Northwestern Community Services Privacy Notice

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: 04/14/03

Your Privacy is Important

Northwestern Community Services understands your privacy is important. We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.  We are required to abide by the terms of this notice. Any and all information we receive about you will be used only to assist you.  We will handle this information only as allowed by federal/ state law and agency policy, adhering to the most stringent law that protects your health information.

If at any time you believe your privacy rights have been violated, you may verbally or in writing contact:

Addresses and phone numbers to use are listed on the second page of this notice. You will not suffer change in services or retaliation for filing a complaint.

Each time you receive services from us, the provider makes a record of the visit. Typically, this record contains your assessment, service plan, progress notes, diagnoses, treatment, and plan for future care or treatment.

Your federally defined rights under 45 CFR Parts 160 and 164, HIPAA, and The Commonwealth of Virginia’s Code 35-115-80 and 35-115-90, Human Rights.

There are several rights concerning your protected health information that we want you to be aware of:

Use and Disclosure of Your Information 

Upon signing the agency’s Consent to Treatment/Service form, you are allowing us to use and disclose necessary information about you within the agency and with business associates in order to provide treatment/service, receive payment of provided treatment/service, and conduct our day to day business practices.


In order to effectively provide treatment/service, your Primary Service Provider may consult with various service providers within the agency. During those consultations health information about you may be shared.

In order to receive payment of services provided, your health information may be sent to those companies or groups responsible for payment coverage, and a monthly bill is sent to the Responsible Party identified by you and noted on the financial form.

In day-to-day business practices, trained staff may handle your physical medical record in order to have the record assembled, available for review by the Primary Service Provider, or for filing of documentation. Certain data elements are entered into our computer system that processes most billing and for state statistical reporting to The Department of Behavioral Health & Developmental Services (DBHDS). As a part of our continuous quality improvement efforts to provide the most effective services, your record may be reviewed by professional staff to assure accuracy, completeness and organization. Records may also be reviewed during audits by DBHDS.

Enhancing Your Healthcare

Some agency programs provide the following support to enhance your overall health care and may contact you to provide:

Specific Circumstances for Disclosure

Although you have the right to give or not give consent to the disclosure of  information the agency maintains about you, the agency is allowed by federal and state law in certain circumstances to disclose specific health information about you without your consent, authorization, or opportunity to agree or object.

These specific circumstances are:

Documentation will be included in your health record of information disclosed without consent to those who are not agency employees, The Department, or other health providers involved in your service plan. 

Other Uses and Disclosures of Your Information by Authorization Only

We are required to get your authorization to use or disclose your protected health information for any reason other than treatment/services, payment, or health care operations, and those specific circumstances outlined previously. We use an Authorization to Use/Disclose form that specifically states what information will be given to whom, for what purpose, and is signed by you or your legal representative. You have the ability to revoke the signed authorization at any time by a written statement except to the extent that we have acted on the authorization.

Changes to Privacy Practices

Northwestern Community Services reserves the right to change any of its privacy policies and related practices at any time, as allowed by federal and state law and to make the change effective for all protected health information that we maintain.

Revised Privacy Notices will be posted at all service sites, and available upon request by mailing or discussion with an agency representative or electronically or a combination of the three.

For additional information concerning our Privacy Policy, or the federal and state laws pertaining to privacy, please contact: