Notice of Privacy Practices
Effective Date: November 11, 2010
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED, DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
Federal and state laws require us to protect your medical information. These laws also require us to inform you as to how we will protect information, and what your rights are with regard to your access to this information.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
In some circumstances we are permitted or required to use or disclose your health information without obtaining your prior authorization and without offering you the opportunity to object.
The most common release of information regarding your healthcare is for treatment, payment and coordination of healthcare operations:
Treatment: We may use your healthcare information to provide, or coordinate with others to provide, treatment. An example would be disclosing information from our records to your primary healthcare provider for coordination of treatment. Also, we may contact you for appointment reminders.
Payment: We may use or disclose your health information to obtain payment for the services you receive at Northeastern Center. For example, we may inform your health insurance company of your diagnosis and treatment in order to assist insurer in processing our claim for payment for services provided to you.
Healthcare Operations: Northeastern Center, Inc. may use and/or disclose your information for the purpose of day-to-day operations and functions. Your healthcare information may be used in oversight activities as required by law such as audits, inspections and licensing functions required for state licensure.
There are times Northeastern Center, Inc may release information without prior authorization for your protection or the safety of others. This release requirement is dictated by Federal and State law and may include:
a) National Security;
b) For Public Health Reasons;
c) To disclose information about victims of abuse, neglect or domestic violence as required by law;
d) For oversight activities such as audits or civil, administrative or criminal investigations;
e) To facilitate organ, eye, or tissue donation;
f) To avert serious threat to health or safety;
g) For specialized government functions such as military, lawful intelligence, counterintelligence;
h) To correctional institution or law enforcement personnel having lawful custody of protected health information of inmate or patient.
Northeastern Center, Inc. may also disclose healthcare information to family members or close personal friends to help with payment or with coordinating treatment unless you sign a form objecting to the release of this information.
Northeastern Center, Inc. may contact individuals to provide appointment reminders.
Except as described above, disclosure of information from your mental health record or drug or alcohol treatment record will be made only with your written authorization, or as dictated by Federal or State laws or rules.
As a client of Northeastern Center, Inc. you have the following rights:
The right to request restrictions on the use and disclosure of your health information for treatment. Northeastern Center, Inc. is not required to agree to this restriction request. In the event of an emergency or your incapacity, we reserve the right to disclose information that is directly relevant to someone involved in your healthcare. In these circumstances, the staff of Northeastern Center will use our professional judgment and experience.
The right to limit communications. You have the right to receive confidential communications of health information by alternative means or at alternative locations. This means you may designate location or means of communication such as only telephone contacts at your home. To request communications by alternative means or at alternative locations, you must submit written request to the Contact listed on the final page of this Notice.
The right to inspect and copy health information. Despite this general right, access may be denied in some limited circumstances. For example, access may be denied if you are an inmate at a correctional institution, if the federal Privacy Act applies or if access to the information is reasonably likely to endanger the life or physical safety of you or someone else. To have access to your records or receive a copy of your health information, you must make this request in writing. If copies are provided, you will be charged reasonable cost-based fees for copying and mailing the requested information. To arrange for access to your records, or to receive a copy of you records, submit a request to the Contact listed on the final page of this Notice.
The right to request an amendment. You may request that your healthcare record information be amended. This request should be submitted in writing. Your request for amendment will be reviewed by the physician and your request may be denied under certain circumstances. If your request is denied, you may submit a written statement disagreeing with this denial which will be kept on file and distributed with future disclosures of relevant information. Requests for amendments to records must be submitted in writing to the Contact listed on the final page of this Notice.
The right to an accounting of disclosures. You have the right to an accounting of disclosures of health information made during the previous six years, but not before April 4, 2003. Request for this disclosure more than one time per year may result in a reasonable, cost-based fee. Requests for an accounting of disclosures must be submitted in writing to the Contact listed on the final page of this Notice.
The right to a paper copy of this notice. You have the right to obtain a copy of this Privacy Notice upon request.
Northeastern Center, Inc. is required by law to maintain the privacy of your protected health information and to provide individuals with this notice of our legal duties and privacy practices with respect to protected health information.
Northeastern Center, Inc. is required to abide by the Privacy Notice currently in effect. Northeastern Center, Inc. reserves the right to change the terms of this notice and to make those changes applicable to all health information we maintain. Any changes to this notice will be posted on our website and at our facility, and will be available upon request.
QUESTIONS OR COMPLAINTS
You may submit a written complaint to the Northeastern Center, Inc. privacy officer at the location below or to the U.S. Department of Health and Human Services. Northeastern Center, Inc. supports your right to the privacy of your health information. No action will be taken against you for filing any complaint.
For more information about our privacy practices or with questions or concerns, please contact:
Privacy Officer or Designee
220 S Main Street, PO Box 817
Kendallville, IN 46755 (260)347-2453
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Privacy and Protection of Personal Information
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