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NOTICE OF PRIVACY
PRACTICES
Effective Date: 03/27/06
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 our Privacy Officer; contact
information is listed at the end of this notice.
WHO WILL FOLLOW
THIS NOTICE
This notice
describes our practices and that of:
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Any health care
professional authorized to enter information into your chart.
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Any member of a
volunteer group we allow to help you at Improving Lives Community Mental
Health Center
-
All employees, staff
and other personnel of Improving Lives Community Mental Health Center
All these entities,
sites and locations follow the terms of this notice. In addition, these
entities, sites and locations may share medical information with each
other for treatment, payment or Improving Lives CMHC operations purposes
described in this notice.
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 Improving Lives CMHC. 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 by Improving Lives Community Mental Health Center.
Other Health Care Providers may have different policies or notices
regarding use and disclosure of your medical information.
This notice will
tell you about the ways in which we may use and disclose medical
information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of medical
information.
We are required by
law to:
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make sure that
medical information that identifies you is kept private;
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give you this notice
of 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 ARE
REQUIRED BY LAW TO DISCLOSE MEDICAL INFORMATION ABOUT YOU
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 will use and disclose medical
information about you when we have a “Duty to Report” under state or
federal law; because we believe that it is 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.
Public Health
Risks. We will disclose medical information about you for public
health reporting required by federal and state law. These activities
generally include the following:
-
to prevent or
control disease, injury or disability;
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to report births and
deaths;
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to report child
abuse or neglect;
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to report reactions
to medications or problems with products;
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to notify people of
recalls of products they may be using;
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to notify a person
who may have been exposed to a disease or may be at risk for contracting
or spreading a disease or condition;
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to notify the
appropriate government authority if we believe a Patient has been the
victim of abuse, neglect or domestic violence. We will only make this
disclosure if you agree or when required or authorized by law.
Health Oversight
Activities. We will disclose medical information as required by law
to a health oversight agency for activities authorized by law. These
oversight activities include, for example, audits, investigations,
inspections, and licensure. These activities are necessary for the
government to monitor the health care system, government programs, and
compliance with civil rights laws.
Lawsuits and
Disputes. If you are involved in a lawsuit or a dispute, we will
disclose medical information about you when properly ordered to do so by
a court.
Law
Enforcement. We will release medical
information if asked to do so by a law enforcement official, and if
permitted by law:
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In response to a
court order;
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If required by state
or federal law;
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To identify or
locate a suspect, fugitive, material witness, or missing person;
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About the victim of
a crime if, under certain limited circumstances, we are unable to obtain
the person's agreement;
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About a death we
believe may be the result of criminal conduct;
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About criminal
conduct at a Improving Lives CMHC facility; and
In emergency circumstances to report a crime; the location of the crime
or victims; or the identity, description or location of the person who
committed the crime.
Protective
Services for the President and Others. We will
disclose medical information about you to federal officials so they may
provide protection to the President, other authorized persons or foreign
heads of state or conduct special investigations.
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.
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, psychologists,
nurses, social workers, therapists, technicians, medical students, or
another provider’s personnel who are involved in taking care of you.
Different departments of Improving Lives CMHC also may share medical
information about you in order to coordinate the different things you
need. We also may disclose medical information about you to people
outside Improving Lives CMHC, such as other health care providers
involved in providing medical treatment for you and to people who may be
involved in your medical care, such as family members, clergy or others
we use to provide services that are part of your care.
For
Payment. We may use and disclose medical
information about you so that the treatment and services you receive at
Improving Lives CMHC, or other health care providers from whom you
receive treatment, may be billed to, and payment may be collected from,
you, an insurance company or a third party. For example, we may need to
give your health plan information about treatment you received at
Improving Lives CMHC so your health plan will pay us or reimburse you
for your treatment. We may also tell your health plan about a treatment
you are going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
For Health
Care Operations. We may use and disclose
medical information about you for Improving Lives CMHC operations or to
another health care provider or health plan, if you have a relationship
with that health care provider or health plan . These uses and
disclosures are necessary to run Improving Lives CMHC and make sure that
all of our Clients receive quality care. For example, we may use medical
information to review our treatment and services and to evaluate the
performance of our staff in caring for you. We may also combine medical
information about many Clients to decide what additional services
Improving Lives CMHC should offer, what services are not needed, and
whether certain new treatments are effective. We may also disclose
information to doctors, social workers, therapists, nurses,
psychologists, technicians, medical students, and other personnel for
review and learning purposes. We may also combine the medical
information we have with medical information from other Health Care
Providers to compare how we are doing and see where we can make
improvements in the care and services we offer. We may remove
information that identifies you from this set of medical information so
others may use it to study health care and health care delivery without
learning who the specific Clients are.
Appointment
Reminders. We may use and disclose medical
information to contact you as a reminder that you have an appointment
for treatment or medical care at Improving Lives Community Mental Health
Center
Treatment
Alternatives. We may use and disclose medical
information to tell you about or recommend possible treatment options or
alternatives that may be of interest to you.
Health-Related Benefits and Services. We may
use and disclose medical information to tell you about health-related
benefits or services that may be of interest to you.
Fundraising
Activities. We may use medical information
about you to contact you in an effort to raise money for Improving Lives
CMHC and its operations. We may disclose medical information to a
foundation related to Improving Lives CMHC so that the foundation may
contact you in raising money for Improving Lives Community Mental Health
Center. We only would release contact information, such as your name,
address and phone number and the dates you received treatment or
services at Improving Lives Community Mental Health Center. If you do
not want Improving Lives CMHC to contact you for fundraising efforts,
you must notify the Privacy Officer in writing.
Individuals
Involved in Your Care or Payment for Your Care.
We may release certain limited information about you to a friend or
family member who is involved in your medical care. We may also give
information to someone who helps pay for your care. We may also tell
your family or friends your condition. In addition, we may disclose
medical information about you to an entity assisting in a disaster
relief effort so that your family can be notified about your condition,
status and location.
SPECIAL
SITUATIONS
Organ and
Tissue Donation. If you are an organ donor, we
may release medical information to organizations that handle organ
procurement or organ, eye or tissue transplantation or to an organ
donation bank, as necessary to facilitate organ or tissue donation and
transplantation.
Military
and Veterans. If you are a member of the armed
forces, we may release medical information about you as required by
military command authorities. We may also release medical information
about foreign military personnel to the appropriate foreign military
authority.
Coroners,
Medical Examiners and Funeral Directors. We
may release medical information to a coroner or medical examiner. This
may be necessary, for example, to identify a deceased person or
determine the cause of death. We may also release medical information
about Clients of Improving Lives CMHC to funeral directors as necessary
to carry out their duties.
National
Security and Intelligence Activities. We may
release medical information about you to authorized federal officials
for intelligence, counterintelligence, and other national security
activities authorized by law.
Inmates.
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release medical information about
you to the correctional institution or law enforcement official. This
release would be necessary (1) for the institution to provide you with
health care; (2) to protect your health and safety or the health and
safety of others; or (3) for the safety and security of the correctional
institution.
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.
To inspect and copy
medical information that may be used to make decisions about you, you
must submit your request in writing to our Privacy Officer. 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, under some circumstances
you may request that the denial be reviewed. Another licensed health
care professional chosen by Improving Lives CMHC 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 Improving Lives Community Mental
Health Center
To request an
amendment, your request must be made in writing and submitted to our
Privacy Officer. 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:
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Was not created by
us, unless the person or entity that created the information is no
longer available to make the amendment;
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Is not part of the
medical information kept by or for the hospital;
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Is not part of the
information which you would be permitted to inspect and copy; or
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Is accurate and
complete.
Right to an
Accounting of Disclosures. You have the right
to request an “Accounting of Disclosures.” This is a list of the
disclosures we made of medical information about you. Your “Accounting
of Disclosures” will not include certain Disclosures that are exempt
from accounting requirements by federal or state law, including but not
limited to Disclosures made for Treatment, Payment, and Health Care
Operations and pursuant to an Authorization.
To request this list
or accounting of disclosures, you must submit your request in writing to
the Privacy Officer. Your request must state a time period, which may
not be longer than six years and may not include dates before April 14,
2003. Your request should indicate in what form you want the list (for
example, on paper, electronically). The first list you request within a
12 month period will be free. For additional lists, we may charge you
for the costs of providing the list. We will notify you of the cost
involved and you may choose to withdraw or modify your request at that
time before any costs are incurred.
Right to
Request Restrictions. You have the right to
request a restriction or limitation on the medical information we use or
disclose about you for treatment, payment or health care operations. You
also have the right to request a limit on the medical information we
disclose about you to someone who is involved in your care or the
payment for your care, like a family member or friend. For example, you
could ask that we not use or disclose information about a specific
treatment session you had.
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 emergency
treatment.
To request
restrictions, you must make your request in writing to the Privacy
Officer. 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
Request Confidential Communications. You have
the right to request that we communicate with you about medical matters
in a certain way or at a certain location. For example, you can ask that
we only contact you at work or by mail.
To request
confidential communications, you must make your request in writing to
the Privacy Officer. We will not ask you the reason for your request. We
will accommodate all reasonable requests. Your request must specify how
or where you wish to be contacted.
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.
You may obtain
a copy of this notice at our website, www.cmhcinc.org. To obtain a paper
copy of this notice, please request additional information from the site
secretary or your therapist.
CHANGES TO THIS NOTICE
We reserve
the right to change this notice. We reserve
the right to make the revised or changed notice effective for medical
information we already have about you as well as any information we
receive in the future. We will have available, upon request, a reference
copy of the current notice in each of our facilities. The notice will
contain on the first page, in the top right-hand corner, the effective
date. In addition, each time you register at or are admitted
to Improving Lives CMHC for treatment or health care services as an
inpatient or outpatient, we will offer you a copy of the current notice
in effect.
COMPLAINTS
If you believe your
privacy rights have been violated, you may file a complaint with
Improving Lives Community Mental Health Center or with the Secretary of
the Department of Health and Human Services. To file a complaint with
Improving Lives Community Mental Health Center, contact the Improving
Lives Community Mental Health Center Privacy Officer, 11040 N Kendall
drive suite C-100, Miami, Fl. 33176 Tel 305.270.5305. You may send a
written complaint to the U.S. Department of Health and Human Services
Office of Civil Rights. Our Privacy Officer can provide you the address.
All complaints must be submitted in writing. You will not be penalized
for filing a complaint.
OTHER USES OF
MEDICAL INFORMATION
Other uses and
disclosures of medical information not covered by this notice or the
laws that apply to us will be made only with your written permission. If
you provide us permission to use or disclose medical information about
you, you may revoke that permission, in writing, at any time. If you
revoke your permission, we will no longer use or disclose medical
information about you for the reasons covered by your written
authorization. You understand that we are unable to take back any
disclosures we have already made with your permission, and that we are
required to retain our records of the care that we provided to you.
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