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PRIVACY AND PATIENT RIGHTS

This notice describes how identifiable health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

THIS NOTICE EFFECTIVE APRIL 14, 2003

Our Commitment to You

At AHRC we understand that information about you and your family is personal. We are committed to protecting your privacy and sharing information only with those who need to know and are allowed to see the information to assure quality services for you. This notice tells you how AHRC uses and discloses information to assure quality service for you. It describes your rights and what our responsibilities are. You will also be able to obtain a copy by calling any of our offices.

Who will follow this notice:

All people who work for (or volunteer for) AHRC in our residences, in our day (non-residential) services and in our administrative offices will follow this notice. This includes employees and persons we contract with (business associates) who are authorized to enter information in your clinical record or need to review your record to provide services to you.

What information is protected:

The fact that you are a participant at, or receiving health related services from our agency
Information about your health condition (such as diseases you may have)
Information about health care products or services you have received or may receive in the future (such as individualized service plan or treatment)
Information about your health care benefits under an insurance plan (such as whether a prescription is covered)

The following information is protected when it is combined with the above information:

Geographic information (such as where you live or work)
Demographic information (such as your race, gender, ethnicity or marital status)
Unique numbers that may identify you (such as your social security number, your phone number, or your driver's license number) and
Other types of information that may identify who you are such as name and birth date

HOW AHRC USES AND DISCLOSES HEALTH INFORMATION

Treatment, Payment and Business Operation:

AHRC and its staff may use your health information or share it with others in order to treat your condition, obtain payment for that treatment, and run AHRC’s normal business operations. Your health information may also be shared with affiliated agencies so that they may jointly perform certain payment activities and business operations along with AHRC. Your health information may be disclosed to another health care provider for its treatment and payment activities, and for certain limited business operations by it. Below are further examples of how your information may be used and disclosed by AHRC.

Treatment:

We may share your health information with doctors, nurses, therapists, social workers, aides, volunteers and other AHRC staff members who are involved in providing services to you. Staff members may share your personal health information to coordinate different services that you need. Health care professionals at our agency may also share your health information with another agency or provider to whom you have been referred for further health care. Finally, we may share your health information with others outside the agency as necessary to carry out your treatment plan. For example, we may disclose certain information about your health to a prospective employer in connection with a job placement or training program.

Payments:

We may use your health information or share it with others so that we can obtain payment for your health care services. These uses and disclosures are necessary in order for AHRC programs and residences to continue to offer quality care. For example, we may share information about you with your health insurance company or other agencies such as OMRDD and OCDMH in order to obtain reimbursement after we have provided services to you. In some cases, we may share information about you with your health insurance company to determine whether it will cover your services. We might also need to inform your health insurance company about your health condition in order to obtain pre-approval for your services, such as care provided at a residential treatment facility. Finally, we may share your health information with other providers and payers for their payment activities.

Business Operations:

We may use your health information or share it with others in order to conduct our normal business operations. For example, we may use your health information to evaluate the performance of our staff in caring for you or to educate our staff on how to improve the care they provide for you. We may also share your health information with another company that performs business services for us, such as billing companies. If so, we will have a written contract to ensure that this company also protects the privacy of your health information. Finally, we may share your health information with other providers and payers of their business operations if that other party also has had a treatment or payment relationship with you, and in that event, we will only share information that pertains to that relationship.

Appointment Reminders, Treatment Alternatives, Benefits and Services:

We may use your health information when we contact you with a reminder that you have an appointment for treatment or services at our facility. We may also use your health information in order to recommend possible treatment alternatives or health-related benefits and services that may be of interest to you.

Fundraising:

We may use demographic information about you, including information about your age and gender, and where you live or work, and the dates that you received treatment, in order to contact you to raise money to help us operate. We may also share this information with a charitable foundation that will contact you to raise money in our behalf. If you do not want to be contacted for these fundraising efforts, please write to the Department of Development, 249 Broadway, Newburgh, New York 12550.

Facility Directory / Friends and Family

We may use your health information in, and disclose it from, our Facility Directory, or share it with friends and family involved in your care, without your written authorization or other written permission. We will always give you an opportunity to object unless there is insufficient time because of a medical emergency (in which case we will discuss your preferences with you as soon as the emergency is over).

Agency Directory:

Unless you object, we will include your name, your location in our facility, your general condition (e.g., fair, stable, critical, etc.) and your religious affiliation in our Agency Directory while you are a consumer in our facility. This directory information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if he or she doesn’t ask for you by name.

Friends and Family Involved in Your Care:

If you do not object, we may share your health information with a family member, relative or close friend who is involved in your care or payment for that care. We may also notify a family member, personal representative, or persons listed on the admission agreement as contacts. In some cases, we may need to share your information with a disaster relief organization that will help us notify these persons.

Incidental Disclosures:

While we will take reasonable steps to safeguard the privacy of your health information, certain disclosures of your health information may occur during or as an unavoidable result of our otherwise permissible uses or disclosures of your health information. For example, during the course of a treatment session, other consumers in the treatment area may see or overhear discussion of your health information.

Public Needs

In addition to treatment, payment and health care operations we may use your health information, and share it with others, in order to meet important public needs. We will not be required to obtain your written authorization, consent or any other type of permission before using or disclosing your information for the following reasons. We will notify you of these uses and disclosures if law requires notice.

For public health reasons: including prevention and control of disease, injury or disability, reporting births and deaths, reporting child abuse or neglect, reporting reactions to medication or problems with products and to notify people who may have been exposed to a disease or are at risk of spreading the disease.
To report domestic violence and adult abuse or neglect to government authorities: For example, we may report your information to government officials if we reasonably believe that you have been a victim of abuse, neglect or domestic violence. We will make every effort to obtain your permission before releasing this information, but in some cases we may be required or authorized to act without your permission.
For health oversight activities: may release your health information to government agencies authorized to conduct audits, investigations and inspections of our facility. These government agencies monitor the operation of the health care system, government benefit programs, such as Medicare and Medicaid, and compliance with government regulatory programs and civil rights laws.
Product monitoring, repair and recall: We may disclose your health information to a person or company that is required by the Food and Drug Administration to (1) report or track product defects, correct problems, repair, replace or recall defective or dangerous products, or (2) monitor the performance of a product after it has been approved for use by the general public.
For law enforcement purposes: in response to a subpoena, or other legal process, to identify a suspect or witness or missing person, regarding a victim of a crime, a death, criminal conduct at the facility, and in emergency circumstances, to report a crime.
Coroners or medical examiners: for identification purposes or to determine cause of death, and to funeral directors to allow them to carry out their duties.
Organ Donations: in the unfortunate event of your death, we may disclose your health information to organizations that procure or store organs, eyes or other tissues so that these organizations may investigate whether donation or transplantation is possible under applicable laws.
For Research: in most cases, we will ask for your written authorization before using health information or sharing it with others in order to conduct research. However, under some circumstances, we may use and disclose your health information without your authorization if we obtain approval through a special process to ensure that research without your authorization poses minimal risk to your privacy. Under no circumstances would we allow researchers to use your name or identity publicly.
Lawsuits and Disputes: we may disclose your health information if we are ordered to do so by a court or an administrative tribunal that is handling a lawsuit or other dispute.
To prevent or lessen a serious and imminent threat to your health and safety or someone else’s; to authorized federal officials for intelligence and other national security activities authorized by law or to provide protective services to the President and other officials; to correctional institutions or Law enforcement officials if you are an inmate and the information is necessary to provide you with health care, protect your health and safety or that of others.

YOUR RIGHTS TO ACCESS AND CONTROL YOUR HEALTH INFORMATION

We want you to know that you have the following rights to access and control your health information. These rights are important because they will help you make sure that the health information we have about you is accurate. They may also help you control the way we use your information and share it with others, or the way we communicate with you about your service and matters.

You Have the Right to inspect and Request a Copy of Your Records

You have the right to inspect and obtain a copy of any of your health information that may be used to make decisions about you and your service for as long as we maintain this information in our records. This includes medical and billing records. To inspect or obtain a copy of your health information, please submit your request in writing to the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550.

We will respond to your request for inspection of records within 10 days. We ordinarily will respond to requests for copies within 30 days if the information is located in our facility and within 60 days if it is located off-site at another facility. If we need additional time to respond to a request for copies, we will notify you in writing within the timeframe above to explain the reason for the delay and when you can expect to have a final answer to your request.

Under certain very limited circumstances, we may deny your request to inspect or obtain a copy of your information. If we do, we will provide you with a summary of the information instead. We will also provide a written notice that explains our reasons for providing only a summary and a complete description of your rights to have that decision reviewed and how you can exercise those rights. The notice will also include information on how to file a complaint about these issues with us or with the Secretary of the Department of Health and Human Services. If we have reason to deny only part of your request, we will provide complete access to the remaining parts after excluding the information we cannot let you inspect or copy.

You Have the Right to Request Amendment of Records

If you believe that the health 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 in our records. To request an amendment, please write to the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550. Your request should include the reasons why you think we should make the amendment. Ordinarily we will respond to your request within 60 days. If we need additional time to respond, we will notify you in writing within 60 days to explain the reason for the delay and when you can expect to have a final answer to your request.

If we deny part or your entire request, we will provide a written notice that explains our reasons for doing so. You will have the right to have certain information related to your requested amendment included in your records. For example, if you disagree with our decision, you will have an opportunity to submit a statement explaining your disagreement, which we will include in your records. We will also include information on how to file a complaint with us or with the Secretary of the Department of Health and Human Services. These procedures will be explained in more detail in any written denial notice we send you.

Right to an Accounting of Disclosures

After April 14, 2003, you have a right to request an “accounting of disclosures” which is a list that contains certain information about how we have shared your information with others. An accounting list, however, will not include any information about:

Disclosures we made to you
Disclosures we made pursuant to your authorization
Disclosures we made for treatment, payment or health care operations
Disclosures made in the facility directory
Disclosures made to your friends and family involved in your care or payment for your care
Disclosures made to federal officials for national security and intelligence activities
Disclosures that were incidental to permissible uses and disclosures of your health information
Disclosures for purposes of research, public health or our normal business operations of limited portions of your health information that do not directly identify you
Disclosures about inmates to correctional institutions or law enforcement officers or
Disclosures made before April 14, 2003

To request this accounting list, please write to the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550. Your request must state a time period within the past six years (but after April 14, 2003) for the disclosures you want us to include. For example, you may request a list of the disclosures that we made between January 1, 2004 and January 1, 2005. You have a right to receive one accounting list within every 12-month period for free. However, we may charge you for the cost of providing any additional accounting list in that same 12-month period. We will always notify you of any cost involved so that you may choose to withdraw or modify your request before any costs are incurred.

Ordinarily we will respond to your request for an accounting list within 60 days. If we need additional time to prepare the accounting list you have requested, we will notify you in writing about the reason for the delay and the date when you can expect to receive the accounting list. In rare cases, we may have to delay providing you with the accounting list without notifying you because a law enforcement official or government agency has asked us to do so.

Right To Request Additional Privacy Protections

You have the right to request that we further restrict the way we use and disclose your health information to treat your condition, collect payment for that treatment, or run our agency’s normal business operations. You may also request that we limit how we disclose information about you to family or friends involved in your care. For example, you could request that we not disclose information about a surgery that you had. To request restrictions please write to the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550. Your request should include (1) what information you want to limit, (2) whether you want to limit how we use the information, how we share it with others, or both and (3) to whom you want the limits to apply.

We are not required to agree to your request for a restriction, and in some cases, the restriction you request may not be permitted under law. However, if we do agree, we will be bound by our agreement unless the information is needed to provide you with emergency treatment or comply with the law. Once we have agreed to a restriction, you have the right to revoke the restriction at any time. Under some circumstances, we will also have the right to revoke the restriction as long as we notify you before doing so; in other cases, we will need your permission before we can revoke the restriction.

Right To Request Confidential Communications

You have the right to request that we communicate with you about your medical matters in a more confidential way by requesting that we communicate with you by alternative means or at alternative locations. For example, you may ask that we contact you by fax instead of by mail or at work instead of at home. To request more confidential communications, please write to the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550. We will not ask you the reason for your request, and we will try to accommodate all reasonable requests. Please specify in your request how or where you wish to be contacted, and how payment for your health care will be handled if we communicate with you through this alternative method or location.

IMPORTANT SUMMARY INFORMATION

Requirements for a written authorization:

We will generally obtain your written authorization before using your health information or sharing it with others outside the agency. You may also initiate the transfer of your records to another person by completing an authorization form. If you provide us with written authorization, you may revoke that authorization at any time, except to the extent that we have already relied upon it. To revoke an authorization, please write to the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550.

How Someone May Act On Your Behalf

You have the right to name a personal representative who may act on your behalf to control the privacy of your health information. Parents and guardians will generally have the right to control the privacy of health information about minors unless the minors are permitted by law to act on their own behalf.

How to Learn about Special Protections for HIV, Alcohol and Substance Abuse, Mental Health and Genetic Information:

Special privacy protections apply to HIV-related information, alcohol and substance abuse treatment information, mental health information, and genetic information. Some parts of this general Notice of Privacy Practices may not apply to these types of information. If your treatment involves this information, you will be provided with separate notices explaining how the information will be protected. To request copies of these other notices now, please contact the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550 at (845) 561-0670, Ext. 167.

How to Obtain A Copy of This Notice:

You have the right to a paper copy of this notice. You may request a paper copy at any time, even if you have previously agreed to receive this notice electronically. To do so, please call the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550 at (845) 561-0670, Ext. 167. You may also print this copy from our web site (click print) or by requesting a copy at your next visit.

How to Obtain A Copy of Revised Notice:

We may change our privacy practices from time to time. If we do, we will revise this notice so you will have an accurate summary of our practices. The revised notice will apply to all of your health information, and we will be required by law to abide by its terms. We will post any revised notice in our agency reception area. You will also be able to obtain your own copy of the revised notice by:

Accessing our web site at www.orangeahrc.org or
Calling the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550 at (845) 561-0670, Ext. 167 or
Asking for one at the time of your next visit.

Privacy Questions or Complaints

If you have questions about your privacy rights or how we handle personal health information, we encourage you to contact your Service Coordinator, Program Director or AHRC’s Corporate Compliance and Privacy Coordinator at (845) 561-0670, Ext. 167. If you feel your privacy rights have been violated, you may file a complaint with the Corporate Compliance and Privacy Coordinator, 249 Broadway, Newburgh, NY 12550. Your complaint will be taken very seriously and we will make every effort to resolve your complaint promptly. If you are not satisfied, you may file a complaint with the Secretary of the Department of Health and Human Services. You can write to them at 200 Independence Avenue, S.W., Washington, D.C., 20201.

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