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.
If you have any questions about this notice, please contact: Teresa Cendejas,
Program Director/Privacy Officer at 773/883-3913.
WHO WILL FOLLOW THIS NOTICE:
This notice describes our facilitys practices and that of:
· Any health care professional authorized to enter information
into your medical chart.
· All departments and units of the facility.
· Any member of a volunteer group we allow to help you while you
are here.
· All employees, staff and other facility personnel.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal.
We are committed to protecting medical information about you. We create
a record of the care and services you receive at this facility. We need
this record to provide you with quality care and to comply with certain
legal requirements. This notice applies to all of the records of your
care generated, whether made by personnel or our medical doctors.
Our uses and disclosures of information about you are protected by federal
law and regulations on Confidentiality of Alcohol and Drug Abuse Patient
Records, by federal law and standards protecting individually identifiable
health information under the Health Insurance Portability and Accountability
Act (HIPAA), and by state law and regulations.
This notice will tell you about the ways in which we may use and disclose
medical information about you. This notice will also describe your rights
and certain obligations that we have regarding the use and disclosure
of your medical information.
We are required by law to:
· Make sure that medical information that identifies you is kept
private;
· Give you this notice, which contains our legal duties and privacy
practices with respect to medical information about you; and
· Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
The following categories describe different ways that we use and disclose
medical information. For each category of uses or disclosures we will
explain what we mean and try to give some examples. Not every use or disclosure
in a category will be listed. However, all of the ways we are permitted
to use and disclose information will fall within one of the categories.
I. USES AND DISLOSURES WITHOUT YOUR AUTHORIZATION OR CONSENT
· For Treatment. We may use medical information about you to provide
you with medical treatment or services. We may disclose medical information
about you to doctors, nurses, technicians, medical students, or other
personnel who are involved in taking care of you at this facility. Different
departments of the facility also may share medical information about you
in order to coordinate the different things you need, such as prescriptions,
lab work and x-rays.
· For Health Care Operations. Health Care Operations include internal
administration and planning and various activities that improve the quality
and effectiveness of care. For example, we may use information about your
care to evaluate the quality and competence of our clinical staff. We
may disclose information to qualified personnel for outcome evaluation,
management audits, financial audits, or program evaluation; however, such
personnel may not identify, directly or indirectly, any individual patient
in any report of such audit or evaluation, or otherwise disclose patient
identities in any manner. We may disclose your information as needed within
the facility in order to resolve any complaints or issues arising regarding
your care. We may also disclose your protected health information to an
agent or agency which provides services to us under a qualified service
organization agreement and/or business associate agreement, in which they
agree to abide by 42 CFR Part 2 and HIPAA. Health Care Operations may
also include use of your protected health information for programs offered
by us, such as sending you invitations to alumni events and workshops
sponsored by us. This list of examples is for illustration only and is
not an exclusive list of all of the potential uses and disclosures which
may be made for health care operations.
· Appointment Reminders. We may use and disclose medical information
to contact you as a reminder that you have an appointment for ongoing
treatment.
· Research. Under certain circumstances, we may use and disclose
medical information about you for research purposes. For example, a research
project may involve comparing the health and recovery of all patients
who received one medication to those who received another, for the same
condition. All research projects, however, are subject to a special approval
process. This process evaluates a proposed research project and its use
of medical information, trying to balance the research needs with patients
need for privacy of their medical information, trying to balance the research
approval process, but we may, however, disclose medical information about
you to people preparing to conduct a research project, for example, to
help them look for patients with specific medical needs, so long as the
medical information they review does not leave the facility. We will most
always ask for your specific permission if the researcher will have access
to your name, address or other information that reveals who you are, or
will be involved in your care at the facility.
· As Required By Law. We will disclose medical information about
you when required to do so by federal, state or local law.
· To Avert a Serious Threat to Health or Safety. We may use and
disclose medical information about you when necessary to prevent a serious
threat to your health and safety or the health and safety of the public
or another person. Any disclosure, however, would only be to someone able
to help prevent the threat.
· Medical Emergencies. We may disclose your protected health information
to medical personnel to the extent necessary to meet a bona fide medical
emergency (as defined by 42 CFR Part 2).
· Minors. We may disclose facts relevant to reducing a threat
to the life or physical well being of the applicant or any other individual
to a parent, guardian, or other person authorized under state law to act
in the minors behalf if the program director judges that the minor applicant
lacks capacity to make a rational decision and the applicants situation
poses a substantial threat to the life or physical well being of the applicant
or any other individual which may be reduced by communicating relevant
facts to such person.
· Incompetent and Deceased Patients. In such cases authorization
of a personal representative, guardian or other substituted decision?maker
may be given in accordance with 42 CFR Part 2.
· Decedents. We may disclose protected health information to a
coroner or medical examiner as authorized by law.
· Duty to Warn. Where the program learns that a patient has made
a specific threat of serious physical harm to another specific person
or the public, and disclosure is otherwise required under statute and/or
common law, the program will carefully consider appropriate options which
would permit disclosure, subject to 45 CFR 164.512(i).
· Judicial and Administrative Proceedings. We may disclose your
protected health information in response to a court order that meets the
requirements of federal regulations, 42 CFR Part 2 concerning Confidentiality
of Alcohol and Drug Abuse Patient Records. Note also that if your records
are not actually patient records within the meaning of 42 CFR Part 2 (e.g.
if your records are created as a result of your participation in the family
program or another non?treatment setting), your records may not be subject
to the protections of 42 CFR Part 2.
· Law Enforcement Officials. We may disclose your protected health
information to the police or other law enforcement officials for the purpose
of seeking assistance of law enforcement agencies if you commit a crime
on the premises or against program personnel or threaten to commit such
a crime.
· Public Health Activities. We may disclose your protected health
information for the following public health activities and purposes: (1)
to report child abuse and neglect to public health authorities or other
government authorities authorized by law to receive such reports; and
(2) to report deaths as required by law.
· Health Oversight Activities. We may disclose protected health
information to a health oversight agency, e.g., state licensure or certification
agencies, the Joint Commission on Accreditation of Healthcare Organizations,
which oversees the health care system and ensures compliance with regulations
and standards.
· Fundraising Communications. We may contact you to request a
tax?deductible contribution to support our many important activities.
In connection with any fundraising, we may use certain demographic information
about you and dates of health care provided to you. If you do not want
to receive fundraising requests, contact us at 1?800?707-4673 and we will
make good faith efforts to honor your request.
· Marketing Communications. We may contact you with information
about our health?related services and products that may be beneficial
to you. Such communications are a part of Health Care Operations, and
examples of these communications are invitations to continuing care programs,
alumni events and catalogs of recovery and self?help materials such as
books, videotapes and other items.
II. USES AND DISCLOSURES WITH YOUR AUTHORIZATION OR CONSENT
Other than as described above, we may use or disclose your protected
health information only when you give your authorization to do so in writing
on a form that specifically meets the requirements of laws and regulations
cited previously herein. You may revoke your authorization by delivering
a written statement to your primary counselor or therapist during the
time you are receiving care or, after you are discharged, by sending the
written statement to our Privacy Officer, except to the extent that the
program has acted in reliance upon the authorization. Please be aware
of the fact that a court or other third party could request or compel
you to sign an authorization.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
You have the following rights regarding medical information we maintain
about you:
· Right to Inspect and Copy. You have the right to inspect and
copy medical information that may be used to make decisions about your
care. Usually, this includes medical and billing records, but does not
include psychotherapy notes.
To inspect and copy medical information that may by used to make decisions
about you, you must submit your request in writing. If you request a copy
of the information, we may charge a fee for the costs of copying, mailing
or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information, you may
request that the denial be reviewed. Another licensed health care professional
chosen by us will review your request and the denial. The person conducting
the review will not be the person who denied your request. We will comply
with the outcome of the review.
· Right to Amend. If you feel that medical 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 by or for the facility.
To request an amendment, your request must be made in writing. In addition,
you must provide a reason that supports your request. We may deny your
request for an amendment if it is not in writing or does not include a
reason to support the request. In addition, we may deny your request if
you ask us to amend information that:
o Was not created by us, unless the person or entity that created the
information is no longer available to make the amendment;
o Is not part of the medical information kept by or for the facility;
o Is not part of the information which you would be permitted to inspect
and copy; or
o Is accurate and complete.
· Right to an Accounting of Disclosures. Upon written request,
you may obtain an accounting of disclosures of your protected health information
other than those for which you gave written authorization or those related
to your treatment or our health care operations. The accounting will apply
only to covered disclosures prior to the date of your request provided
such period does not exceed six years and does not apply to disclosures
that occurred prior to April 14, 2003. If you request an accounting more
than once during a twelve (12) month period, there will be a charge. You
will be told the cost prior to the request being filled.
· Right to Request Restrictions. You have the right to request
a restriction or limitation on our use and disclosure of your protected
health information for treatment or health care operations. You also have
the right to request a limit on the protected health information that
we disclose about you to someone who is involved in your care or the payment
for your care. We are not required to agree to your request. If we do
agree, we will comply with your request unless the information is needed
to provide you with emergency treatment.
To request restrictions, you must make your request in writing. In your
request, you must tell us (1) what information you want to limit; (2)
whether you want to limit our use, disclosure or both; and (3) to whom
you want the limits to apply, for example, disclosures to your spouse.
· Right to Receive Confidential Communications. You may request,
and we will accommodate, any reasonable (written) request for you to receive
protected health information by alternative means of communication or
at alternative locations.
· Right to a Paper Copy of This Notice. You have the right to
a paper copy of this notice. You may ask us to give you a copy of this
notice at any time. Even if you have agreed to receive this notice electronically,
you are still entitled to a paper copy of this notice.
CHANGES TO THIS NOTICE:
We are required to follow the terms of this Notice until the Notice is
revised. We may change the terms of this notice at any time. If we change
this notice, we may make the new notice terms effective to all protected
health information that we maintain, including any information created
or received prior to issuing the new notice. If we change this notice,
we will post the new notice on the premises of our facility and on our
website at www.new-hope-recovery.com within 30 days after the effective
date of the change. The new notice will state Revised and
will include the date the change became effective. You may also obtain
any new notice by contacting the Privacy Officer.
COMPLAINTS:
If you believe that your privacy rights have been violated, you may file
a complaint with the facility or the Secretary of the Department of Health
and Human Services. To file a complaint with the facility, contact Teresa
Cendejas, Program Director/Privacy Officer at 773/883-3913. All complaints
must be submitted in writing. We will not retaliate against you if you
file a complaint.
PRIVACY OFFICER:
To request additional copies of this Notice or to receive more information
about our privacy practices, your rights, or to file a complaint, please
contact our Privacy Officer at the address below:
Teresa Cendejas
Program Director/Privacy Officer
New Hope Recovery Center
550 W. Webster
Chicago, IL 60614
773-883-3913
Violation of federal law and regulations on Confidentiality of Alcohol
and Drug Abuse Patient Records is a crime and suspected violations of
42 CFR Part 2 may be reported to the United States Attorney in the district
where the violation occurs.
THIS NOTICE WAS REVISED AND IS EFFECTIVE ON OCTOBER 20, 2003