| |
| NOTICE OF
PRIVACY PRACTICES |
CUMBERLAND COUNTY AREA
MH/DD/SA AUTHORITY
This Notice is effective on April 14, 2003
Cumberland County Mental Health Center is
required by the privacy regulations issued under the Health Insurance
Portability and Accountability Act (HIPAA) of 1996 to maintain the privacy of
your health information and to provide you with notice of our privacy
practices in regard to medical information. The medical information may be
health information that is created or received by us that may relate to your
past, present, or future medical condition; provision of health care to you;
or information that relates to the past, present, or future payment for the
provision of health care to you. That includes any treatment and payment
records and any information that identifies you as a client.
We are required to protect your health
information by both state and federal laws. In the event another applicable
law, other than HIPAA, prohibits or limits our uses and disclosures of your
health information, as set forth below, we will restrict our uses or
disclosure of your health information in accordance with the more stringent
standard. In other words, we are only allowed to use and disclose medical
information in the manner that we have described in this Notice.
We are required to abide by the terms of
this Notice so long as it remains in effect. We reserve the right to change
the terms of this Notice of Privacy Practices as necessary and to make the new
Notice effective for all Protected Health Information maintained by us. If we
make material changes to our privacy practices, we are required to advise all
consumers then active in treatment of our new Privacy Practice by:
Copies of our current Notice may be obtained
by contacting our Privacy Officer at 910-323-0601, at the address listed
below, or on our Web site at www.ccmentalhealth.org.
In this Notice we will describe how we may
use and disclose the health information about you, explain your privacy rights
in regard to your health information, and describe how and where you may file
a privacy-related complaint. At any time you need information about the uses
or disclosures, our privacy practice, or other related information, contact
our Privacy Officer at 910-323-0601.
The following categories describe different
ways that we may use and disclose your health information in order to provide
health care, obtain payment for that health care, and for operations of our
agency. Not every use or disclosure in a category will be listed. We will
use and disclose only the minimum
information necessary to meet the requirements.
-
For Treatment. We
may use or disclose your health information to provide treatment, coordinate
or manage
the services provided to you. This may include communicating
with other health care providers who are involved
in your health care and
coordinating and managing your health care with others.
Example: Information obtained
about you by your therapist, psychiatrist, case manager, nurse or other member of your healthcare team will be
recorded in your record and used to determine the course of treatment that should work best
for you. Members of your healthcare team will also record goals that you established and the
interventions used to help you reach your goals. Your psychiatrist will also record information about
medications they have prescribed for you as well as your response to these medications.
-
For Payment. You will be
asked to sign a consent form allowing Area Authority to seek payment for the
health care services that we provide to you. This may include preparing
bills, checking for eligibility,
coverage, pre-approval of services, and
management of your account. Even though federal law allows us to use
or
disclose information to get payment for the health care services you receive,
North Carolina law requires that
you consent to such an action.
Example: A bill for services
provided to you will be sent to you and/or a third-party payer. Information on or accompanying the bill may
include information that identifies you as well as your diagnosis, your treating clinician and the
type of services you have received.
-
For Health Care Operations.
We may use or disclose
information during routine operations or for
organizational improvement.
Examples of routine operations include the use of sign-in sheets, calling your
name in the waiting room, review quality of services you receive, conduct
utilization management, record
audits, peer review, appointment reminders,
resolving complaints, use of volunteers and students. We are also
required to
disclose health information to the North Carolina Division of Mental Health,
Developmental
Disabilities, and Substance Abuse Services for purpose of
tracking, monitoring, planning, and eligibility
determination.
Example: Members of the
treatment team and Quality Improvement staff may use the health information in
your health record to access the care and outcomes of your case. This
information will then be used to improve the quality and effectiveness of the
services we provide to you and others.
-
For Other Persons Involved in Your Care.
We may disclose health 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 except as mandated by state and federal
regulations. We will try to obtain your
authorization, but in
the event that is difficult or impossible, we may discuss
protected health information if it
is our professional judgment
that it is in your best interest. In a situation where you are
unable to give
authorization, we may use or discuss protected
health information to notify or assist in notifying a family
member, personal representative or any other person that is
responsible for your care. We may reveal your
location; general
condition; including death or serious injury; or any information
that may assist in disaster
relief
efforts.
If the patient is a minor, we may disclose
health 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 910-323-0601.
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 emergencies) or if the patient is a minor. If the
patient is a minor, we may or may not be able to agree to your request.
Example: Jane’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, Jane
invites her husband to come into the private room. The nurse discusses the
new medication with Jane and Jane’s husband.
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.
-
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 health information
without your permission. We will only disclose medical information about you
in the following circumstances when we are permitted to do so by law. Below
are brief descriptions of the “national priority” activities recognized 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 health information as
required by law to report certain communicable diseases to
health agencies. For example, we are required to report any cases of HIV,
certain sexually transmitted diseases, or tuberculosis to the Health Department.
-
Health oversight activities.
We may use or disclose your health information to a health agency that is
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.
-
Abuse reports and investigations.
We will use and disclose information required by law to report any suspicion
of abuse, neglect, or exploitation to the Department of Social Services (DSS).
We are required by North Carolina law to cooperate with DSS investigations
into possible abuse, neglect, or exploitation allegations. We are also
required to report to Health Care Personnel Register.
-
Court proceedings and for Law Enforcement.
We will use and disclose information when required or permitted by federal or
state law or by a court order. Health information regarding substance abuse
information can only be disclosed with your authorization or by a court
order. For example, we would disclose health information about you to a court
if a judge orders us to do so.
-
Coroners and others. We may
disclose health 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 health information about you in order to comply with worker’s
compensation laws.
-
Research organizations.
We may use or disclose health information about you to research organizations
if the organization has satisfied certain conditions about protecting the
privacy of health information and approved by an institutional review board.
-
Government programs. We may
use and disclose information for public benefits under other government
programs, including but not limited to military and veterans’ activities,
national security and intelligence activities. We may also use or disclose
health information about you to a correctional institution in some
circumstances.
-
Your Authorization. Except as
outlined above, we will not use or disclose your health information unless you
or your representative has signed a form authorizing the use or disclosure.
You have the right to revoke that
authorization in writing (except in very
limited circumstances related to obtaining insurance coverage). The
Area
Authority is not responsible for any uses or disclosures already made before
you cancel an authorization.
North Carolina law places limits on the amount
of time that an authorization to disclose may cover (up to one
year). An
Authorization Revocation Form is available from our Privacy Officer.
You have several rights with respect to the
health information about you. This section of the Notice will briefly mention
each of these rights.
-
Access to your Protected Health Information (PHI).
You have the right to inspect (see or
review) and obtain a copy of your health care information that we maintain in
your file. Some records may not be available, such as psychotherapy notes.
Requests for access to your health information must be in writing specifically
identifying the information you wish to review. Access request forms are
available through our Privacy Officer. We must act on your request no later
than 30 days after receipt of the request. We may deny your request for access in
certain circumstances and will provide written explanation for the denial. If
it is determined by a clinical professional that the information you requested
would jeopardize your health, safety, security, custody, or rehabilitation or
would be detrimental or harmful to someone else, we will deny access, in whole
or in part, to that information. We may choose to provide you a summary of
the information. We will also inform you in writing of your right to have our
decision reviewed by a licensed health care professional designated as a
reviewing official. We cannot provide you with copies of any information that
was sent to us by another source. You may be charged a fee for the cost of
copying your information.
-
Amendments to your Protected Health Information (PHI).
You have the right to request that
health
information maintained by us about you be amended or corrected. Your
amendment request must be
made in writing, must be signed by you or your
representative, and must state the reasons for the
amendment/correction
request. Amendment request forms are available through our Privacy Officer.
If we
accept the amendment, you will be informed of the acceptance and
notification will be made to those
individuals/agencies identified by you
needing the amendment. We may deny the request for amendment
in
certain
circumstances. We cannot honor requests to change records provided to us by
other sources,
nor
can we change those that are believed to be accurate and
complete. A written statement will be
provided to you giving the basis for
the denial and your rights to disagree.
-
Accounting for Disclosures of our Protected Health Information
(PHI). You have the right to receive an
accounting of certain disclosures made by us of your health information after
April 14, 2003. Your request
must be made in writing, signed by you or your
representative. Accounting of disclosure forms is available
through our
Privacy Officer. The accounting will include to whom the information was
disclosed, the date it
was disclosed, and what specific information was
disclosed. This list will not include the disclosures made
for treatment,
payment or other health care operations. The first accounting within a
12-month period is
free; however, we may charge you a fee for each subsequent
accounting you request within the same
12-month time period.
Restrictions
on Uses or Disclosures of Protected Health Information (PHI). You have the
right to request
restrictions on certain uses or disclosures of your health
information.
-
The request must be
made in writing,
signed by you or your representative, stating what information
you want to restrict and to whom you want the restrictions to
apply. We are not required to agree to the restriction if we do
not think it is in your best interest. We cannot honor requests
that limit our ability to engage in treatment, payment or other
health care operations. You also have the right to terminate,
in writing or orally, any agreed-to restriction. However, any
oral request will need to be verified at next office visit.
Requests for a restriction (or termination of an existing
restriction) may be made by contacting our Privacy Officer.
-
Request for Confidential Communications.
You have the right to request that
communications about
your health information be made by alternative means or
at alternative locations. If such a request is made
we may ask for more
information about billing or alternative contacts. For example, you may
request that
messages not be left on voice mail or sent to a particular
address. We are required to follow reasonable
requests if you inform us that
disclosure of all or part of your information could place you in danger.
Requests for confidential communications must be specific and in writing,
signed by you or your
representative.
-
Complaints.
If you believe
your privacy rights have been violated, you can file a complaint with our
Consumer Relations Officer at the address below. You may also file a
complaint in writing with the
Secretary of the U.S. Department of Health and
Human Services, Office of Civil Rights within 180 days of a
violation of your
rights. There will be no retaliation for filing a complaint.
-
Right to a Copy of the Notice.
You have the right to request a paper copy
of this Notice by asking the
receptionist for a copy or contacting our Privacy
Officer at the telephone number and address below.
FOR
FURTHER
INFORMATION:
If you have questions about this Notice, you
may ask to speak with the Privacy Officer of Cumberland County Mental Health
Center. To exercise your Privacy Rights as listed above, you may contact our
Privacy Officer for the form(s) you need at the address below.
ATTENTION: Privacy Officer
Cumberland County Area
MH/DD/SA Authority
P.O. Box 3069
Fayetteville, North Carolina 28302
Phone: 910-323-0601
HOW TO FILE A
COMPLAINT:
You may complain to Cumberland County Mental
Health Center or to the Secretary of the U.S. Department of Health and Human
Services, Office of Civil Rights if you believe we have violated your privacy
rights. Cumberland County Mental Health Center cannot retaliate against you
for filing a complaint, cooperating in an investigation, or refusing to agree
to something you believe to be unlawful.
To file a complaint with
Cumberland County Mental Health Center (all complaints will be
investigated), please mail to the following address:
ATTENTION: Consumer Relations Officer
Cumberland County Area
MH/DD/SA
Authority
P. O. Box 3069
Fayetteville, North Carolina
28302
To file a complaint with the Secretary of
the U.S. Department of Health and Human Services, Office of Civil Rights, you
may contact:
U.S. Department of Health and Human Services
Office of Civil Rights
Medical Privacy Complaint
Division
200 Independence Avenue, SW
Washington, DC 20201
Phone: 866-627-7748
Notice of Privacy Practices
Effective Date 4/14/2003
|
|