OUR PRIVACY COMMITMENT TO YOU:
AT ARC OF ROCKLAND, WE UNDERSTAND THAT INFORMATION ABOUT YOU (INCLUDING INFORMATION ABOUT THE CARE AND SERVICES YOU RECEIVE) IS PERSONAL AND CONFIDENTIAL. WE ARE COMMITTED TO PROTECTING YOUR PRIVACY AND SHARING INFORMATION ONLY WITH THOSE WHO NEED TO KNOW, ARE ALLOWED TO SEE THE INFORMATION IN ORDER TO ASSURE THAT QUALITY SERVICES ARE PROVIDED TO YOU.
THIS NOTICE DESCRIBES HOW CLINICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU, YOUR GUARDIAN (IF ANY) AND/OR YOUR PERSONAL REPRESENTATIVE(S), CAN GET ACCESS TO THIS INFORMATION. GUARDIANS AND PERSONAL REPRESENTATIVES SHOULD BE AWARE THAT THE WORD "YOU" IN THIS NOTICE REFERS TO THE INDIVIDUAL, NOT TO THE GUARDIAN.
We are required by both federal and state law protect the privacy and confidentiality of mental hygiene information that may reveal your identity, and to provide you with a copy of this notice which describes the clinical information privacy practices of our agency, its staff, and affiliated service providers that jointly provide services for you. A copy of our current notice will always be available in each of our houses and program sites. You will also be able to obtain a copy by accessing our website, calling our office at (845) 267-2500 x3144 or asking for one at the time of your next visit. We are also required to notify you following a breach of your unsecured protected health information.
If you have any questions about this notice or would like further information, please contact the Privacy Officer at (845)267-2500 x3144.
CONFIDENTIALITY OF MENTAL HYGIENE INFORMATION
Clinical information about you may be used by our agency (or its business associates) in connection with our duties to provide you with treatment, to obtain payment for that treatment, or to conduct our agency's business operations.
1. We will request your general consent to use your information for treatment, payment and health care operations purposes, as more thoroughly set forth below. Except as described in this Notice, uses and disclosures will be made with your written authorization, including any use or disclosure, with certain exceptions, of psychotherapy notes, for marketing purposes or involving the sale of your protected health information. The following are examples of the types of uses and/or disclosures of your protected health information that may occur. These examples are not meant to include all possible types of uses and/or disclosures.
2. If you do not object, we may disclose information about you in the following situations:
3. Special Situations
WHAT 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:
when combined with identifying information such as:
Incidental Disclosures. While we will take reasonable steps to safeguard the privacy of your information, certain disclosures of your information may occur during or as an unavoidable result of our otherwise permissible uses or disclosures of your information. For example, during the course of a treatment session, other individuals in the treatment area may see, or overhear discussion of, your information.
WHAT RIGHTS DO YOU HAVE
How To Access Your Clinical Information. You generally have the right to inspect and copy your clinical information. For more information, please see later in this notice. See (1) under the section below titled "Your Rights".
How To Correct Your Clinical Information. You have the right to request that we amend your clinical information if you believe it is inaccurate or incomplete. For more information, please see later in this notice. See (2) under the section below titled "Your Rights".
How To Keep Track Of The Ways Your Health Information Has Been Shared With Others. You have the right to receive a list from us, called an accounting list, which provides information about when and how we have disclosed clinical information about you to outside persons or organizations. Many routine disclosures we make will not be included on this accounting list, but the accounting list will identify non-routine disclosures of your information. For more information, please see later in this notice. See (3) under the section below titled "Your Rights".
How To Request Additional Privacy Protections. You have the right to request further restrictions on the way we use clinical information about you or share it with others. We are not required to agree to the restriction you request, except we must agree to your request to restrict the information we provide to your health plan if the disclosure is not required by law and the information relates to health care being paid in full by someone other than the health plan. Where we do agree to a restriction, we will be bound by our agreement. For more information, please see later in this notice. See (4) under the section below titled "Your Rights".
How To Request More Confidential Communications. You have the right to request that we contact you in a way that is more confidential for you, such as at home instead of at work. We will try to accommodate all reasonable requests. For more information, please see later in this notice. See (5) under the section below titled "Your Rights".
How Someone May Act On Your Behalf. You have the right to name a personal representative who may act on your behalf to control the privacy of your clinical information. Parents and guardians will generally have the right to control the privacy of clinical 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, And Genetic Information. Special privacy protections apply to HIV-related information, alcohol and substance abuse treatment information, and genetic information. Some parts of this general Notice of Privacy Practices may not apply to these types of information. If your clinical records include this type of 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 the Privacy Officer at (845) 267-2500 x 3144.
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. To do so, please call the Privacy Officer at (845) 267-2500 x 3144. You may also obtain a copy of this notice from our website, or by requesting a copy at 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 clinical information, and we will be required by law to abide by its terms. We will post any revised notice in each of our houses and program sites. You will also be able to obtain your own copy of the revised notice by accessing our website, calling our office at (845) 267-2500 x3144, or asking for one at the time of your next visit. The effective date of the notice will always be noted in the top right corner of the first 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 the Privacy Officer at (845) 267-2500 x 3144. No one will retaliate or take action against you for filing a complaint.
HOW YOU CAN EXERCISE YOUR RIGHTS TO ACCESS AND
CONTROL OF YOUR CLINICAL INFORMATION
We want you to know that you have the following rights to access and control your clinical information. These rights are important because they will help you make sure that the clinical 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, clinical, treatment and billing records. To inspect or obtain a copy of your health information, please submit your request in writing to the Privacy Officer at the address above. If you request a copy of information, we may charge a nominal fee. We will let you know the amount of the fee at the time of your request.
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 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, which will not be more than 60 days from 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 clinical 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 the Privacy Officer at the address above. 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. There are certain exceptions to the disclosures that are listed in an accounting.
To request this accounting list, please write to the Privacy Officer at the address above. Your request must state a time period within the past six years for paper records or three years for electronic records for the disclosures you want us to include.
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 has 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 clinical 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 the Privacy Officer at the address above. 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, except we must agree to your request to restrict the information we provide to your health plan if the disclosure is not required by law and the information relates to health care being paid in full by someone other than the health plan. In addition, 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.
5. Right To Request Confidential Communications
You have the right to request that we communicate with you about your medical matters in a more confidential way by requesting that we communicated with you by alternative means or at alternative locations. For example, you may ask that we contact you by fax instead of by mail, or at work instead of at home.