Family Alternatives exists to improve the lives of persons with or impacted by
behavioral health needs. We accomplish this with input from others and a
wide range of community based services that reflect our commitment to
professional excellence, sound fiscal practices, social responsibility and
integrity.
Any questions, concerns and/or
comments, please contact Bobbi Ellis, HIPAA Privacy Officer, at (910)
739-6624
NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE: 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 IT CAREFULLY.
If you have any questions about this notice,
please contact the Privacy Officer, Bobbi Ellis at (910) 739-6624.
WHO WILL FOLLOW THIS
NOTICE.
This notice describes Family Alternatives, Inc.(hereafter referred to as “F.A.”) practices at all its locations and
that of:
Any qualified and/or licensed
professional, associate professional, professional, or paraprofessional who
manages or provides direct and/or indirect services for individuals at F.A.
and is authorized to enter information into your medical record.
All departments and units of F.A.
All employees of F.A.
Any volunteers we allow to help
you while you are with F.A.
Any agency contract providers,
vendors, or independent contractors who have access to protected health
information of individuals served at F.A.
All students, interns, or
trainees.
Any F.A. corporate office staff.
All the above listed persons,
entities, sites and locations follow the terms of this notice. In addition,
these persons, entities, sites and locations may share medical information
with each other for your services to be provided or F. A. operations
purposes and the purposes described in this notice. The F.A. Agency
Contract Providers, who provide services for F.A. and have agreed to follow
the terms of this notice, are not employees or agents of F.A. and F.A. is
not responsible for how they fulfill their professional responsibilities.
THE MEDICAL INFORMATION TO WHICH NOTICE APPLIES:
This notice applies to all of the records of your
care and billing for servicesthat are provided at F.A., Inc., whether made by F.A.
personnel, your assigned social worker or other agency contract providers, who
are responsible for their own actions. These records are the physical property
of and are owned by F.A., Inc. and/or the referring mental health center. Your
personal doctor or other health care service provider(s) you have may have
different policies regarding confidentiality and disclosure of your medical
information that is created in their office or locations other than F.A.
WHAT THIS NOTICE DOES:
This notice will tell you about the ways in which the
people listed above may use and disclose medical information about you at F.A.
We also describe your rights and certain obligations we have regarding the use
and disclosure of medical information at F.A.
We are required by law to:
make sure that medical information
that identifies you is kept private;
give you this notice of our legal
duties and privacy practices at F.A. 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.
For Treatment.
We may use medical information about you to provide you with treatment or
services. We may disclose medical information about you, to persons who are
involved in taking care of you at F.A., such as assigned social worker and
other staff who have been assigned and permitted to provide services for you
as a F.A. client, nurses, nurses aides and other F.A. personnel or
students/interns and other qualified professionals who are participating in
clinical teaching experiences at F.A., or others in the healthcare field
whose services may be needed. For example, a doctor treating you for a
broken leg may need to know if you have diabetes because diabetes may slow
the healing process. In addition, the doctor may need to tell the dietitian
if you have diabetes so that we can arrange for appropriate meals.
Different departments of the F.A. also may share medical information about
you in order to coordinate what you need, such as therapy, additional needed
services and activities. We also may need to disclose medical information
about you to people outside F.A. who may be involved in your medical care
before, during or after you leave F.A., such as family members, or others
who provide services, such as hospitals, therapists, or medical specialists,
that are part of your care. We may provide, without your consent, medical
information about you in connection with any transfer of you to obtain
services elsewhere. We will otherwise only disclose medical information
about you to people outside F.A., who are not currently involved in your
care at F.A., with your consent, except for disclosures that are required or
permitted by law.
For Payment.
We may need to use and disclose medical information about you so that the
treatment and services you receive at F.A. or as given by other providers
may be billed to and payment may be collected from you, Medicare and
Medicaid, an insurance company/health plan, or a third party. For example,
we may need to give Medicare or Medicaid information about services or
therapy you received at F.A. so Medicare or Medicaid will pay us or
reimburse you for the services or therapy. We are permitted by law to
disclose the amount of medical information necessary for us to obtain
payment for the care and services provided to you. Our disclosure of
medical information for the purpose of obtaining payment for the care and
services provided to you, may also include our giving information to your
family members who are involved in your care, who are insureds on your
policy, or who help pay for your care.
For Health Care Operations.
We may use and disclose medical information about you for F.A. operations.
These uses and disclosures are necessary to run F.A. 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
qualifications and performance of our staff in caring for you. We may also
combine medical information about many F.A. Clients to decide what
additional services F.A. should offer, what services are not needed, and
whether improvements can be made. We may also disclose information to
nurses, technicians and other F.A. personnel, independent doctors and mental
health professionals who are involved in treatment of Clients at F.A. or
F.A. personnel and students/interns who are having clinical education
experiences at F.A. for review and learning purposes. We will only
disclose, with your consent, medical information about you that identifies
you to people outside F.A., who are not currently involved in your care,
except for disclosures that are required or permitted by law.
Treatment Alternatives.
We may use and disclose medical information to tell you about or recommend
different ways to serve 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.
F. A. Master Caseload Lists.
Unless you tell us otherwise,we will include certain limited
information about you in a F.A. master caseload list while you are a client
at F.A.. This information may include your name, record number and county
through which you are served. This caseload information, will be given to
limited F.A. personnel that require it in order to complete their job
duties. Examples are: Medical Records and Transcription Staff,
Supervisor/Coordinators of F.A. location client is being served from, Health
Information Manager, Billing Department Staff and Program Services
Coordinator. Assigned social workers may have a master caseload list of
their assigned cases. These lists are to be kept in a secure location to be
accessed when needed to perform a necessary job function in which it is
required.
Individuals Involved in Your
Care. Except as explained above
concerning information furnished in connection with the F.A. Master Caseload
Lists we may disclose medical information about you to a friend or family
member who is involved in providing you services, unless you are able to and
object. 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. You can object to
these disclosures by telling us that you do not wish any or all individuals
involved in your care to receive this information. If you cannot agree or
object, we will use our professional judgment to decide whether it is in
your best interest to disclose relevant information to someone who is
involved in your care or to an entity assisting in a disaster relief effort.
Research.
Under rare circumstances, we may use and disclose medical information about
you for research purposes. For example, a research project may involve
comparing the progress or lack of progress of all Clients who received one
service to those who received another for the same situation. All research
projects, however, will require your written consent if the researchers will
know who you are. Medical information about you that has had identifying
information removed may be used for research without your consent.
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 and limited to the information needed.
SPECIAL SITUATIONS:
Organ and Tissue Donation.
If you are an organ or tissue donor, we are required by law to provide
medical information about you to the person or entity who receives the organ
or tissue donation.
Public Health Risks.
We may disclose without your consent medical information about you for
public health activities. These activities generally include the following:
to prevent or control disease, injury, or
disability;
to report cancer, deaths or other items required
to be reported;
to report suspected abuse or neglect as required
by law;
to report reactions to medications or problems
with products;
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.
Surveys and Other Health
Oversight Activities. We may
disclose without your consent medical information to a health oversight
agency when authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the mental health
care system, government programs, and compliance with applicable laws. The
Department of Health and Human Services has authority to inspect F.A. and to
review any records of the current or former clients of F.A. unless you
object in writing to review of your records. The state ombudsman can review
your records with your consent or the consent of your legal representative.
Some professional licensing boards, have the right to review your records
when investigating a particular mental health professional.
Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, we must disclose medical
information about you in response to a court or administrative order. We
also may disclose medical information about you in response to a subpoena or
other lawful process from someone involved in a dispute by furnishing your
medical records or information under seal to the court. The copies of your
medical record under seal may only be opened by the judge, the parties to
the case, or their attorneys unless a judge orders otherwise.
Law Enforcement.
We may release without your consent medical information to a law enforcement
official:
In response
to a court order, grand jury demand, or search warrant;
To report a death or injury we believe may be the
result of criminal conduct; or
To report criminal conduct committed at F.A..
Coroners, Medical Examiners,
and Funeral Directors. We may
release without your consent 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 the identity of Clients at F.A. to funeral directors as necessary to
carry out their duties.
Behavioral Health Care.
Regardless of the other parts of this Notice, any information relating to
alcohol and drug treatment or other behavioral health care treatment,
including psychotherapy notes, will not be disclosed outside F. A. except as
authorized by you in writing, pursuant to a court order, or as required by
law. Psychotherapy notes about you will not be disclosed to personnel
working within F.A., other than to the person who wrote the notes, except
for training purposes or to defend a legal action brought against F.A.,
unless you have properly authorized such disclosure in writing.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights
regarding medical information we maintain about you:
Right to Inspect and Copy.
If you are a current Client, you or your representative have the right to
inspect your records within 24 hours of your request, excluding weekends and
holidays. If you are a current Client, you or your legal representative
have a right to purchase copies of your records or any portions of your
records from April 14, 2003 (effective date of HIPAA NPP) forward on two
working days’ advance notice to F.A.. If you are no longer a current Client
at the time of your request or have multiple volumes of records kept in
offsite secure locations at the time of your request to inspect or copy your
records, F.A. has a longer time within which to respond to your request up
to 60 days from the date of your request.
To inspect or receive a copy of your records, you
must submit your request in writing to the F.A. Privacy Officer at the F.A.
Administrative Office located at 103 N. Elm Street, Lumberton, NC 28358.
If you request a copy of the information, we may charge a fee not to exceed
the community standard rate for the costs of copying, mailing, or other
supplies associated with your request and may collect the fee before
providing the copy to you. If you agree, we may provide you with a summary
of the information instead of providing you with access to it, or with an
explanation of the information instead of a copy. Before providing you with
such a summary or explanation, we first will obtain your agreement to pay
and will collect the fees, if any, for preparing the summary or explanation.
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 F.A..
To request an amendment,
your request must be made in writing and submitted to the Medical Records
Department who will contact F.A. 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:
created by a provider other than the F.A., unless
the provider who created the information is no longer available to consider
or make the amendment;
Is not part of the medical information kept by or
for F.A.;
Is not part of the information that you would be
permitted to inspect and copy; or
Has been determined to be accurate and complete.
Right to an Accounting of
Disclosures. You have the right
to request a list of certain disclosures we have made of medical information
about you.
To request this list or
accounting of disclosures, you must submit your request in writing to F.A.
Privacy Officer. Your request must state a time period that may not be
longer than six years prior to the request and may not include dates before
April 14, 2003. Your request should indicate in what form you want the list
(for example, on paper, or 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. We may collect the fee before providing the
list to you.
Right to Request
Restrictions. Except where we are
required to disclose the information by law, you have the right to request a
restriction or limitation on the medical information we use or disclose
about you. For example, you could ask that we not use or disclose
information about a service you had to a family member or friend.
We are
not required to agree to your request to restrict use or disclosure of your
information within F.A. or among the mental health care
professionals/paraprofessionals currently involved in your care at F.A. except
with regard to psychotherapy notes. If we do agree, we will comply with your
requested restriction unless the information is needed to provide you emergency
services and/or treatment. Except as permitted or required by law, we will only
disclose your confidential medical information to persons outside F.A. who are
not currently involved in your care at F.A., in accordance with your written
authorization.
To
request restrictions, you must make your request in writing to the Medical
Records Department who will contact F.A. Privacy Officer/Health Information
Manger. 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 Alternative
Communications. You or your
representative 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 by speaking with you in a certain location
or contacting your representative at work or at a certain mailing address.
To
request communications by certain means, you must make your request in
writing to the Medical Records Department and specify how or where you wish
to be contacted. Medical Records Staff will inform F.A. Privacy
Officer/Health Information Manager. We will not ask you the reason for your
request. We will accommodate all reasonable requests.
Right to a Paper Copy of
This Notice. You have the right
to a paper copy of this notice or any revised 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.
To obtain a paper copy of this notice, contact the
Medical Records Department at the location where your assigned social
worker/therapist is located.
OTHER USES OF MEDICAL INFORMATION.
Other uses and disclosures of
medical information not covered by this notice will be made only with your
written permission or as required by law. 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 purposes that you had authorized
in writing. 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.
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 post a copy of the current notice in each F.A. location.
The notice will remain in effect for each subsequent visit unless changed. If
the notice changes, a copy will be made available to you upon request.
COMPLAINTS.
If you believe your privacy
rights have been violated, you may file a complaint with F.A. or with the
Secretary of the United States Department of Health and Human Services. To file
a complaint with F.A., contact the Privacy Officer, at (910) 739-6624 located at
103 N. Elm Street, Lumberton, NC 28358. All complaints must be submitted in
writing.
