|
|
|
|
|
|
|
|
NOTICE
OF PRIVACY PRACTICES Effective
Date: 4/14/03
. THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT OUR CONSUMERS MAY BE USED AND DISCLOSED, AND HOW OUR
CONSUMERS, THEIR GUARDIANS AND/OR THEIR PERSONAL REPRESENTATIVES, CAN GET
ACCESS TO THIS INFORMATION. GUARDIANS
AND PERSONAL REPRESENTATIVES SHOULD BE AWARE THAT THE WORD “YOU” IN
THIS NOTICE REFERS TO THE CONSUMER, NOT TO THE GUARDIAN.
PLEASE REVIEW CAREFULLY. We are required by law to protect the privacy of health
information that may reveal your identity, and to post a copy of this
notice which describes the health information privacy practices of our
agency, its staff, and affiliated health care providers that jointly
provide treatment, and perform payment activities and business operations,
with our agency. You will be
able to obtain a copy by calling our office at [718] 643-5300, or asking
for one at the time of your next visit. If
you have any questions about this notice or would like further
information, please contact Privacy
Officer at [718]643 -5300. IMPORTANT INFORMATION
Requirements For Written Authorization.
We will generally obtain your written authorization before using
your health information or sharing it with others outside the agency.
You may also initiate the transfer of your records to another
person by completing an authorization form.
If you provide us with written authorization, you may revoke that
authorization at any time, except to the extent that we have already
relied upon it. To revoke an
authorization, please write to: The
Privacy Officer, League Treatment Center, 30 Washington Street, Brooklyn,
NY 11201 How Someone May Act On Your Behalf.
You have to right to name a personal representative who may act on
your behalf to control the privacy of your health information.
Parents and guardians will generally have the right to control the
privacy of health information about minors unless the minors are permitted
by law to act on their own behalf. How To Learn About Special Protections For HIV, Alcohol And
Substance Abuse, Mental Health And Genetic Information.
Special privacy protections apply to HIV-related information,
alcohol and substance abuse treatment information, mental health
information, and genetic information.
Some parts of this general Notice of Privacy Practices may not
apply to these types of information.
If your treatment involves this information, you will be provided
with separate notices explaining how the information will be protected.
To request copies of these other notices now, please contact Privacy
Officer at [718]643-5300. How To Obtain A Copy Of This Notice.
You have the right to a paper copy of this notice.
You may request a paper copy at any time, even if you have
previously agreed to receive this notice electronically.
To do so, please call Privacy
Officer at [718]643-5300. You
may also obtain a copy of this notice by requesting a copy at the time of
your next visit. How To Obtain A Copy Of Revised Notice.
We may change our privacy practices from time to time.
If we do, we will revise this notice so you will have an accurate
summary of our practices. The revised notice will apply to all of your health
information, and we will be required by law to abide by its terms. We will post any revised notice in our agency reception area.
You will also be able to obtain your own copy of the revised notice
by calling our office at [718]643-5300, or asking for one at the
time of your next visit. The effective date of the notice will always be noted at the
top of the page. How To File A Complaint. If you
believe your privacy rights have been violated, you may file a complaint
with us or with the Secretary of the
Department of Health and Human Services.
To file a complaint with us, please contact: Privacy
Officer, League Treatment Center, 30 Washington Street, Brooklyn, NY
11201, [718]643-5300. No one will retaliate or take action against you for filing a
complaint. WHAT HEALTH INFORMATION IS PROTECTED
We are committed to protecting the privacy of information we
gather about you while providing health-related services.
Some examples of protected health information are: ·
the fact
that you are a participant at, or receiving treatment or health-related
services from, our agency; ·
information
about your health condition (such as a disease you may have); ·
information
about health care products or services you have received or may receive in
the future (such as a medication or treatment); or ·
information
about your health care benefits under an insurance plan (such as whether a
prescription is covered); when
combined with:
HOW
WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR WRITTEN
AUTHORIZATION 1. Treatment,
Payment And Agency Business Operations. The
agency and its staff may use your health information or share it with
others in order to treat your condition, obtain payment for that
treatment, and run the agency’s normal business operations.
Your health information may also be shared with affiliated agencies
so that they may jointly perform certain payment activities and business
operations along with our agency. Your
health information also may be disclosed to another health care provider
for its treatment and payment activities, and for certain limited business
operations by it. Below are
further examples of how your information may be used and disclosed by our
agency. Treatment. We may share your health information with doctors, nurses,
therapists, aides and other health care professionals at the agency who
are involved in providing services to you, and they may in turn use that
information to diagnose or treat you, or to develop a plan of services
for, you. A health care
professional at our agency may share your health information with a health
care professional at another agency, to determine how to diagnose or treat
you. Your health care
professional may also share your health information with another agency or
provider to whom you have been referred for further health care.
Finally, we may share your health information with others outside
the agency as necessary to carry out your treatment plan; for example, we
may disclose certain information about your health to a prospective
employer in connection with a job placement or training program. Payment. We may use your health
information or share it with others so that we obtain payment for your
health care services. For
example, we may share information about you with your health insurance
company in order to obtain reimbursement after we have provided services
to you. In some cases, we may
share information about you with your health insurance company in order to
obtain reimbursement after we have provided services to you. We might also
need to inform your health insurance company about your health condition
in order to obtain pre-approval for your services, such as care provided
at a residential treatment facility.
Finally, we may share your health information with other providers
and payors for their payment activities. Business Operations. We may use your health information or share it with others in order
to conduct our normal business operations. For example, we may use your health information to evaluate
the performance of our staff in caring for you, or to educate our staff on
how to improve the care they provide for you.
We may also share your health information with another company that
performs business services for us, such as billing companies.
If so, we will have a written contract to ensure that this company
also protects the privacy of your health information.
Finally, we may share your health information with other providers
and payors for certain of their business operations if that other party
also has or had a treatment or payment relationship with you, and in that
event we will only share information that pertains to that relationship. Appointment Reminders, Treatment Alternatives, Benefits And
Services.
We may use your health information when we contact you with a
reminder that you have an appointment for treatment or services at our
facility. We may also use
your health information in order to recommend possible treatment
alternatives or health-related benefits and services that may be of
interest to you. Fundraising. We may use demographic information about you, including information
about your age and gender, and where you live or work, and the dates that
you received treatment, in order to contact you to raise money to help us
operate. We may also share this information with a charitable foundation
that will contact you to raise money on our behalf.
If you do not want to be contacted for these fundraising efforts,
please write to: Privacy
Officer, League Treatment Center, 30 Washington Street, Brooklyn, NY
11201. 2. Facility
Directory/Friends And Family We may use your health information in, and disclose it from,
our Facility Directory, or share it with friends and family involved in
your care, without your written authorization or other written
permission. We will always
give you an opportunity to object unless there is insufficient time
because of a medical emergency (in which case we will discuss your
preferences with you as soon as the emergency is over).
We will follow your wishes unless we are required by law to do
otherwise. Agency Directory. Unless you object, we will include your name, in our
agency Directory while you are a consumer at our facility.
This directory information, except for your religious affiliation,
may be released to people who ask for you by name.
Friends And Family Involved In Your Care.
If you do not object, we may share your health information with a
family member, relative or close personal friend who is involved in your
care or payment for that care. We may also notify a family member, personal representative,
or another person responsible for your care about your location and
general condition here at our facility, or about the unfortunate event of
your death. In some cases, we
may need to share your information with a disaster relief organization
that will help us notify these persons. Incidental Disclosures. While we will take reasonable steps to
safeguard the privacy of your health information, certain disclosures of
your health information may occur during or as an unavoidable result of
our otherwise permissible uses or disclosures of your health information.
For example, during the course of a treatment session, other
consumers in the treatment area may see, or overhear discussion of, your
health information. 3. Public
Need. We
may use your health information, and share it with others, in order to
meet important public needs. We
will not be required to obtain your written authorization, consent or any
other type of permission before using or disclosing your information for
these reasons. As Required By Law. We may use or
disclose your health information if we are required by law to do so.
We also will notify you of these uses and disclosures if notice is
required by law. Public Health Activities. We may
disclose your health information to authorized public health officials (or
a foreign government agency collaborating with such officials) so they may
carry out their public health activities.
For example, we may share your health information with government
officials that are responsible for controlling disease, injury or
disability. We may also
disclose your health information to a person who may have been exposed to
a communicable disease or be at risk for contracting or spreading the
disease if a law permits us to do so. And finally, we may release some health information about you
to your employer. Victims Of Abuse, Neglect Or Domestic Violence.
We may release your health information to a public health authority
that is authorized to receive reports of abuse, neglected or domestic
violence. For example, we may
report your information to government officials if we reasonably believe
that you have been a victim of abuse, neglect or domestic violence.
We will make every effort to obtain your permission before
releasing this information, but in some cases we may be required or
authorized to act without your permission. Health Oversight Activities.
We may release your health information to government agencies
authorized to conduct audits, investigations, and inspections of our
facility. These government
agencies monitor the operation of the health care system, government
benefit programs such as Medicare and Medicaid, and compliance with
government regulatory programs and civil rights laws. Product Monitoring, Repair And Recall.
We may disclose your health information to a person or company that
is required by the Food and Drug Administration to: (1) report or track
product defects or problems; (2) repair, replace, or recall defective or
dangerous products; or (3) monitor the performance of a product after it
has been approved for use by the general public. Lawsuits And Disputes. We may
disclose your health information if we are ordered to do so by a court or
administrative tribunal that is handling a lawsuit or other dispute. Law Enforcement. We may disclose
your health information to law enforcement officials for the following
reasons:
To Avert A Serious Threat To Health Or Safety.
We may use your health information or share it with others
when necessary to prevent a serious threat to your health or safety, or
the health or safety of another person or the public.
In such cases, we will only share your information with someone
able to help prevent the threat. We
may also disclose your health information to law enforcement officers if
you tell us that you participated in a violent crime that may have caused
serious physical harm to another person (unless you admitted that fact
while in counseling), or if we determine that you escaped from lawful
custody (such as a prison or mental health institution). National Security And Intelligence Activities Or Protective
Services. We may disclose your health information to authorized federal
officials who are conducting national security and intelligence activities
or providing protective services to the President or other important
officials. Military And Veterans. If you
are in the Armed Forces, we may disclose health information about you to
appropriate military command authorities for activities they deem
necessary to carry out their military mission.
We may also release health information about foreign military
personnel to the appropriate foreign military authority. Inmates And Correctional Institutions.
If you are an inmate, or you are detained by a law enforcement
officer, we may disclose your health information to the prison officers or
law enforcement officers if necessary to provide you with health care, or
to maintain safety, security and good order at the place where you are
confined. This includes
sharing information that is necessary to protect the health and safety of
other inmates or persons involved in supervising or transporting inmates. Workers’ Compensation. We may
disclose your health information for workers’ compensation or similar
programs that provide benefits for work-related injuries. Coroners, Medical Examiners And Funeral Directors.
In the unfortunate event of your death, we may disclose your
health information to a coroner or medical examiner.
This may be necessary, for example, to determine the cause of
death. We may also release
this information to funeral directors as necessary to carry out their
duties. Organ And Tissue Donation. In the
unfortunate event of your death, we may disclose your health information
to organizations that procure or store organs, eyes or other tissues so
that these organizations may investigate whether donation or
transplantation is possible under applicable laws. Research. In most cases, we will ask
for your written authorization before using your health information or
sharing it with others in order to conduct research.
However, under some circumstances, we may use and disclose your
health information without your authorization if we obtain approval
through a special process to ensure that research without your
authorization poses minimal risk to your privacy.
Under no circumstances, however, would we allow researchers to use
your name or identity publicly. We
may also release your health information without your authorization to
people who are preparing a future research project, so long as any
information identifying you does not leave our facility.
In the unfortunate event of your death, we may share your health
information with people who are conducting research using the information
of deceased person, as long as they agree not to remove from our facility
any information that identifies you. YOUR
RIGHTS TO ACCESS AND CONTROL YOUR HEALTH INFORMATION We
want you to know that you have the following rights to access and control
your health information. These
rights are important because they will help you make sure that the health
information we have about you is accurate.
They may also help you control the way we use your information and
share it with others, or the way we communicate with you about your
medical matters. 1.
Right To Inspect And Copy Records.
You have the right to inspect and obtain a copy of any of your
health information that may be used to make decisions about you and your
treatment for as long as we maintain this information in our records.
This includes medical and billing records. To inspect or obtain a copy of your health information,
please submit your request in writing to: Privacy
Officer, League Treatment Center, 30 Washington Street, Brooklyn, NY 11201. If
you request a copy of the information, we may charge a fee for the costs
of copying, mailing or other supplies we use to fulfill your request.
The standard fee is $0.75 per page and must generally be paid
before or at the time we give the copies to you. We
will respond to your request for inspection of records within 10 days.
We ordinarily will respond to requests for copies within 30 days if
the information is located in our facility, and within 60 days if it is
located off-site at another facility.
If we need additional time to respond to a request for copies, we
will notify you in writing within the time frame above to explain the
reason for the delay and when you can expect to have a final answer to
your request. Under certain
very limited circumstances, we may deny your request to inspect or obtain
a copy of your information. If
we do, we will provide you with a summary of the information instead.
We will also provide a written notice that explains our reasons for
providing only a summary, and a complete description of your rights to
have that decision reviewed and how you can exercise those rights.
The notice will also include information on how to file a complaint
about these issues with us or with the Secretary
of the Department of Health and Human Services. If we have reason to deny only part of your request, we will
provide complete access to the remaining parts after excluding the
information we cannot let you inspect or copy. 2.
Right To Request Amendment of Records.
If you believe that the health information we have about you is
incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the
information is kept in our records. To
request an amendment, please write to: Privacy
Officer, League Treatment Center, 30 Washington Street, Brooklyn, NY 11201. Your
request should include the reasons why you think we should make the
amendment. Ordinarily we will
respond to your request within 60 days.
If we need additional time to respond, we will notify you in
writing within 60 days to explain the reason for the delay and when you
can expect to have a final answer to your request. If
we deny part or all of your request, we will provide a written notice that
explains our reasons for doing so. You
will have the right to have certain information related to your requested
amendment included in your records. For
example, if you disagree with our decision, you will have an opportunity
to submit a statement explaining your disagreement which we will include
in your records. We will also
include information on how to file a complaint with us or with the
Secretary of the Department of Health and Human Services.
These procedures will be explained in more detail in any written
denial notice we send you. 3. Right
to An Accounting Of Disclosures. After April 14,
2003, you have a right to request an “accounting of disclosures” which
is a list that contains certain information about how we have shared your
information with others. An
accounting list, however, will not include any information about: ·
Disclosures
we made to you; ·
Disclosures
we made pursuant to your authorization; ·
Disclosures
we made for treatment, payment or health care operations; ·
Disclosures
made in the facility directory; ·
Disclosures
made to your friends and family involved in your care or payment for your
care; ·
Disclosures
made to federal officials for national security and intelligence
activities; ·
Disclosures
that were incidental to permissible uses and disclosures of your health
information. ·
Disclosures
for purposes of research, public health or our normal business operations
of limited portions of your health information that do not directly
identify you; ·
Disclosures
about inmates to correctional institutions or law enforcement officers; or ·
Disclosures
made before April 14, 2003. To
request this accounting list, please write to Privacy Officer.
Your request must state a time period within the past six years
(but after April 14, 2003) for the disclosures you want us to include.
For example, you may request a list of the disclosures that we made
between January 1, 2004 and January 1, 2005.
You have a right to receive one accounting list within every
12-month period for free. However,
we may charge you for the cost of providing any additional accounting list
in that same 12-month period. We
will always notify you of any costs involved so that you may choose to
withdraw or modify your request before any costs are incurred. Ordinarily
we will respond to your request for an accounting list within 60 days.
If we need additional time to prepare the accounting list you have
requested, we will notify you in writing about the reason for the delay
and the date when you can expect to receive the accounting list.
In rare cases, we may have to delay providing you with the
accounting list without notifying you because a law enforcement official
or government agency ahs asked us to do so. 4.
Right To Request Additional Privacy Protections.
You have the right to request that we further restrict the way we
use and disclose your health information to treat your condition, collect
payment for that treatment, or run our agency’s normal business
operations. You may also request that we limit how we disclose information
about you to family or friends involved in your care.
For example, you could request that we not disclose information
about a surgery you had. To
request restrictions, please write to: Privacy
Officer, League Treatment Center, 30 Washington Street, Brooklyn, NY 11201. Your
request should include (1) what information you want to limit; (2) whether
you want to limit how we use the information, how we share it with others,
or both; and (3) to whom you want the limits to apply. We
are not required to agree to your request for a restriction, and in some
cases the restriction you request may not be permitted under law.
However, if we do agree, we will be bound by our agreement
unless the information is needed to provide you with emergency treatment
or comply with the law. Once
we have agreed to a restriction, you have the right to revoke the
restriction at any time. Under
some circumstances, we will also have the right to revoke the restriction
as long as we notify you before doing so; in other cases, we will need
your permission before we can revoke the restriction. Privacy
Officer, League Treatment Center, 30 Washington Street, Brooklyn, NY 11201. We
will not ask you the reason for your request, and we will try to
accommodate all reasonable requests. Please specify in your
request how or where you wish to be contacted, and how payment for your
health care will be a handled if we communicate with you through this
alternative method or location. |
|
>>Privacy<< |
