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NOTICE OF PRIVACY 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. Si usted necesita esta informatcion en espanol, por favor llame 1-800-243-7483. Our Agency and Your Privacy We, the Riverhaven Coordinating Agency, have been chosen by the State of Michigan to assist residents in Arenac, Bay, Huron, Montcalm, Shiawassee, and Tuscola Counties to obtain various chemical dependency treatment health care services. Our agency knows that your health information is protected. We are required to protect your privacy and provide you with this Notice as a Substance Abuse Coordinating Agency and provider of treatment. In the following paragraphs, we explain in more detail how we are obligated to protect your protected health information. Please read it carefully. Privacy Notice Introduction This Notice tells you about the ways health information is used. It describes your rights and our obligations regarding the use and disclosure (give out) of health information. Over time, we may change this Notice. If we do, we are required to inform you of our new privacy policy by making a revised Notice available to you. You can also find this Notice on our website www.babha.org. Copies of the Notice can be obtained in our office. We may ask you to sign a statement (Acknowledgment) telling others we gave you this Notice. If there is an emergency, we may not be able to give this Notice until after you receive care. General Privacy Information When you contact or come to our agency, a record is usually made. These records contain “demographic information” (such as name, address, telephone number, social security number, birth date, and health insurance information). The records may also contain other information including how you say you feel, what health problems you have, treatments you may have received, observations by health care providers, diagnosis, and plan of care. These kinds of record information are known as Protected Health Information, or PHI, and are used for a number of purposes that are explained in more detail in this brochure. As a Coordinating Agency, we perform a variety of acts. Sometimes, we provide health services, for example, your assessment for treatment. At other times, we may also make payment for or authorize payment to health care providers for chemical dependency and other services. Often, these payments are made under the Medicaid program. Sometimes, we distribute grant monies to health care providers for the care of area residents, or we may coordinate with insurers to obtain payment for health care services. In any of these situations, we may need to access your PHI. We do not sell your PHI and we take steps to protect your PHI from people who do not need and have the legal right to see it. Confidentiality of alcohol and drug abuse information Your alcohol and drug abuse client records are also protected by federal law and regulations (42CFR Part 2). Generally, this means that information about you is not disclosed without your written consent. Uses for Treatment, Payment, and Operations We may use your PHI for treatment, payment purposes, or for agency operations. If we disclose (give out) your PHI to another person or entity, we must do so consistent with Federal and State law and regulation (e.g., 42 CFR Part 2). In many circumstances, this requires you to sign an Authorization allowing us to provide that information to the other party. If you do not sign an Authorization, we may not be able to provide care or make payment for your health services. When you sign an Authorization for the use and disclosure of your PHI for treatment, payment purposes, or for agency operations, this means: Treatment. We will use and disclose your PHI to provide, coordinate, or manage your care and related services. This includes the coordination or management of your health care with another person like a doctor or therapist for treatment purposes. Payment. We may use and disclose PHI about you so that the chemical dependency or other services you received can be billed for, and paid. For example, we may need to disclose your PHI to health care professionals or to your health plan about treatment you received so that the people who provide care to you can receive payment. It may also include statistical reports to Federal and State agencies making funds available to us for your benefit. Operations. We may use or disclose your PHI for our operations in order to maintain or improve services. This can include quality assessment, accreditation, licensing or business management, and general administrative activities. Other uses and disclosures included within treatment, payment and operations include: Appointments. To remind you of an appointment. Treatment Options. To inform you of potential treatment options. Benefits and Services. To inform you of health benefits or services that may be of interest to you. Education. Training of health professional students such as counselors and therapists who are working in our agency. Research. For research purposes if the study is approved by our privacy committee, the program director and also meets the requirements of Federal and State law and regulation (e.g., 42 CFR Part 2).
Uses and Disclosure Without Your Authorization When required by law, we may also disclose some protected health information. For example, we may provide limited information: Health Risk or Death. To prevent, control orreport disease, injury, disability or death.
Abuse, Neglect or Domestic Violence Reporting. To alert State or local authorities if we believe someone is a victim of child abuse or neglect or domestic violence. Duty to Warn: To alert authorities or medical personnel if we believe someone is at risk of injury by means of violence. Health oversight. To health oversight agencies for things like audits, civil or administrative reviews, proceedings, inspections and licensing activities. Judicial and legal proceedings. In response to an order of a court. Law enforcement. To a law enforcement official in response to a court order or to report a crime on the agency premises. Privacy Rights Right to request restrictions. You may request limitations on the use of your PHI. For example, you can ask that your information not be shared with certain family members. We are not always able to comply with these requests. If we are unable to do or do not agree to your request we will let you know. If we do agree to a restriction and the restricted information is needed for your emergency care, we may still use or disclose the information as we think appropriate. To request a restriction on your information, please contact the Privacy Officer at the number on the back of this brochure. Right to request alternate methods of communication. You may request an alternate method of receiving confidential mailings and other communications of your PHI. For instance, you may request that your PHI be sent to your office or to a post office box rather than to your home address. You may also request that calls be made to a certain telephone number. We do not require that you state a reason for your request. We will try to accommodate reasonable requests. Right to review and copy. You may request a copy of your PHI. You may also request to review your PHI. If your request is accepted, we will arrange a mutually agreeable time for you to look at your PHI. We may deny your request to review and copy in a few limited circumstances. If your rquest is denied, you may ask for a review of that denial by contacting our Privacy Officer for the location where you received health services. This review will be done by a licensed healthcare professional and we will comply with the decision of the reviewer. The contact numbers for our Privacy Officer can be found on the back of this brochure. Copies of PHI may be provided to patients for a reasonable fee. We will let you know what the fee will be before a copy of your PHI is made. Right to request an amendment. You may request an amendment to your PHI if you think it is incorrect or incomplete. We may ask that the request be in writing and state the reasons for the amendment. We will notify you to let you know if we agree or disagree with your request. If we do not agree, we will provide you with information on why we disagree and what options you have. To request an amendment, please contact the local Privacy Officer at the location where you received care. Right to an accounting of disclosures. You have the right to request a periodic accounting of the disclosures of your PHI so that you will be aware of who has had access to your information. Your request may specify a time period up to six (6) years. We are not required to provide an accounting for disclosures prior to April 14, 2003. Not every disclosure made is included in the accounting. Disclosures you authorized in writing, routine internal disclosures such as those made to agency personnel in the course of providing you services and /or disclosures made in connection with payment are all examples of things not included in the accounting. The accounting will state the time of the disclosure, the purpose for which it was disclosed, and a description of the information disclosed. If there is any fee for the accounting, we will let you know what it is before the accounting is done. Right to receive a copy. Copies of this Privacy Notice will be available upon request at agency facilities and is also available on the agency website at: www.babha.org. Uses requiring patient authorization. There are some uses of PHI that require patient authorization. If your PHI is requested for a use that requires your approval or Authorization, you will be told why your information is requested, who is asking for the information and what information is requested. You will also be told how you may cancel (revoke) you authorization. If we have already acted on an Authorization you gave us earlier, your cancellation will affect information released for the future.
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Riverhaven Coordinating Agency 5449 Hampton Place Saginaw, MI. 48604 |