Our agency is required by law to protect the privacy of medical information about participants in our programs. This medical information may include but not be limited to services we provide or payment for provided services. It may also include information about our consumer’s past, present, or future medical condition.
MENTAL HEALTH ASSOCIATES
OF THE TRIAD
NOTICE OF PRIVACY PRACTICES
This Notice is effective April 14, 2003
As mental health care givers, we are required by law to protect the privacy of medical information either about you or that identifies you. This medical information may be about the mental health care we provide to you or payment for health care provided to you. It may also contain information about your past, present, or future medical condition.
We are also required by law to provide you with the Notice of Privacy Practices explaining our legal duties and privacy practices with respect to medical information. We are legally required to follow the terms of this Notice. In other words, we are only allowed to use and disclose medical 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 medical information that we maintain. If we make changes to the Notice, we will provide copies of the new Notice to you.
The rest of this Notice will
- Discuss how we may use and disclose medical information about you
- Explain your rights with respect to medical information about you
- Describe how and where you may file a privacy-related complaint
If, at any time, you have questions about information in this Notice or about our privacy policies, procedures or practices, you can contact our clinical director, Dr. Kim Soban, at 883-7480.
WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCES
We use and disclose medical information about consumers every day. This section of our Notice explains how we may use and disclose medical information about you in order to provide 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 medical information about you.
We may use and disclose medical 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.
We may use and disclose medical information about you to obtain payment for health care services that you received. In some instances, we may disclose medical information about you to an insurance plan before you receive certain health care services because we may want to know whether the insurance plan will pay for a particular service.
3. HEALTH CARE OPERATIONS
We may use and disclose medical information about you in performing a variety of business activities.
- Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you.
- Providing training programs for interns, 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 consumers.
- Cooperating with outside organizations that assess the quality of the care we and others provide, including government agencies and private organizations.
- Resolving grievances within our organization.
- Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly changes.
- Working with others (such as lawyers, accountants and other providers) who assist us to comply with this Notice and other applicable laws.
4. PERSONS INVOLVED IN YOUR CARE
We may disclose medical information about you to a relative, close personal friend or any other person you identify if that person is involved in your care and the information is relevant to your care. We may also use or disclose medical information about you to a relative, another person involved in your care or possibly a disaster relief organization, such as the Red Cross, if we need to notify someone about your locations or condition.
You may ask us at any time not to disclose medical 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 an emergency.
5. REQUIRED BY LAW
We will use and disclose medical information about you whenever we are required by law to do so. There are many state and federal laws that require us to use and disclose medical information. For example, state law requires us to report gunshot wounds and other injuries to the police and to report known or suspected child abuse or neglect to the Department of Social Services. We will comply with those state laws and with all other applicable laws.
6. NATIONAL PRIORITY USES AND DISCLOSURES
When permitted by law, we may use or disclose medical information about you without your permission for various activities that are recognized as “national priorities.” In other words, the government has determined that under certain circumstances described below, it is so important to disclose medical information that it is acceptable to disclose without the individual’s permission. We will only disclose medical information about you in the following circumstances when we are permitted to do so by law.
- Threat to health or safety: We may use or disclose medical information about you if we believe it is necessary to prevent or lessen a serious threat to health or safety.
- Public health activities: We may use or disclose medical information about your 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. For example, if you have been exposed to a communicable disease, we may report it to the State and take other actions to prevent spread of the disease.
- Abuse, neglect or domestic violence: We may disclose medical information about you to a government authority, such as the Department of Social Services, if we believe that you may be a victim of abuse, neglect, or domestic violence.
- Health oversight activities: We may disclose medical information about you to a health oversight agency, which is an agency responsible for overseeing the health care system or certain government programs. For example, a government agency may request information from us while they are investigating possible insurance fraud.
- Court proceedings: We may disclose medical information about you to a court or an officer of the court, such as an attorney. For example, we would disclose medical information about you to a court if a judge orders us to do so.
- Law enforcement: We may disclose medical information about you to a law enforcement official for specific law enforcement purposes. For example, we may disclose limited medical information about you to a police officer if the officer needs the information to help find or identify a missing person.
- Coroners and others: We may disclose medical information about you to a coroner, medical examiner, or funeral director or to organizations that help with organ, eye and tissue transplants.
- Workers’ compensation: We may disclose medical information about you in order to comply with workers’ compensation laws.
- Research organizations: We may use or disclose medical information about you to research organizations if the organization has satisfied certain conditions about protecting the privacy of medical information.
- Certain government functions: We may use or disclose medical information about you for certain government functions, including, but not limited to, military and veterans’ activities and national security and intelligence activities. We may also use or disclose medical information about you to a correctional institution in some circumstances.
Other than the uses and disclosures described above, we will not use or disclose medical information about you without the authorization or signed permission of you or your personal representative. In some instances, we may wish to use or disclose medical information about you and we may contact you to ask you to sign an authorization form. In other instances, you may contact us to ask us to disclose medical information and we will ask you to sign an authorization form.
If you sign a written authorization allowing us to disclose medical information about you, you may later cancel your authorization in writing (except in very limited circumstances related to obtaining insurance coverage). If you would like to cancel your authorization, you may write us a letter canceling your authorization.
YOU HAVE RIGHTS WITH RESPECT TO MEDICAL INFORMATION ABOUT YOU
You have several rights with respect to medical 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 let a member of our staff know this.
1. RIGHT TO A COPY OF THIS NOTICE
You have a right to have a paper copy of our Notice of Privacy Practices. In addition, a copy of this Notice will always be posted in the lobby.
2. RIGHT OF ACCESS TO INSPECT AND COPY
You have the right to inspect and receive a copy of medical information about you that we maintain in certain groups of records. If you would like to inspect or receive a copy of medical information about you, you must provide us with a request in writing.
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 if you have the right to have our decision reviewed by another person.
3. RIGHT TO HAVE MEDICAL INFORMATION AMENDED
You have the right to have us amend medical information about you that we maintain in certain groups of records. If you believe that we have information that is either inaccurate or incomplete, we may 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 and explain why you would like us to amend the information. You may write us a letter requesting an amendment.
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 of disclosures that we have made for the previous six years. If you would like to receive an accounting, you may send us a letter requesting an accounting.
The accounting will not include several types of disclosures, including disclosures for treatment, payment or health care operations. It will also not include disclosures made prior to April 14, 2003.
5. RIGHT TO REQUEST RESTRICTIONS ON USES AND DISCLOSURES
You have the right to request that we limit the use and disclosure of medical 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 request 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 to 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 FILE A COMPLAINT
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.
A written complaint should be given to our Clinical Director, Dr. Kim Soban.
If you wish to file a complaint with the federal government, you may send your complaint to the following address:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201