NOTICE OF
PRIVACY PRACTICES
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. You should read this
Notice before signing the Consent to the Use and Disclosure of Health
Information for Treatment, Payment and Health Care Operations.
·
Our Duty to Safeguard Your Protected Health
Information
Individually identifiable
information about your past, present, or future health or condition, the
provision of health care to you, or payment for the health care is considered
“Protected Health Information” (“PHI”).
We are required to extend certain protections to your PHI, and to give
you this Notice about our privacy practices that explains how, when and why we
may use or disclose your PHI. Except in
specified circumstances, we must use or disclose only the minimum necessary PHI
to accomplish the purpose of the use or disclosure.
We are required to follow
the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of
this Notice at any time. If we do
so, we will post a new Notice prominently in lobbies and reception areas at
each facility. You may request a copy
of the new notice from the agency Privacy Officer at 259 Parkers Mill Road,
Somerset, Kentucky 42501, and it will also be posted on our website at www.adanta.org.
·
How We May Use and Disclose Your Protected Health
Information
We use and disclose PHI for
a variety of reasons. For most
uses/disclosures, we must obtain your consent.
For others, we must have your written authorization. However, the law provides that we are
permitted to make some uses/disclosures without your consent or
authorization. The following offers
more description and examples of our potential uses/disclosures of your PHI.
·
Uses and Disclosures Relating to Treatment, Payment,
or Health Care Operations
For Treatment:
We may disclose your PHI to
doctors, nurses, and other health care personnel who are involved in providing
your health care. For example, your PHI
will be shared among members of your treatment team, (psychiatrist, nurse,
therapist).
To Obtain Payment: We may use/disclose your PHI in
order to bill and collect payment for your health care services. For example, we may release portions of your
PHI to Medicaid, the Kentucky Department for Mental Health/Mental Retardation,
and/or a private insurer to get paid for services that we delivered to you.
For Health Care Operations: We may
use/disclose your PHI in the course of operating our Community Mental Health
Center. For example, we may use your
PHI in evaluating the quality of services provided, or disclose your PHI to our
accountant or attorney for audit purposes.
Members of the medical staff, the risk or quality improvement manager,
or members of the quality improvement team may use information in your health
record to access the care and outcomes in your case and others like it. This information will then be used in an
effort to continually improve the quality and effectiveness of the healthcare
and service we provide.
Appointment Reminders: Unless you
provide us with alternative instructions, we may send appointment reminders and
other similar materials to your home.
Business Associates: There are
some services provided in our organization through contacts with business
associates. Examples of Business
Associates include LCRH-after hours emergency services and certain laboratory
tests, and consulting attorneys. When
these services are contracted, we may disclose your health information to our
business associate so that they can perform the job we’ve asked them to do and
bill you or your third-party payer for services rendered. To protect your health information, however,
we require the business associate to appropriately safeguard your
information.
Exceptions: Although your consent is usually required
for the use/disclosure of your PHI for the activities described above, the law
allows us to use/disclose your PHI without your consent in certain
situations. For example, we may
disclose your PHI if needed for emergency treatment if it is not reasonably
possible to obtain your consent prior to the disclosure and we think that you
would give consent if able. Also, if we
are required by law to provide your treatment, we may use/disclose your PHI for
treatment, payment and operations without obtaining your prior consent.
·
Uses and Disclosures Requiring Authorization
For uses and disclosures
beyond treatment, payment and operations purposes we are required to have your
written authorization. Like consents,
authorizations can be revoked at any time to stop future uses/disclosures except
to the extent that we have already undertaken an action in reliance upon your
authorization.
·
Confidentiality of Alcohol and Drug Abuse Patient
Information
If you are receiving alcohol
or drug abuse services from our Agency, information that would identify you as
a person seeking help for a substance abuse problem is protected under a
separate set of federal regulations known as “Confidentiality of Alcohol and
Drug Abuse Patient Records”, 42 C.F.R. Part 2.
Under certain circumstances these regulations will provide your health
information with additional privacy protections beyond those that have already
been described.
For instance, in general,
any information identifying you as addressing a substance abuse problem cannot
be shared outside of this Agency without your specific consent in writing to do
so. Exceptions to this rule include
court orders to release your health information, the provision of your health
information to medical personnel in an emergency, sharing information with
qualified personnel conducting research and for audits or program
evaluations. As an example, before your
substance abuse health related information can be released to family, friends,
law enforcement, judicial and corrections personnel, public health authorities,
or other providers of medical services we are required to ask for your written
authorization to do so. The regulations 42 C.F.R. Part 2, Confidentiality of
Alcohol and Drug Abuse Patient Records, does allow a health care provider to
comply with the Kentucky statute requiring the reporting of suspected child
abuse or neglect to the Cabinet for Families and Children. However, before specific information
pertaining to the care you are receiving for your substance abuse problem can
be released, you must authorize the release in writing. Child abuse and neglect authorities may also
pursue a court order to release the information without your written
permission.
In those instances where you
did authorize us to release your substance abuse related health information,
the authorization will always be accompanied by a notice prohibiting the
individual or agency/organization receiving your health information from
re-releasing it unless permitted under the regulations 42 C.F.R.,
Confidentiality of Alcohol and Drug Abuse Patient Records.
Violation of the federal law
and regulations by a program is a crime.
Suspected violations may be reported to the United States Attorney in
the district where the violation occurs.
·
Uses and Disclosures Not Requiring Consent or
Authorization
The law provides that we may
use/disclose your PHI without consent or authorization in the following
circumstances:
When Required by Law: We may
disclose PHI when a law requires that we report information about suspected
abuse, neglect or domestic violence, or relating to suspected criminal
activity, or in response to a court order.
We must also disclose PHI to authorities who monitor compliance with
these privacy requirements.
For Public Health Activities: We may
disclose PHI when we are required to collect information about disease or
injury, or to report vital statistics to the public health authority.
For Health Oversight Activities: We may
disclose PHI to the Kentucky State Department of Mental Health protection and
advocacy agency, or other agency responsible for monitoring the health care
system for such purposes as reporting or investigation of unusual incidents and
those responsible for licensure and monitoring of regulations.
Relating to Decedents: We may
disclose PHI relating to an individual’s death to coroners, medical examiners
or funeral directors, and to organ procurement organizations relating to organ,
eye, or tissue donations or transplants.
For Research Purposes: In certain
circumstances, and under supervision of a privacy board, we may disclose PHI in
order to assist medical/psychiatric research.
To Avert Threat to Health or Safety: In order to
avoid a serious threat to health or safety, we may disclose PHI as necessary to
law enforcement or other persons who can reasonably prevent or lessen the
threat of harm.
Food and Drug Administration (FDA): We may
disclose to the FDA health information relative to adverse events with respect
to food, supplements product and product defects, or post marketing
surveillance information to enable product recalls, repairs, or replacement.
Law Enforcement/Legal Proceedings: We may
disclose mental health records for law enforcement purpose as required
by law or in response to a valid subpoena, discovery request or other lawful
process. These law enforcement purposes
include (1) legal processes otherwise required by law, (2) limited information
requests for identification and location purposes; (3) pertaining to victims of
a crime; (4) suspicion that death has occurred as a result of criminal conduct;
(5) in the event that a crime occurs on the premises of the Agency, including
its facilities; and (6) medical emergency and it is likely that a crime has
occurred. Also we may disclose
information to government officials for national security and intelligence
reasons. For example, during an FBI
investigation we may release information in response to a lawful order of the
court.
Correctional Institution: Should you
be an inmate of a correctional institution, we may disclose to the Corrections
Cabinet health information necessary for your health and the health and safety
of other individuals.
Workers Compensation: We may
disclose health information to the extent authorized by and to the extent
necessary to comply with laws relating to workers compensation or other similar
programs established by law.
·
Uses and Disclosures Requiring You To Have An
Opportunity To Object
In the following situations,
we may disclose your PHI if we inform you about the disclosure in advance and
you do not object. However, if there is
an emergency situation and you cannot be given your opportunity to object,
disclosure may be made if it is consistent with any prior expressed wishes and
disclosure is determined to be in your best interests. You must be informed and given an
opportunity to object to further disclosure as soon as you are able to do
so.
Client Directories: Your name, location, general
condition, and religious affiliation may be put into our client directory for
use by clergy and callers or visitors who ask for you by name.
To Families, Friends, or Others involved in your
Care: We may share with these people information directly related to
your family’s, friend’s or other person’s involvement in your care, or payment
for your care. We may also share PHI
with these people to notify them about your location, general condition, or
death.
Marketing and Fundraising: We may only
use or share your health information in connection with limited marketing or
fund-raising. We may disclose medical
information to a foundation so that it may contact you in raising money. We would only release contact information
such as: your name, address, and phone
number, and the dates you received treatment or services. If you do not want the entity to contact you
about fundraising efforts, you must notify the Privacy Officer in writing.
·
Your rights Regarding Your Protected Health
Information
You have the following
rights relating to your protected health information:
To Request Restrictions on Uses/Disclosures: You
have the right to ask that we limit how we use or disclose your PHI. We will consider your request, but are not
legally bound to agree to the restriction.
To the extent that we do agree to any restrictions on our use/disclosure
of your PHI, we will put the agreement in writing and abide by it except in
emergency situations. We cannot agree
to limit uses/disclosures that are required by law.
To Choose How We Contact You: You
have the right to ask that we send you information at an alternative address or
by an alternative means. We must agree
to your request as long as it is reasonably easy for us to do so. Rule 522
To Inspect and Copy Your PHI: Unless your
access is restricted for clear and documented treatment reasons, you have a
right to see your protected health information if you put your request in
writing. We will respond to your
request within 30 days. If we deny your
access, we will give you written reasons for the denial and explain any right
to have the denial reviewed. If you
want copies of your PHI, a charge for copying may be imposed, but may be
waived, depending on your circumstances.
You have a right to choose what portions of your information you want
copied and to have prior information on the cost of copying. Rule 524
To Request Amendment of Your PHI: If you
believe that there is a mistake or missing information in our record of your
PHI, you may request, in writing, that we correct or add to the record. We will respond within 60 days of receiving
your request. We may deny the request
if we determine that the PHI is: (1) correct and complete; (ii) not created by
us and/or not part of our records, or; (iii) not permitted to be
disclosed. Any denial will state the
reasons for denial and explain your rights to have the request and denial,
along with any statement in response that you provide, appended to your
PHI. If we approve the request for
amendment, we will change the PHI and so inform you, and tell others that need
to know about the change in the PHI.
Rule 526
To Find Out What Disclosures Have Been Made: You have a
right to get a list of when, to whom, for what purpose, and what content of
your PHI has been released other than instances of disclosure for which you
gave consent (i.e. for treatment, payment, operations, to you, your family, or the facility directory). The list also will not include any
disclosures made for national security purposes, to law enforcement official or
correctional facilities, or before April 2003.
We will respond to your written request for such a list within 60 days
of receiving it. Your request can
relate to disclosures going as far back as six years. There will be no charge for up to one such list each year. There may be a charge for more frequent
requests. Rule 528
To Receive This Notice: You have a
right to receive a paper copy of this Notice.
·
For More Information Or To Report A Problem
If you have questions and
would like additional information, you may contact the practice’s Privacy
Officer, 259 Parkers Mill Road, Somerset, Kentucky 42501
If you believe your privacy
rights have been violated, you can file a complaint with the practice'’ Privacy
Officer, or with the Office for Civil Rights, U.S. Department of Health and
Human Services. There will be no
retaliation for filing a complaint with either the Privacy Officer or the
Office for Civil Rights. The address
for the OCR is listed below:
Office for Civil Rights
U.S. Department of Health
and Human Services
200 Independence Avenue,
S.W.
Room 509F, HHH Building
Washington, D.C. 20201
·
EFFECTIVE DATE
This Notice was effective on: 04/14/03