Notice of Privacy Practices
Effective 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.
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How Medical Information About "You" ("Protected Health Information")
May Be Used and Disclosed By the Provider:
- The Provider receives and generates certain Protected Health Information about "you" that is stored in a medical record especially for "you".
- Federal and State law requires that we maintain the privacy of "your" Protected Health Information;
- Federal law requires that the Provider provide "you" with this written Notice regarding its duties and practices in using "your" Protected Health Information;
- The Provider is required to abide by the terms of this Notice;
- The Provider is required to notify "you" if it can't abide by a requested restriction on how "your" information is used or disclosed;
- The Provider must accommodate reasonable requests that "you" make for it to communicate "your" Protected Health Information by alternative means or locations; and
- The Provider reserves the right to change this Notice and have the changes apply not only to Protected Health Information acquired after the change in Notice, but have it also apply to Protected Health Information received before the change in Notice. Should our Notice be revised, we will post the revised Notice on our Web Site.
- To provide treatment (e.g., discussions between caregivers for coordination and planning of "your" care). Treatment means the provision of health care and related services, including coordinating and managing "your" health care with a third party, consulting between health care providers; and referring "you" to another health care provider to receive care; and
- To conduct our administrative and business operations (e.g., activities relating to improving quality of care and/or evaluating our staff). Health Care Operations includes, but is not limited to, conducting quality improvement activities, reviewing the competence or qualifications of health care professionals, case management and care coordination, contacting of health care providers and patients with information regarding treatment alternatives, conducting or arranging for legal counsel, medical review and auditing functions, including fraud and abuse detection, business planning and development, management activities relating to compliance with State and Federal laws, resolution of internal grievances, and activities in connection with a sale of assets.
Federal law allows the Provider to use and disclose "your" Protected
Health Information (except Psychotherapy Notes described below) for treatment,
payment, and health care operations without "your" consent. However,
since State law continues to require that we obtain "your" consent
for disclosure of Protected Health Information for payment purposes (e.g., "your"
insurer will require certain information to support our claim for payment),
coordination of care with other providers (e.g., discharge planning and referrals),
and the disclosure of certain sensitive information protected under State law,
we will request "your" consent for disclosure of Protected Health
Information upon admission [or intake].
Unless "you" object or specifically request to restrict use, some
of the other ways in which we will use "your" Protected Health Information
are:
Notification and Involvement in "Your" Care: We may communicate Protected
Health Information: (a) to "your" family member(s), legally authorized
representative(s), and any other person identified by "you", which
is directly relevant to such person's involvement in "your" care,
or payment for "your" care; and (b) to notify or assist in the notification
of a family member, a personal representative, or any other person responsible
for "you". Such notification may include "your" location,
general condition, or death, but will not include confidential HIV-related,
drug and alcohol or psychiatric information. If "you" are able, we
will provide "you" with the opportunity to consent or object to such
disclosure. If "you" are unable to object due to "your"
incapacity or an emergency circumstance, the Provider, based upon its professional
judgment, will make such disclosure if it determines that it is in "your"
best interest to do so. Such disclosure of Protected Health Information will
be limited to information that is directly relevant to the recipient's involvement
with "your" health care.
We may make disclosures of "your" Protected Health Information to
a public or a private entity charged by law or its charter to assist in disaster
relief efforts for the purposes of coordinating the disclosures described in
(a) and (b) of the above paragraph.
Unless the Protected Health Information is protected by State drug, alcohol,
psychiatric or HIV-related information confidentiality laws, we may use and
disclose "your" Protected Health Information without "your"
consent or without providing "you" the opportunity to object as follows:
- If the use or disclosure of Protected Health Information is required by law and is limited to the relevant requirements of the law (e.g. reporting an adverse incident in our facility);
- Disclosures made by law to state and federal public health authorities (e.g., to report a defective medical device to the FDA);
- Disclosures made to government authorities for the purpose of reporting suspected abuse and neglect of children, the elderly, and the mentally retarded;
- Disclosures to health oversight agencies authorized by law, in connection with audits, civil, administrative, or criminal investigations, licensure or disciplinary actions; or for monitoring compliance and quality, and program eligibility (e.g., Medicare, Medicaid, and State of Connecticut Department of Public Health);
- Disclosures to persons exposed to a communicable disease if authorized by law to make such disclosure;
- Disclosures in connection with judicial and administrative proceedings in response to an order of the court or administrative tribunal, or in response to a lawfully issued subpoena;
- Disclosures to law enforcement if mandated by law (e.g., reporting gunshot wounds);
- Disclosures to law enforcement in the event of "your" death if it is suspected that "your" death was the result of criminal conduct;
- Disclosures to law enforcement if there is evidence of criminal conduct
that occurred on the Provider premises;
- Disclosures to the Office of State Medical Examiner as mandated by law (e.g., the occurrence of a suspicious death, contagious disease, and cremation);
- Disclosures to funeral directors as permitted by law;
- Disclosures to organ procurement organizations ("organ banks") in connection with organ donation and transplantation;
- Limited disclosures made in connection with record reviews in preparation for conducting research;
- Disclosures to persons reasonably able to prevent or lessen serious and imminent threat to the health or safety of a person or the public; or if necessary to apprehend an individual involved in a violent crime that we believe may have caused serious physical harm to "you";
- Disclosures regarding armed forces personnel to appropriate military command authorities to assure proper execution of the military mission;
- Disclosures to Federal officials for protective services to the President or other governmental authorities;
- Disclosures to correctional institutions for the purpose of providing services to "you" or for the health and safety of the inmates or employees of the correctional institution; and
- Disclosures to comply with Workers' Compensation or other programs that provide benefits for work-related injuries without regard to fault.
All other uses or disclosures will only be made with "your" specific written authorization, which may be revoked, except to the extent it has already been relied upon.
Special rules for Psychiatric, Drug and Alcohol and HIV-related protected information:
Protected Psychiatric Information: State law provides special protections when it comes to psychiatric information (e.g., communications between a psychiatrist, psychologist, licensed professional counselor, and licensed social worker, and those working under their supervision, and his or her patient). Except for treatment, or Provider business and administrative operations, psychiatric communications will not be disclosed without "your" specific written consent, unless the disclosure is made: (i) to another health care Provider for the purpose of treatment and diagnosis (with notice to "you"); (ii) when there is substantial risk of imminent physical injury to "you" or others and the disclosure is necessary to place "you" in a treatment facility; (iii) to a court as part of a court ordered psychiatric examination; (iv) in a civil court proceeding if "you" introduce "your" mental condition as an element of a claim or defense; (v) after "your" death, when "your" condition is introduced by a party claiming or defending through or as a beneficiary of "you" and a court finds it to be in the interests of justice to disclose such psychiatric information; (vi) to the Commissioner of the State Department of Public Health or the State Department of Mental Health & Addiction Services in connection with an inspection or investigation; (vii) to the family or legal representative of a victim of a homicide committed by "you"; (viii) to individuals or agencies involved in the collection of fees for psychiatric services; and (ix) to the State Department of Mental Health & Addiction Services in connection with the Provider receiving payment for services funded by such agency (with notice to "you"). "You" will not have access to any psychotherapy notes, as they are not part of the medical record.
Psychotherapy Notes are notes recorded by a mental health professional documenting or analyzing communications within a counseling session. Federal law treats Psychotherapy Notes differently than other psychiatric information by prohibiting disclosure without Authorization, unless it is disclosed for the reasons specified in (i), (iii), (vi), (ix) above, and (iv) to the extent that the disclosure is made to defend a legal action against us brought by "you". "You" may have access to the following psychiatric information: medication orders, treatment type and frequency, clinical test result, summaries of diagnoses, functional status, treatment plan symptoms, prognosis and progress to date.
Protected HIV-Related Information: Special rules under State law also limit the disclosure of HIV-related information. According to the rules, the Provider may not disclose such information without "your" specific written authorization, unless such disclosure is: (i) made to a public health official as required or allowed by State or Federal law; (ii) a health care Provider for the purpose of treatment; (iii) a medical examiner to determine the cause of death; (iv) to a Provider committee or another organization for the purpose of oversight or monitoring of the Provider; (v) to a health care worker experiencing a significant occupational exposure to HIV infection; (vi) pursuant to a court order; (v) life and health insurers; (vi) to "your" partner by a physician caring for "you" and "your" partner if it is believed by the physician that "your" partner is at significant risk for transmission; and (v) if "you" are a minor, to "your" parents or legal guardian, unless the physician determines there is cause (as defined by law) not to disclose to them.
Protected Drug and Alcohol Information: Federal law establishes certain protections for any patient identifiable information relating to drug and alcohol treatment, treatment referral, research and/or rehabilitation, (but excludes protection for a diagnosis of drug overdose or alcohol intoxication or a diagnosis made solely for the purpose of providing evidence for use by law enforcement authorities). As a general rule, protected drug and alcohol information is confidential and may not be disclosed without "your" authorization or pursuant to Federal law. Exceptions for disclosure of Protected drug and alcohol information without "your" authorization are as follows: (1) to medical personnel to the extent necessary to meet a bona fide medical emergency; (2) to qualified personnel for the purpose of conducting research, management audits, program evaluation, provided "you" are not identified in any report; (3) pursuant to a court order where good cause for such disclosure has been established; (4) communications between a program and an entity and an affiliated covered entity having direct administrative control over our program; (5) to a business associate performing services on the Provider's behalf; (6) limited communications with law enforcement regarding a crime committed or threatened by "you" on our premises; (7) the reporting of incidents of suspected child abuse and neglect to the appropriate state authorities; and (8) to the FDA when they assert that "your" health may be threatened by an error in the manufacture, labeling, or sale of a product under FDA jurisdiction. Please note that the exceptions do not apply to Psychotherapy Notes, unless one of the drug/alcohol exceptions also satisfies one of the exceptions for disclosure of Psychotherapy Notes without authorization.
"Your" Rights Relating to Your Protected Health Information.
- You have the right to request certain restrictions on the use of "your" Protected Health Information for treatment, payment and our operations, disclosures to notify family and friends of "your" location, general condition and/or death, and disclosures to notify others involved in "your" care or payment of "your" care. However, we are not required to honor such restrictions
- The right to receive communications of Protected Health Information from the Provider by other means or locations
- The right to inspect and copy Protected Health Information, except Psychotherapy Notes, information collected for use in a court proceeding, or certain other information protected by Federal law governing clinical laboratories;
- The right to request to amend Protected Health Information so long as the amendment is accurate and complete;
- The right to revoke "your" Authorization and Consent except to the extent relied upon by notifying the Provider's Privacy Officer; and
- "You" have the right to request an accounting of disclosures for a period of six years prior to the date of the request within 60 - 90 days of "your" request (but not including disclosures that occurred prior to April 14, 2003 ).
Complaints: "You" have the right to complain to us, or the Secretary of the Department of Health and Human Services, if "you" believe that "your" privacy rights have been violated. To bring a complaint with us, "you" may write to our Privacy Officer or Security Officer at 103 Woodland Street , Hartford CT or call 1-(866)-321-1663.
You will not be retaliated against for bringing a complaint.
