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Notice of Privacy Practices
Effective Date: April 14, 2003
Important
This notice describes how medical information about you
may be used and disclosed by HARC and how you can get access to this
information. Please review it carefully. It is important to read and
understand this Notice of Privacy Practices before signing the Consent and
Acknowledgment Form.
If you have any questions about this Notice or would like further
information concerning your privacy rights, please contact the privacy
officer at HARC.
Hollace P. Brooks
900 Asylum Avenue
Hartford, CT 06105
860-218-6028
Purpose of the Notice of Privacy Practices
This Notice of Privacy Practices (the "Notice") is meant to inform you of
the uses and disclosures that The Greater Hartford Association for Retarded
Citizens, Inc. (hereinafter "HARC," "we," or "us") may make of protected
health information. It also describes your rights to access and control your
protected health information and certain obligations we have regarding the
use and disclosure of your protected health information.
Your "protected health information" is information about you created and
received by us, including demographic information, that may reasonably
identify you and that relates to your past, present or future physical or
mental health or condition, or payment for the provision of your health
care.
We are required by law to maintain the privacy of your protected health
information. We are also required by law to provide you with this Notice of
our legal duties and privacy practices with respect to your protected health
information and to abide by the terms of the Notice that is currently in
effect. However, we may change our notice at any time. The new revised
Notice will apply to all of your protected health information maintained by
us. You will not automatically receive a revised Notice. If you would like
to receive a copy of any revised Notice you should access our web site at
www.harc-ct.org. or contact HARC or ask at your next appointment.
How We May Use or Disclose Your Protected Health Information
HARC will ask you to sign a consent form that allows HARC to use and
disclose your protected health information for treatment, payment and health
care operations. You will also be asked to acknowledge receipt of this
Notice.
The following categories describe some of the different ways that we may
use or disclose your protected health information. Even if not specifically
listed below, HARC may use and disclose your protected health information as
permitted or required by law or as authorized by you. We will make
reasonable efforts to limit access to your protected health information to
those persons or classes of persons, as appropriate, in our workforce who
need access to carry out their duties. In addition, if required, we will
make reasonable efforts to limit the protected health information to the
minimum amount necessary to accomplish the intended purpose of any use or
disclosure and to the extent such use or disclosure is limited by law.
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For Payment - We may use and disclose your protected health
information so that we can bill and receive payment for the treatment and
related services you receive. For billing and payment purposes, we may
disclose your health information to your payment source, including an
insurance or managed care company, Medicare, Medicaid, or another third
party payor. For example, we may need to give your health plan information
about the treatment you received so your health plan will pay us or
reimburse us for the treatment, or we may contact your health plan to
confirm your coverage or to request prior authorization for a proposed
treatment. |
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For Health Care Operations - We may use and disclose your health
information as necessary for operations of HARC, such as quality assurance
and improvement activities, reviewing the competence and qualifications of
health care professionals, medical review, legal services and auditing
functions, and general administrative activities of HARC. For example,
HARC may use PHI to review its programs and services and to evaluate the
performance of staff and to combine PHI about many individuals to decide
about changes in service and to evaluate those changes. |
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Business Associates - There may be some services provided by our
business associates, such as a billing service, transcription company or
legal or accounting consultants. We may disclose your protected health
information to our business associates so that they can perform the job we
have asked them to do. To protect your health information, we require our
business associates to enter into a written contract that requires them to
appropriately safeguard your information. |
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Appointment Reminders - We may use and disclose protected health
information to contact you as a reminder that you have an appointment at
HARC. |
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Treatment Alternatives and Other Health-Related Benefits and Services
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We may use and disclose protected health information
to tell you about or recommend possible treatment options or
alternatives and to tell you about health related benefits, services, or
medical education classes that may be of interest to you. |
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Fundraising Activities -
We may use information about you to
contact you to raise money for HARC and its operations. The information we
use will be limited to your contact information, such as your name,
address and telephone number. |
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Individuals Involved in Your Care or Payment of Your Care
- Unless you object, we may disclose your
protected health information to a family member, a relative, a close
friend or any other person you identify, if the information relates to the
person’s involvement in your health care to notify the person of your
location or general condition or payment related to your health care. In
addition, we may disclose your protected health information to a public or
private entity authorized by law to assist in a disaster relief effort. If
you are unable to agree or object to such a disclosure we may disclose
such information if we determine that it is in your best interest based on
our professional judgment or if we reasonably infer that you would not
object. |
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Public Health Activities - We may disclose your protected health
information to a public health authority that is authorized by law to
collect or receive such information, such as for the purpose of preventing
or controlling disease, injury, or disability; reporting births, deaths or
other vital statistics; reporting child abuse or neglect; notifying
individuals of recalls of products they may be using; notifying a person
who may have been exposed to a disease or may be at risk of contracting or
spreading a disease or condition. |
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Health Oversight Activities - We may disclose your protected
health information to a health oversight agency for activities authorized
by law, such as audits, investigations, inspections, accreditation,
licensure and disciplinary actions. |
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Judicial and Administrative Proceedings - If you are involved in a
lawsuit or a dispute, we may disclose your protected health information in
response to your authorization or a court or administrative order. We may
also disclose your protected health information in response to a subpoena,
discovery request, or other lawful process if such disclosure is permitted
by law. |
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Law Enforcement -
We may disclose your protected health
information for certain law enforcement purposes if permitted or required
by law. For example, to report gunshot wounds; to report emergencies or
suspicious deaths; to comply with a court order, warrant, or similar legal
process; or to answer certain requests for information concerning crimes.
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Coroners, Medical Examiners, Funeral Directors, Organ Procurement
Organizations - We may release your protected health information to a
coroner, medical examiner, funeral director, or, if you are an organ
donor, to an organization involved in the donation of organs and tissues.
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Research Purposes
- Your protected health information will
not be used or disclosed for research purposes only if you provide
authorization. |
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To Avert a Serious Threat to Health or Safety - We may use and
disclose your protected health information when necessary to prevent a
serious threat to your health or safety or the health or safety of the
public or another person. Any disclosure, however, would be to someone
able to help prevent the threat. |
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Military and National Security
- If required by law, if
you are a member of the armed forces, we may use and disclose your
protected health information as required by military command authorities
or the Department of Veterans Affairs. If required by law, we may
disclosure your protected health information to authorized federal
officials for the conduct of lawful intelligence, counter-intelligence,
and other national security activities authorized by law. If required by
law, we may disclose your protected health information to authorized
federal officials so they may provide protection to the President, other
authorized persons or foreign heads of state or conduct special
investigations. |
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Workers’ Compensation -
We may use or disclose your protected
health information as permitted by laws relating to workers’ compensation
or related programs. |
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Special Rules Regarding Disclosure of Psychiatric, Substance Abuse and
HIV-Related Information - For disclosures concerning protected health information relating to care
for psychiatric conditions, substance abuse or HIV-related testing and
treatment, special restrictions may apply. For example, we generally may
not disclose this specially protected information in response to a
subpoena, warrant or other legal process unless you sign a special
Authorization or a court orders the disclosure. |
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Mental health information. Certain mental health information may
be disclosed for treatment, payment and health care operations as
permitted or required by law. Otherwise, we will only disclose such
information pursuant to an authorization, court order or as otherwise
required by law. For example, all communications between you and a
psychologist, psychiatrist, social worker and certain therapists and
counselors will be privileged and confidential in accordance with
Connecticut and Federal law. |
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Substance abuse treatment information. If you are treated in a
specialized substance abuse program, the confidentiality of alcohol and
drug abuse patient records is protected by Federal law and regulations.
Generally, we may not say to a person outside the program that you attend
the program, or disclose any information identifying you as an alcohol or
drug abuser, unless: |
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1.You consent in writing;
2. The disclosure is allowed by a court order; or
3. The disclosure is made to medical personnel in
a medical emergency or to qualified personnel for research, audit, or
program evaluation.
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Violation of these Federal laws and regulations by us is a crime.
Suspected violations may be reported to appropriate authorities in
accordance with Federal regulations. Federal law and regulations do not
protect any information about a crime committed by a patient either at the
substance abuse program or against any person who works for the program or
about any threat to commit such a crime. Federal laws and regulations do
not protect any information about suspected child abuse or neglect from
being reported under State law to appropriate State or local authorities.
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HIV-related information. We may disclose HIV-related information
as permitted or required by Connecticut law. For example, your HIV-related
information, if any, may be disclosed without your authorization for
treatment purposes, certain health oversight activities, pursuant to a
court order, or in the event of certain exposures to HIV by personnel of
HARC, another person, or a known partner. |
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Minors. We will comply with Connecticut law when using or
disclosing protected health information of minors. For example, if you are
an unemancipated minor consenting to a health care service related to
HIV/AIDS, venereal disease, abortion, outpatient mental health treatment
or alcohol/drug dependence, and you have not requested that another person
be treated as a personal representative, you may have the authority to
consent to the use and disclosure of your health information. |
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When We May Not Use or Disclose Your Protected Health Information
Except as described in this Notice, or as permitted by Connecticut or
Federal law, we will not use or disclose your protected health information
without your written authorization.
Your written authorization will specify particular uses or disclosures
that you choose to allow. Under certain limited circumstances, HARC may
condition treatment on the provision of an authorization, such as for
research related to treatment. If you do authorize us to use or disclose
your protected health information for reasons other than treatment, payment
or health care operations, you may revoke your authorization in writing at
any time by contacting HARC’s Privacy Officer. If you revoke your
authorization, we will no longer use or disclose your protected health
information for the purposes covered by the authorization, except where we
have already relied on the authorization.
Psychotherapy Notes
A signed authorization or court order is required for any use or
disclosure of psychotherapy notes except to carry out certain treatment,
payment, or health care operations and for use by HARC for treatment, for
training programs, or for defense in a legal action.
Marketing
A signed authorization is required for the use or disclosure of your
protected health information for a purpose that encourages you to purchase
or use a product or service except for certain limited circumstances such as
when the marketing communication is face-to-face or when marketing includes
the distribution of a promotional gift of nominal value provided by HARC.
Your Health Information Rights
You have the following rights with respect to your protected health
information. The following briefly describes how you may exercise these
rights.
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Right to Request Restrictions of Your Protected Health Information -
You have the right to request certain restrictions or limitations on
the protected health information we use or
disclose about you. You may request a
restriction or revise a restriction on the use or disclosure of your
protected health information by providing a written request stating the
specific restriction requested. You can obtain a Request for Restriction
form from HARC. We are not required to agree to your requested
restriction. If we do agree to accept your requested restriction, we will
comply with your request except as needed to provide you with emergency
treatment. If restricted protected health information is disclosed to a
health care provider for emergency treatment, we will request that such
health care provider not further use or disclose the information. In
addition, you and HARC may terminate the restriction if the other party is
notified in writing of the termination. Unless you agree, the termination
of the restriction is only effective with respect to protected health
information created or received after we have informed you of the
termination.
Right to Receive Confidential Communications - You have the right
to request a reasonable accommodation regarding how you receive
communications of protected health information. You have the right to
request an alternative means of communication or an alternative location
where you would like to receive communications. You may submit a request
in writing to HARC requesting confidential communications. You can obtain
a Request for Confidential Communications form from HARC.
Right to Access, Inspect and Copy Your Protected Health Information -
You have the right to access, inspect and obtain a copy of your
protected health information that is used to make decisions about your
care for as long as the protected health information is maintained by
HARC. To access, inspect and copy your protected health information that
may be used to make decisions about you, you must submit your request in
writing to HARC. If you request a copy of the information, we may charge a
fee for the costs of preparing, copying, mailing or other supplies
associated with your request. We may deny, in whole or in part, your
request to access, inspect and copy your protected health information
under certain limited circumstances. If we deny your request, we will
provide you with a written explanation of the reason for the denial. You
may have the right to have this denial reviewed by an independent health
care professional designated by us to act as a reviewing official. This
individual will not have participated in the original decision to deny
your request. You may also have the right to request a review of our
denial of access through a court of law. All requirements, court costs and
attorney’s fees associated with a review of denial by a court are your
responsibility. You should seek legal advice if you are interested in
pursuing such rights.
Right to Amend Your Protected Health Information - You have the
right to request an amendment to your protected health information for as
long as the information is maintained by or for HARC. Your request must be
made in writing to HARC and must state the reason for the requested
amendment. You can obtain a Request for Amendment form from HARC. If we
deny your request for amendment, we will give you a written denial
including the reasons for the denial and the right to submit a written
statement disagreeing with the denial. We may rebut your statement of
disagreement. If you do not wish to submit a written statement disagreeing
with the denial, you may request that your request for amendment and your
denial be disclosed with any future disclosure of your relevant
information.
Right to Receive An Accounting of Disclosures of Protected Health
Information - You have the right to request an accounting of certain
disclosures of your protected health information by HARC or by others on
our behalf. To request an accounting of disclosures, you must submit a
request in writing, stating a time period beginning on or after April 14,
2003 that is within six (6) years from the date of your request. The first
accounting provided within a twelve-month period will be free. We may
charge you a reasonable, cost-based fee for each future request for an
accounting within a single twelve-month period. However, you will be given
the opportunity to withdraw or modify your request for an accounting of
disclosures in order to avoid or reduce the fee.
Right
to Obtain A Paper Copy of Notice - You have the right to obtain a
paper copy of this Notice, even if you have agreed to receive this
Notice electronically. You may request a copy of this Notice at any time
by contacting HARC. In addition, you may obtain a copy of this Notice at
our web site,
www.harc-ct.org.
Right
to Complain - You may file a complaint with us or with the Secretary
of Health and Human Services if you believe your privacy rights have
been violated by us. You may file a complaint with us by notifying our
Privacy Officer of your complaint. You will not be penalized for filing
a complaint and we will make every reasonable effort to resolve your
complaint with you.
Hollace P. Brooks
The Greater Hartford Association for Retarded Citizens,
Inc.
900 Asylum Avenue
Hartford, CT 06105
860-218-6028
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