Privacy and your rights.

Part one

Notice of Privacy Practices — substance use disorder patient records

Federal law protects the confidentiality of substance use disorder patient records (42 CFR Part 2 and HIPAA).

This notice describes:

• How your health information, including information about substance use disorder (SUD) treatment, may be used and disclosed
• Your rights with respect to your health information
• How to file a complaint if you believe your privacy rights have been violated

Please review this notice carefully. You have a right to a copy of this notice, in paper or electronic form, and to discuss it with Sharon Fountain at [email protected] if you have any questions.

I. Who follows this notice

This notice applies to Mana Health and Wellness and all staff, clinicians, interns, and volunteers who provide intensive outpatient (IOP) substance use disorder treatment services at our program, including any records we create, receive, or maintain about your care.

II. How we may use and disclose your information

A. Uses and disclosures that do NOT require your written consent

Federal law permits us to use or disclose your records, without your written consent, only in limited circumstances, including:

• Internally, among our own staff, as necessary to provide you with SUD diagnosis, treatment, or referral for treatment
• To medical personnel, in a bona fide medical emergency, to the extent necessary to meet that emergency
• To qualified personnel for the purpose of conducting scientific research, audits, or program evaluation, consistent with 42 CFR Part 2
• As required by a valid court order, or as otherwise permitted or required by applicable federal or state law
• To report suspected child abuse or neglect to the appropriate state or local authorities, as required by law
• To our qualified service organizations / business associates, under a written agreement limiting their use of the information to the purposes for which it was disclosed

Where a use or disclosure is also limited by other applicable law (such as state confidentiality law), we follow whichever law is more protective of your privacy.

B. Uses and disclosures that DO require your written consent

Other than the limited circumstances above, we will not use or disclose your SUD treatment records without your written consent. This includes, for example, disclosures to:

• Your family members, friends, or other support persons
• Other health care providers not involved in a medical emergency
• Your employer, school, or criminal justice agencies
• Health plans or insurers, beyond what is needed for a claim already authorized
• You may sign a single, general consent authorizing use and disclosure of your records for treatment, payment, and health care operations (TPO). You no longer need to sign a separate consent for each purpose or recipient.
• Once your records are disclosed to a HIPAA-covered entity or business associate based on your TPO consent, that entity may further use or disclose the records to the extent HIPAA permits, unless you have restricted this (see Section III).
• Any disclosure we make with your written consent will be accompanied by a statement that 42 CFR Part 2 prohibits unauthorized use or disclosure of these records, along with a copy of your consent or a clear explanation of its scope.
• We will not use or disclose your records to fundraise on our behalf unless you are first given a clear and conspicuous opportunity to opt out.

C. Revoking your consent

You may revoke your consent at any time, in writing, except to the extent we have already acted in reliance on it. If you need an alternative or accommodated way to revoke consent, you may also request that by contacting the same contact above.

If you were mandated to treatment through the criminal legal system (e.g., drug court, probation, or parole) and you signed a consent authorizing disclosures to criminal legal system agencies, your right to revoke that specific consent may be more limited. This will be explained clearly on the consent form itself.

D. Court orders and legal proceedings

Your records, or testimony relaying their contents, will not be used or disclosed in any civil, administrative, criminal, or legislative proceeding against you unless you provide specific written consent or a court issues an order following notice and an opportunity for you and/or the record holder to be heard, as required under 42 USC § 290dd-2 and 42 CFR Part 2. A court order alone is not sufficient. It must be accompanied by a subpoena or similar legal mandate before we will disclose your records.

III. Your rights

• Request restrictions on disclosures of your records for treatment, payment, or health care operations purposes, including disclosures you previously consented to.
• Request and obtain a restriction on disclosure to your health plan for services you have paid for in full out of pocket.
• Request an accounting of certain disclosures of your electronic records made in the prior three years, including who received the information, when, and a brief description of what was disclosed.
• Obtain a copy of this notice at any time from Mana Health and Wellness, Admissions Office
• Discuss this notice with our designated privacy contact (see Section V).
• Opt out of fundraising communications from our program at any time.

To exercise any of these rights, contact Sharon M Fountain, at email: [email protected].

IV. Our responsibilities

• We are required by law to maintain the privacy of your SUD treatment records.
• We must provide you with this notice of our legal duties and privacy practices.
• We must notify you if a breach of your unsecured records occurs.
• We must abide by the terms of the notice currently in effect.
• We reserve the right to change the terms of this notice; any revised notice will apply to records we already maintain, and we will make the updated notice available as described below.

V. Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

• Our program, by contacting Sharon Fountain at [email protected], and/or
• The U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/hipaa/filing-a-complaint

You are not required to report to both. You may report to either or both. We will not retaliate against you in any way for filing a complaint.

VI. Contact and effective date

Program name

Mana Health and Wellness

Address

4550 N Black Canyon Hwy, Phoenix, AZ 85017

Privacy contact

Sharon Fountain

Phone / email

[email protected]

Effective date

06/15/2026