The effective date of this Notice is April 14, 2003.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
If you have any questions about this Notice of Privacy Practices, please contact our Privacy Officer:
1050 8th Avenue
Beaver Falls, PA 15010
Protected Health Information (“PHI”) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with all applicable laws and your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will make available a revised Notice of Privacy Practices by sending a copy to you in the mail upon request or providing one to you at your next appointment.
The confidentiality of alcohol and drug abuse patient records is protected by additional Federal laws and regulations. (42 U.S.C. 290dd-3 and 290ee-3, 42 C.F.R. Part 2). Beaver County Behavioral Health Drug and Alcohol Program is required to comply with these restrictions for its substance abuse programs. This includes a prohibition, with few exceptions, on informing anyone outside the program that you attend the program or disclosing any information that identifies you as an alcohol or drug abuser. The violation of Federal laws or regulations by this program is a crime. If you suspect a violation, you may file a report to the appropriate authorities in accordance with Federal regulations.
How We May Use and Disclose Health Information About You
Listed below are examples of how Beaver County Behavioral Health Drug and Alcohol Program may use or disclose your PHI in its substance abuse programs. These examples are not meant to be exhaustive, but describe the types of uses and disclosures that may be made.
Your PHI may be used by and disclosed to our physicians, case managers, program and administrative staff that are involved in your care, without your authorization, for the purpose of providing, coordinating, or managing your treatment and any related services. In addition, we may disclose your PHI from time-to-time to another treatment provider, physician or health care provider either with your authorization or if we have a written contract with certain qualified organizations.
We will not use your PHI to obtain payment for your health care services without your written authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity or undertaking utilization review activities.
We may use or disclose your PHI, as needed, to operate our program in an efficient and orderly manner, including, but not limited to, quality assessment activities, employee review activities, training of students, licensing and conducting or arranging for other business activities. For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician or counselor.
We may also call you by name in the waiting room when it is time to be seen. We may contact you to remind you of your appointments. We may share your PHI with third parties that perform various business activities (e.g., a record custodian or billing service) for Beaver County Behavioral Health Drug and Alcohol Program, provided we have a written contract with the business that prohibits it from re-disclosing your PHI and requires it to safeguard the privacy of your PHI. We may contact you to provide information to you about treatment alternatives or other health-related benefits and services that may be of interest to you. We will format any mailings to you in a way that does not identify you as a substance abuse treatment client.
Required by Law
We may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures. Under the law, we must make disclosures of your PHI to you upon your request except in certain limited circumstances. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the privacy requirements.
We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payers) and peer review organizations performing utilization and quality control. If we disclose PHI to a health oversight agency, we will have an agreement in place that requires the agency to safeguard the privacy of your information.
We may use or disclose your PHI in a medical emergency situation to medical personnel only. Our staff will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.
Child Abuse or Neglect
We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect. However, the information we disclose is limited to only that information which is necessary to make the initial mandated report.
We may disclose PHI of deceased clients for the purpose of determining the cause of death, in connection with laws requiring the collection of death or other vital statistics, or permitting inquiry into the cause of death.
We may disclose PHI to researchers if (a) an Institutional Review Board reviews and approves the research and a waiver to the authorization requirement; (b) the researchers agree to maintain the security of your PHI in accordance with applicable laws and regulations; and (c) the researchers agree not to redisclose your protected health information except back to Beaver County Behavioral Health Drug and Alcohol Program.
We may disclose your PHI if the court issues an appropriate order and follows required procedures.
Criminal Activity on Program Premises / Against Program Personnel
We may disclose your PHI to law enforcement officials if you have committed a crime on program premises or against program personnel.
Other uses and disclosures of your PHI will be made only with your written authorization. You may revoke this authorization at any time, unless the program or its staff has taken an action in reliance on the authorization of the use or disclosure you permitted.
Your Rights Regarding Your Protected Health Information
Your rights with respect to your protected health information are explained below. A brief description of how you may exercise these rights is included. Any requests with respect to these rights must be in writing. Please contact our Privacy Officer if you have any question about any of these rights.
Right to inspect and copy your PHI
You may inspect and obtain a copy of PHI that is contained in a designated record set for as long as we maintain the record. A “designated record set” contains medical and billing records and any other records that the program uses for making decisions about you. We may charge you a reasonable cost-based fee for the copies. We can deny you access to your PHI in certain circumstances and if we do so, we will explain the reason. In some of those cases, you will have a right to appeal the denial of access.
Right to request amendment of your PHI
You may request, in writing, that we amend PHI that has been included in a designated record set. 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. We may prepare a rebuttal to your statement and will provide you with a copy of it.
Right to receive an accounting of some types of PHI disclosures
You may request an accounting of disclosures made during a period of up to six years (excluding disclosures made to you, made for treatment purposes, made as a result of your authorization and certain other disclosures). We may charge you a reasonable fee if you request more than one accounting in any 12-month period.
Right to receive a paper copy of this notice
Right to request restrictions on disclosures and uses of your PHI
You have the right to ask us not to use or disclose any part of your PHI for treatment, payment or health care operations or to family members involved in your care. We are not required to agree to such restrictions.
Right to request confidential communications
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable, written requests. We may also condition this accommodation by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact.
If you believe we have violated your privacy rights, you may file a complaint in writing to us by notifying our Privacy Officer. We will not retaliate against you for filing a complaint. You may also file a complaint with the U.S. Secretary of Health and Human Services as follows:
Region III, Office for Civil Rights, U.S. Department of Health and Human Services, 150 S. Independence Mall West, Suite 372, Public Ledger Building, Philadelphia, PA 19106-9111.
Hotline (800) 368-1019
Voice phone (215) 861-4441
Fax (215) 861-4431
TDD (215) 861-4440