NOTICE OF PRIVACY PRACTICES
This Notice is
effective on
THIS NOTICE DESCRIBES HOW HEALTH CARE
INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE
REVIEW IT CAREFULLY.
We Are Required By Law To
Protect Health Care Information About You
We are required by law to protect the privacy of
health care information about you and that identifies you. This may be information about health care
services that we provide to you or payment for health care provided to
you. It may also be information about
your past, present, or future health care condition.
We are also required by law to provide you with
this Notice of Privacy Practices explaining our legal duties and privacy
practices with respect to health care information. We are legally bound to follow the terms of
this Notice. In other words, we are only
allowed to use and disclose health care information in the manner that we have
described in this Notice.
We may change the terms of this Notice in the
future. We reserve the right to make
changes and to make the new Notice effective for all health care
information that we maintain. If we make
changes to the Notice, we will:
The rest of this Notice will:
What Is A Medical
Record? What Information Is In The
Medical Record?
If, at any time, you have questions about
information in this Notice or about our privacy policies, procedures or
practices, you may contact our Privacy Officer at 828-264-9007 (ext.146).
Each time you receive a service from, or speak to a
representative of New River Behavioral HealthCare, a record of that contact may
be maintained. The information is
collected and
maintained in what is referred to as your Medical Record. Your Medical Record contains information
about your mental health history, sometimes your physical health, current
symptoms, assessments, test results, diagnosis, treatment, medications, legal
history if applicable, demographic information, financial information, family
history, your progress, and a plan for your current and future treatment. The information contained in your Medical
Record serves the following purposes:
Understanding what information is contained in your
Medical Record and how it is used helps you to:
We May Use And Disclose
Health Care Information
About You In Several
Circumstances
We use and disclose health
care information about clients every day.
This section of our Notice explains in some detail how we may use and
disclose health care information about you in order to provide high quality
health care, obtain payment for that health care, and operate our business
efficiently. This section then briefly
mentions several other circumstances in which we may use or disclose health
care information about you. For more
information about any of these uses or disclosures, or about any of our privacy
policies, procedures or practices, you may contact our Privacy Officer at 828-264-9007, ext 146.
1. Treatment
We may use and disclose health care information
about you to provide health care treatment to you. In other words, we may use and/or disclose
health care information about you to provide, coordinate or manage your health
care and related services. This may
include communicating with other health care providers regarding your treatment
and coordinating and managing your health care with others.
Example: If you are
referred to
We may also use and/ or disclose
health care information about you to send you reminders about your appointment.
We may also use or disclose health care information about
you in emergency situations. A
responsible professional may share information about you with a doctor or other
medical personnel who is providing emergency treatment to you.
Example: If you are admitted to the
emergency room in need of treatment or assessment, the crisis worker can
disclose information from your client record to the treating physician.
2. Payment
We may use and disclose health care information
about you to obtain payment for health care services that you received. This means that, within the mental health
center or contracted agency, we may use health care information about
you to arrange for payment (such as preparing billing and managing
accounts). We also may disclose
health care payment information about you to others (such as collection
agencies, and/or client reporting agencies) except as mandated by state and
federal regulations.
Example: Jane Doe
is a client at the mental health center and has insurance (private, Medicaid,
Medicare, etc.). During an appointment
with a doctor, the doctor ordered a blood test. The mental health center billing clerk will use
health care information about Jane Doe when he/she prepares a bill for the
services provided at the appointment and the blood test. Health care information about Jane Doe may be
disclosed to Medicaid or Medicare in order to bill for treatment.
We must obtain your authorization to disclose
information about you to a private insurance company, however if you decline to
give authorization, you will be responsible for the entirety of your bill.
3. Health
care operations
We may use and disclose
health care information about you in performing a variety of business
activities that we call “health care operations.” These “health care operations” activities
allow us to, for example, improve the quality of care we provide and reduce
health care costs. For example, we may
use or disclose health care information about you in performing the following
activities:
·
Providing training programs for students, trainees, health care
providers or non-health care professionals to help them practice or improve
their skills.
·
Cooperating with outside organizations that evaluate, certify, or
license health care providers, staff, or facilities in a particular field or
specialty.
·
Reviewing and improving the quality, efficiency and cost of care that we
provide to you and our other clients.
·
Cooperating with outside organizations that assess the quality of the
care others and we provide, including government agencies and private
organizations. Planning for our organization’s future operations.
·
Reviewing our activities and using or disclosing health care information
in the event that control of our organization significantly changes.
·
Working with others (such as lawyers, accountants, or other providers)
who assist us to comply with this Notice and other applicable laws.
Example: Jane Doe was diagnosed with depression. The mental health center used Jane Doe’s
health care information as well as health care information from all other
mental health center clients diagnosed with depression to develop an
educational program to help clients recognize the early symptoms of
depression. (Note: The educational program would not identify
any specific clients without their permission.)
Example: Jane Doe complained that she did not receive
appropriate health care. The mental
health center reviewed Jane Doe’s record to evaluate the quality of the care
provided to her. The mental health
center also discussed Jane Doe’s care with the mental health center’s attorney
in an effort to resolve the complaint.
4. Persons
Involved in Your Care
We may disclose health care
information about you to a relative, close personal friend or any other person
you identify if that person is involved in your care, and if the information is
relevant to your care, except as mandated by state and federal
regulations. If the client is a minor,
we may disclose health care information about the minor to a parent, guardian
or other person responsible for the minor except in limited circumstances. For more information on the privacy of
minor’s information, contact our Privacy Officer at 828-264-9007, ext 146.
You may ask us at any time
not to disclose health care information about you to persons involved in your
care. We will agree to your request and
not disclose the information except in certain limited circumstances (such as
emergencies) or if the client is a minor.
If the client is a minor, we may or may not be able to agree with your
request.
Example: Jane Doe’s
husband regularly comes to the mental health center with Jane for her
appointments and he helps her with her medication. When the nurse is discussing a new medication
with Jane Doe, Jane invites her husband to come into the private room. The nurse discusses the medication with Jane
Doe and her husband.
5. Required
by law
We may use/disclose certain healthcare information about you without your written authorization in limited circumstances such as: those required by law; public health activities; health oversight activities; disclosures about abuse, neglect or domestic violence; judicial and administrative proceedings; law enforcement purposes; and certain government functions. Please note this list is NOT an exhaustive list and is not limited to the examples listed below.
Examples of Uses/Disclosures Required by Law: We will use/disclose healthcare information
about you whenever we are required by law to do so. There are many federal and state laws that
require us to use/disclose healthcare information. For example, state law requires us to report
certain types of wounds we think were caused by a criminal or violent act.
Examples of Uses/Disclosures for Public Health Activities: We may use or disclose health care information about you when required by law for public health activities. Public health activities require the use of health care information for various activities, including, but not limited to, activities related to investigating diseases, reporting child abuse and neglect, monitoring drugs or devices regulated by the Food and Drug Administration, and monitoring work-related illnesses or injuries.
Examples of Uses/Disclosures for Health Oversight: We may disclose health care information about
you to a health oversight agency, which is basically an agency responsible for
overseeing the health care system or certain governmental programs. For example, a government agency may request
information from us while they are investigating possible insurance fraud.
Examples of Uses/Disclosures for Judicial/Administrative Proceedings: We may disclose health care information about you to a court or an officer of the court (such as an attorney), when we are presented with a valid order from a judge requiring us to do so.
Examples of Uses/Disclosures for Research: On rare occasions
Examples of Uses/Disclosures About Abuse/Neglect: We may disclose healthcare information about you to a governmental authority that is authorized by law to conduct an investigation regarding abuse and/or neglect. For example, if you are an adult and we reasonably believe that you may be a victim of abuse, neglect or domestic violence.
Examples of Uses/Disclosures for Law Enforcement: We may disclose health
care information about you to law enforcement officials for specific law
enforcement purposes. For example, if a
law enforcement officer has a magistrate’s order to take you into custody for
the purpose of transporting you to a physician or psychologist for an
examination under the involuntary commitment law, we are permitted to disclose
to the law enforcement officer information about your mental state when necessary
to assure your health and safety and the health and safety of the officer
transporting you.
Examples of Uses/Disclosures for Governmental
Purposes: We may use or disclose healthcare information
about you for certain governmental functions.
For example, we may disclose information to the Department of Correction
if you are an inmate and need treatment (Not applicable for substance abuse
clients).
* In all cases of use or disclosure,
6.
Authorization
Other than the uses and disclosures described above
(#1-5), we will not use or disclose health care information about you without
the “authorization” – or signed permission on an authorization for
release of information - by you or your personal representative. In some instances, we may wish to use or
disclose health care information about you and we may contact you to ask you to
sign an authorization form (also called a consent for release of
information). In other cases, you may
contact us to ask us to disclose health care information and we will ask you to
sign an authorization form.
If you sign a written
authorization allowing us to disclose health care information about you, you
may later revoke (or cancel) your authorization in writing (except information
which has already been released or in limited circumstances related to
obtaining insurance coverage). If you
would like to revoke your authorization, you may write us a letter revoking
your authorization or fill out an Authorization Revocation Form. Authorization Revocation Forms are available
from the receptionist, your therapist, case manager, the nurse, or from our
Privacy Officer. If you revoke your
authorization, we will follow your instructions except to the extent that we
have already relied upon your authorization and taken some action.
HOW DRUG AND ALCOHOL RELATED INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED
Information regarding your health care, including
payment for health care, is protected by two federal laws: the Health Insurance
Portability and Accountability Act of 1996 (AHIPAA@), 42 U.S.C. ' 1320d et
seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C.
' 290dd-2, 42 C.F.R. Part 2. Under
these laws, New River Behavioral HealthCare may not say to a person outside New
River that you attend the program, nor may New River disclose any information
identifying you as an alcohol or drug abuser, or disclose any other protected
information except as permitted by federal law.
1.
When
2.
For
research, audit or evaluations;
3.
To
report a crime committed on
4.
To
medical personnel in a medical emergency;
5.
To
appropriate authorities to report suspected child abuse or neglect as allowed
by a court order.
For
example,
Before
You Have Rights With Respect
To Health Care Information About You
This section of the Notice will briefly mention
each of these rights. If you would like
to know more about your rights, please contact our Privacy Officer at 828-264-9007, ext 146.
1. Right to
a copy of this Notice
You will be given a copy of this Notice at your
first appointment after
2. Right of
access to inspect and copy
You have the right to inspect (which means see or
review) and to receive a copy of health care information about you that we
maintain in certain groups of records.
If you would like to inspect or receive a copy of health care
information about you, you must provide us with a request in writing. You may write us a letter requesting access
or fill out an Access Request Form.
Access Request Forms are available from our receptionist, your
therapist, case manager, or our Privacy Officer. Our agency must act on this request no later
than 30 days after receipt of the request (with one extension allowed).
We may deny your request in certain
circumstances. If we deny your request,
we will explain our reason for doing so in writing. We will also inform you in writing that you
have the right to have our decision reviewed by the Privacy Oversight
Committee.
If you would like a copy of the information, we may
charge you a fee to cover the costs of the copy. You will be advised of the fee before the
copies are made.
We may be able to provide you with a
summary or explanation of the information.
Contact our Privacy Officer at 828-264-9007, ext 146 for more
information on these services and any possible additional fees.
3. Right to
have health care information amended
You have the right to have us amend (which means
correct or add) health care information about you that we maintain in certain
groups of records. If you believe that
we have information that is either inaccurate or incomplete, it
may be possible for us to amend the information to indicate the problem and
notify others who have copies of the inaccurate or incomplete information. If you would like us to amend information,
you must provide us with a request in writing.
You may write us a letter requesting an amendment or fill out an
Amendment Request Form. Amendment
Request Forms are available from our receptionist, your therapist, case
manager, or our Privacy Officer. Our agency
must act on this request no later than 60 days after receipt of the request.
We may deny your request in certain
circumstances. If we deny your request,
we will explain our reason for doing so in writing. You will have the opportunity to send us a
statement explaining why you disagree with our decision to deny your amendment
request and we will share your statement whenever we disclose the information
in the future.
4. Right to
an accounting of disclosures we have made
You have the right to receive an accounting (which
means a detailed listing) of disclosures that we have made for the previous six
(6) years (not prior to
The accounting may not include several types of
disclosures, including intra-agency disclosures for treatment, payment, or
health care operations. It may also not
include disclosures made prior to
If you request an accounting more than once every
twelve (12 months), we may charge you a fee to cover the costs of preparing the
accounting. We will inform you of the
amount upon your request.
5. Right to
request restrictions on uses and disclosures
You have the right to request that we limit the use
and disclosure of health care information about you for treatment, payment and
health care operations.
We are not required to agree to your
request.
If we do agree to your request, we must follow your
restrictions (except if the information is necessary for emergency
treatment). You may cancel the
restrictions at any time. In addition,
we may cancel a restriction at any time as long as we notify you of the
cancellation and continue to apply the restriction to information collected
before the cancellation.
6. Right to
request an alternative method of contact
You have the right to be contacted at a different
location or by a different method. For
example, you may prefer to have all written information mailed to your work
address rather than your home address.
We will agree to any
reasonable request for alternative methods of contact. If you would like to request an alternative
method of contact, you must provide us with a request in writing. You may write us a letter or fill out an
Alternative Contact Request Form.
Alternative Contact Request Forms are available from your therapist,
case manager, medical records personnel, or the Privacy Officer.
You May File A Complaint
About Our Privacy Practices
If you believe that your privacy rights have been
violated or if you are dissatisfied with our privacy policies or procedures,
you may file a complaint either with us or with the federal government. We will not take any action against you or
change our treatment of you in any way if you file a complaint.
To file a written complaint
with the New River Behavioral HealthCare, you may bring your complaint to your
care provider, his/her supervisor, the Privacy Officer, or you may mail it to
the following address:
|
Privacy Officer
|
To file a
complaint with the federal government, you may send your complaint to the
following address.
Phone: 866-627-7748 TTY: 886-788-4989
Email: www.hhs.gov/ocr
Complaints
must be filed with the Office of Civil Rights within 180 days of when you knew
or should have known that the act occurred.
The Secretary may waive the 180-day time limit if good cause is shown. There will be no retaliation against you for
filing a complaint.
Alternative Method of Contact
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Client Signature/ Personal Representative Date
Relationship to Client: _______________________________________________________ :
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