/office/file