The following is a summary of the contents of the Notice. We encourage you to read the entire Notice and ask any questions you may have concerning its contents. You can also access a copy of our full program and privacy practices here.
Your Rights Regarding Your Health Information. This section describes the following rights you have with respect to your health information and tells you how you may exercise these rights.
Right to inspect and copy
Right to request amendment
Right to an accounting of disclosures
Right to request restrictions on certain uses and disclosures
Right to request alternative means of communication
Right to receive a paper copy of our Notice of Privacy Practices
How To File Complaints Concerning Our Privacy Practices. This section tells you what you can do if you believe any of your rights have been violated. You will not be penalized for filing any complaint.
How We May Use and Disclose Health Information About You Without Your Specific Authorization. This section describes the different ways we may use or disclose your health information without first obtaining from you a specific authorization. These types of uses and disclosures are specifically permitted by federal law because it is assumed you would want us to use or disclose your information for these purposes, or because such use or disclosure is recognized as critical to the proper functioning of our health care system.
You will be asked to acknowledge your receipt of this Notice, and your acknowledgement will be maintained in your permanent record. You should keep this copy of the Notice. Another copy of this Notice will not be provided automatically at any later visit, but you may request a copy of the Notice at any time. Also, the Notice is posted at our facility and on our website for your review. If there is a material revision to the Notice at some later date, you again will be provided with a copy of the Notice and asked to sign an acknowledgement.
Maintaining the privacy of your health information is very important to us. Again, if you have any questions concerning the attached Notice, please do not hesitate to ask.
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
HIPAA Compliance Officer
617 East Elm Street
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION.
Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination/interview and test results, diagnoses, treatment, a plan for your future care or treatment, and billing-related information. Such records are necessary for the healthcare provider to provide you with quality care and to comply with certain legal requirements.
We are committed to protecting the confidentiality of our records containing information about you. This notice applies to all records of your care created or received by the CKF. Other healthcare providers from whom you obtain care and treatment may have different policies or notices regarding the use and disclosure of your health information created or received by that provider. Also, health plans in which you participate may have different policies or notices concerning information they receive about you.
This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
We are required by law to maintain the privacy of your health information; give you this notice of our legal duties and privacy practices and make a good faith effort to obtain your acknowledgement of receipt of this notice; and follow the terms of the notice that is currently in effect.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.
Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy your health information, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the person identified on the first page of this Notice. You will be asked to complete a written authorization form. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies and services associated with your request. We may require that you pay such fee prior to receiving the requested copies.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by CKF 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 Request Amendment. If you believe that our records contain information that 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 CKF.
To request an amendment, you must complete a specific form providing information we need to process your request, including the reason that supports your request. To obtain this form or to obtain more information concerning this process, please contact the person identified on the first page of this Notice.
We may deny your request for an amendment if you fail to complete the required form in its entirety. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
- Is not part of the health information kept by or for CKF.
- Is not part of the information that you would be permitted to inspect and copy; or
- Is accurate and complete.
If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.
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 health information about you, with certain exceptions specifically defined by law.
To request this list or accounting of disclosures, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the person identified on the first page of this Notice.
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 health 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 health 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 episode you had. In all cases other than those listed on the following pages we will not release your health information without a specific authorization from you.
Right to Request Alternative Methods of Communications. You have the right to request that we communicate with you about treatment 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 an alternative method of communications, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the person identified on the first page of this Notice. 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.ckfaddictiontreatment.org/
To obtain a paper copy of this notice, contact the person identified on the first page of this Notice.
If you believe your rights with respect to health information about you have been violated by CKF, you may file a complaint with the CKF or with the Secretary of the Department of Health and Human Services. To file a complaint with CKF, contact the person identified on the first page of this Notice. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU WITHOUT YOUR SPECIFIC AUTHORIZATION.
The following categories describe different ways that we are permitted to use and disclose health information without a specific authorization from you. If you desire to restrict our use of your health information for any of these purposes, you need to submit a request for restrictions in the manner described above.
For Treatment. We may use information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, counselors, counselor aides, case managers, or other personnel who are involved in taking care of you at CKF. For example, a counselor treating you for alcoholism on the residential unit may need to know if you have diabetes in order to provide you with the appropriate food items for meals and snacks. Different departments of CKF also may share health information about you to coordinate the different things you need, such as educational presentations provided by the prevention department.
For Health Care Operations. We may use and disclose health information about you for our internal operations. These uses and disclosures are necessary to run the CKF and make sure that all our clients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, counselors, counselor aides, other personnel for review and learning purposes. We may also combine the health information we have with health 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 health information so others may use it to study health care and health care delivery without learning who the specific patients are.
Appointment Reminders. We may use and disclose health information to contact you as a reminder that you have an appointment for treatment at CKF. Unless you direct us to do otherwise, we may leave messages on your telephone answering machine asking for you to return our call. When leaving a message, we will not disclose the organization name but may leave the phone number and the first name of an individual to contact. Unless we are specifically authorized by you otherwise in a particular circumstance, we will not disclose any health information to any person other than you who answers your phone except to leave a message for you to return the call.
Surveys. We may use and disclose health information to contact you to assess your satisfaction with our services.
Treatment Alternatives. We may use and disclose health 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 health information to tell you about health-related benefits or services that may be of interest to you.
Fundraising Activities. We may use health information about you to contact you in an effort to raise money for the CKF and its operations. The CKF is a non-profit organization that maintains a “membership” that often includes program alumni. CKF holds an annual Membership Drive and fundraiser. For this purpose, CKF may utilize the following health information, such as your name, address and phone number. If you do not want the CKF to contact you for fundraising efforts, you must notify the person identified on the first page of this Notice in writing.
Business Associates/Qualified Service Organization Agreements. There are some services provided in our organization through contracts or arrangements with business associates. For example, we may contract with a computer firm for network maintenance. When these services are contracted, we may disclose your health information to our business associate so they can perform the job we’ve asked them to do. To protect your health information, however, we require our business associates to appropriately safeguard your information.
Research. Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with patients’ need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process, but we may, however, disclose health information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the health information they review does not leave CKF. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care at CKF.
As Required by Law. We will disclose health information about you when required to do so by federal, state, or local law.
Public Health Risks. We may disclose health information about you for public health activities. These activities generally include the following:
- to report child abuse or neglect;
- to notify clients when the Food and Drug Administration (FDA) determines that an error in packaging or manufacturing a drug that is used in substance abuse treatment may endanger the health of clients
Health Oversight Activities. We may disclose health information 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 may disclose health information about you in response to a court order.
Law Enforcement. We may release health information if asked to do so by a law enforcement official:
- In response to a court order;
- About criminal conduct at CKF if a client commits or threatens to commit a crime either at the program or against any person who works for the program.
Coroners, Medical Examiners. We may release health information about a deceased client when required by federal or state laws providing for the collection of vital statistics or an inquiry into the cause of death.
OTHER USES OF HEALTH INFORMATION.
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time, except for some authorizations to the criminal justice system. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by your written authorization. Of course, 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 health 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 at our facility and on our website. The notice will contain on the first page the effective date.
You will be asked to provide a written acknowledgement of your receipt of this Notice. We are required by law to make a good faith effort to provide you with our Notice and obtain such acknowledgement from you. However, your receipt of care and treatment from the CKF is not conditioned upon your providing the written acknowledgement.