THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
If you have any questions about this Notice please contact:
Privacy Officer (315-462-9170)
PLEASE REVIEW IT CAREFULLY
Effective April 14, 2003, FLACRA must inform you how we use, share and protect your health information.
YOUR HEALTH INFORMATION IS PRIVATE FLACRA is required to keep your information private, share your information only when we need to, and follow the privacy practices in this notice. FLACRA is required to provide you with notice of its legal duties and privacy practices with respect to your health information.
This Notice of Privacy Practices describes how we may use and disclose your personal health information to carry out treatment, payment or health care activities and for other purposes that are permitted or required by law.
YOU HAVE THE RIGHT TO ACCESS AND CONTROL YOUR PERSONAL HEALTH INFORMATION
FLACRA must obtain your written consent before we can disclose information about you.
You may revoke any such written consent in writing at any time.
YOU HAVE THE RIGHT TO INSPECT AND COPY YOUR PROTECTED INFORMATION
You may inspect and obtain a copy of protected information about you that is contained in a designated record set for as long as we maintain the protected information. A “designated record set” contains medical and billing record and any other records that your worker and the agency use for making decisions about you.
Under federal law, however, you may not inspect or copy the following records;
• Psychotherapy notes
• Information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and personal health information that is subject to law that prohibits access to personal health information.
Depending on the circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.
YOU HAVE THE RIGHT TO REQUEST A RESTRICTION OF YOUR PROTECTED INFORMATION
You may ask us not to use or disclose any part of your protected information for the purposes of treatment, payment or healthcare operations. Your request must state the specific restriction requested and to whom you want the restriction to apply.
We do not have to agree to a requested restriction, but will consider your request. If we agree to the requested restriction, we may not use or disclose your protected information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your worker. You may request a restriction by submitting a request in writing to your treatment provider.
You have the right to request to receive confidential communication from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to your treatment provider.
You may have the right to amend your protected information. This means you may request an amendment of protected information about you in a chart as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
HOW FLACRA MAY USE OR DISCLOSE YOUR PERSONAL HEALTH INFORMATION
FLACRA will collect and use personal health information only for the purposes of providing services and for supporting the delivery, payment, integrity, and quality of those services. FLACRA and its officers, employees, and agents will not use or supply individual health information for non-health care uses, such as direct marketing, employment, or credit evaluation purposes.
Treatment: We will use and disclose your protected information to provide, coordinate, or manage your treatment and any related services. This includes the coordination or management of your treatment with anyone else you give permission to have access to your records.
Payment: Your protected information will be used, as needed, to obtain payment from your insurance coverage. This may include certain activities that your health insurance plan may undertake before it approves or pays for the services we recommend for you such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you and undertaking utilization review activities. Treatment information may be disclosed to the health plan in order to obtain approval for payment of services.
Operations: We may use or disclose your protected information in order to support the business activities of FLACRA. These activities include, but are not limited to, quality assessment activities, training of staff, licensing, accrediting and conducting or arranging for other business activities.
We will share your protected information with third party “business associates” that perform various activities (e.g. auditing or legal services) for FLACRA. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected information, we will have a written contract that contains terms that will protect the privacy of your protected information.
PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT
Federal law permits FLACRA to disclose information without your written permission under the following conditions:
1. To report a crime committed on FLACRA’s premises, or against FLACRA personnel
2. To medical personnel in a medical emergency
3. To appropriate authorities to report suspected child abuse or neglect
4. As allowed by a court order.
5. Pursuant to an agreement with a business associate
6. For research, audit, or evaluations
ADDITIONAL CONFIDENTIALITY REQUIREMENTS
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.
FLACRA will follow the provisions of 42 CFR Part 2 governing disclosure of personal health information. Except for the circumstances described above, we will not disclose personal health information to a third party without written permission of the individual or a court order.
Certain medial information is particularly sensitive, such as HIV/AIDS information, mental health and developmental disability information, alcohol and drug abuse information, and other information about sexually transmitted or communicable diseases and that disclosure of such information could severely harm clients, such as by causing loss of employment opportunities and insurance coverage, as well as the pain of social stigma. FLACRA and its officers, employees, and agents will treat such information with additional confidentiality protections as required by law, professional ethics, and accreditation requirements.
CHANGES TO THIS NOTICE
FLACRA reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. In the event of a change of the terms of this notice, FLACRA will advise clients of this change in writing no less than two weeks prior to the change.
If you believe that your privacy rights have been violated, you may file a complaint with FLACRA’s Privacy Officer at (315) 462-9148 or the Secretary of Health and Human Services.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services Office of Civil Rights Hubert H. Humphrey Bldg. 200 Independence Avenue, S.W. Room 509F HHH Building Washington, DC 20201
You may also address your complaint to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/office/about/rgn-hqaddresses.html
You will not be denied care or discriminated against for filing a complaint.