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 Privacy Notice, please contact our Privacy officer at (610) 632-8156.
Date Implemented: April 14, 2003
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding health information we maintain about you and a brief description of how you may exercise these rights. This Notice further states the obligations we have to protect your health information.
“Protected health information (PHI)” means health information (including identifying information about you) we have collected from you or received from your health care providers, health plans, your employer or a health care clearinghouse. It may include information about your past, present or future physical or mental health or condition, the provision of your health care, and payment for your health care services.
We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information. We are also required to comply with the terms of our current Notice of Privacy Practices.
II. How We Will Use and Disclose Your Health Information
We will use and disclose your health information as described in each category listed below. For each category, we will explain what we mean in general, but not describe all specific uses or disclosures of health information.
A. Uses and Disclosures for Treatment, Payment and Operations
2. For Payment.
We may need to use or disclose your health information so that the treatment and services you receive are billed to, and payment is collected from, your health plan, county office or other third party payer. By way of example, we may disclose your health information to permit your health plan to take certain actions before your health plan approves or pays for your services. These actions may include:
- making a determination of eligibility or coverage for health insurance;
- reviewing your services to determine if they were medically necessary;
- reviewing your services to determine if they were appropriately authorized or certified in advance of your care; or
- reviewing your services for purposes of utilization review, to ensure the appropriateness of your care, or to justify the charges for your care.
For example, your health plan or third party payer may ask us to share your health information in order to determine if the plan or payer will approve additional services.
We may also need to disclose your health information to another health care provider so that provider can bill you for services they provided to you, for example an ambulance service that transported you to the hospital.
3. For Health Care Operations.
We may use and disclose health information about you, without your specific authorization, for our health care operations. These uses and disclosures are necessary to run our organization and make sure that our consumers receive quality care. These activities may include, for example, quality assessment and improvement, reviewing the performance or qualifications of our staff members, training students in clinical activities, and clinical team conferences. We may combine health information of many of our consumers to decide what additional services we should offer, what services are no longer needed, and whether certain services are effective.
We may also provide your health information to other health care providers or to your health plan to assist them in performing certain of their own health care operations. We will do so only if you have or have had a relationship with the other provider or health plan. For example, we may provide information about you to your health plan to assist them in their quality assurance activities.
We may also use and disclose your health information to contact you to remind you of your appointment, unless you instruct us not to do so.
Finally, we may use and disclose your health information to inform you about possible treatment options or alternatives that may be of interest to you, unless you inform us you would not like us to do this.
4. 5. Fundraising Activities.
At the present time, CareLink does not contact consumers for the purpose of raising funds for the agency. Should we ever decide to do so, you will have a right to request that we not contact you for fundraising purposes by notifying the Privacy Officer in writing at CareLink, 605 E. Baltimore Pike, Media, PA 19063. Please state clearly that you do not want to receive fundraising solicitations from us.
B. Uses and Disclosures For Which You Will Have an Opportunity to Object.
1. Persons Involved in Your Care.
We may provide health information about you to someone who helps pay for your care. In limited circumstances, we may disclose health information about you to a friend or family member who is involved in your care. If you are physically present and have the capacity to make health care decisions, your health information may only be disclosed with your agreement to persons you designate to be involved in your care.
But, if you are in an emergency situation, we may disclose your health information to a spouse, a family member, friend or any such person who may be of assistance in an emergency so that such person may assist in your care. In this case we will determine whether the disclosure is in your best interest and, if so, only disclose information that is directly relevant to participation in your care.
And, if you are not in an emergency situation but are unable to make health care decisions, we will disclose your health information to:
- a person designated to participate in your care in accordance with an advance directive validly executed under agency policy or state law, if applicable;
- your guardian or other fiduciary if one has been appointed by a court, if applicable, the state or county agency responsible for consenting to your care.
C. Uses and Disclosures That May be Made Without Your Authorization or Opportunity to Object.
We may use and disclose your health information in an emergency treatment situation. For example, we may provide your health information to a paramedic who is transporting you in an ambulance. If a clinician is required by law to treat you and your treating clinician has attempted to obtain your authorization but is unable to do so, the treating clinician may nevertheless use or disclose your health information to treat you.
We may disclose your health information to researchers when information that might identify you has been protected. CareLink will secure your authorization before disclosing any identifiable information to researchers. No authorization is required for research on information that does not involve personally identifiable health care information.
3. As Required By Law.
We will disclose health information about you when required to do so by federal, state or local law, for example, to report suspected child abuse or neglect.
4. To Avert a Serious Threat to Health or Safety.
We may use and disclose health information about you when necessary to prevent a serious and imminent threat to your health or safety or to the health or safety of the public or another person, for example, when a threat of self-harm is made. Under these circumstances, we will only disclose health information to someone who is able to help prevent or lessen the threat.
5. Public Health Activities.
We may, when permitted or required by law, disclose health information about you as necessary for public health activities including, for example, disclosures to:
- report elder abuse, neglect, or exploitation;
- notify the appropriate government agency if we believe you have been a victim of abuse, neglect or domestic violence. We will only notify an agency if we obtain your agreement or if we are required or authorized by law to report such abuse, neglect or domestic violence.
6. Disclosures in Legal Proceedings.
We may disclose health information about you to a court or administrative agency when a judge orders us to do so.
We will not provide information in response to a subpoena without your authorization or a court order.
7. Law Enforcement Activities.
We may disclose health information to a law enforcement official for law enforcement purposes, when, for example:
- a court order, warrant, or similar process requires us to do so; or
- we determine that the law enforcement purpose is to respond to a threat of an imminently dangerous activity by you against yourself or another person.
We may also disclose health information about a consumer who is a victim of a crime. However, we will do so only if the disclosure has been requested by a law enforcement official and the victim agrees to the disclosure.
8. National Security and Protective Services for the President and Others.
If required by law, court order or similar process, we may disclose medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities, including protection to the President.
III. Other Uses and Disclosures of Your Health Information with Your Permission.
Other uses and disclosures not described in Section II of this Notice of Privacy Practices will generally only be made with your written permission, called an “Authorization.” Again, you have the right to revoke an authorization at any time. If you revoke your authorization we will not make any further uses or disclosures of your health information under that authorization, unless we have already taken an action relying upon the uses or disclosures you have previously authorized.
IV. Your Rights Regarding Your Health Information
A. Right to Inspect and Copy.
You have the right to request an opportunity to inspect or copy health information used to make decisions about your care – whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes if this would be clinically contraindicated as determined by the treatment team leader. You must submit your request in writing to our Privacy Officer at 605 E. Baltimore Pike, Media, PA 19063. If you request a copy of the information, we may charge a fee for the cost of copying, mailing and supplies associated with your request.
We may deny your request to inspect or copy your health information in certain limited circumstances. In some cases, you will have the right to have the denial reviewed by a licensed health care professional not directly involved in the original decision to deny access. We will inform you in writing if the denial of your request may be reviewed. Once the review is completed, we will honor the decision made by the licensed health care professional reviewer.
B. Right to Amend.
For as long as we keep records about you, you have the right to request us to amend any health information used to make decisions about your care – whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes if we determine that this would be clinically contraindicated.
To request an amendment, you must submit a written document to our Privacy Officer at 605 E. Baltimore Pike, Media, PA 19063 and tell us why you believe the information is incorrect or inaccurate.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend health information that:
- was not created by us, unless the person or entity that created the health information is no longer available to make the amendment;
- is not part of the health information we maintain to make decisions about your care;
- is not part of the health information that you would be permitted to inspect or copy; or
- is accurate and complete.
If we deny your request to amend, we will send you a written notice of the denial stating the basis for the denial and offering you the opportunity to provide a written statement disagreeing with the denial. If you do not wish to prepare a written statement of disagreement, you may ask that the requested amendment and our denial be attached to all future disclosures of the health information that is the subject of your request.
If you choose to submit a written statement of disagreement, we have the right to prepare a written rebuttal to your statement of disagreement. In this case, we will attach the written request and the rebuttal (as well as the original request and denial) to all future disclosures of the health information that is the subject of your request.
C. Right to an Accounting of Disclosures.
You have the right to request that we provide you with an accounting of nonroutine disclosures we have made of your health information, such as disclosures made pursuant to a court order or other disclosures as described in section II (C) above. An accounting is a list of disclosures. But this list will not include certain disclosures of your health information, for example, those we have made for purposes of treatment, payment, and health care operations or pursuant to a signed authorization by you.
To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer at 605 E. Baltimore Pike, Media, PA 19063. For your convenience, you may submit your request on a form called a “Request For Accounting,” which you may obtain from our Privacy Officer. The request should state the time period for which you wish to receive an accounting. This time period should not be longer than six years and not include dates before April 14, 2003.
The first accounting you request within a twelve-month period will be free. For additional requests during the same 12-month period, we will charge you for the costs of providing the accounting. We will notify you of the amount we will charge and you may choose to withdraw or modify your request before we incur any costs.
D. Right to Request Restrictions.
You have the right to request a restriction on the health information we use or disclose about you for treatment, payment or health care operations. To request a restriction, you must request the restriction in writing addressed to the Privacy Officer at 605 E. Baltimore Pike, Media, PA 19063. The Privacy Officer will ask you to sign a request for restriction form, which you should complete and return to the Privacy Officer.
We are not required to agree to a restriction that you may request. If we do agree, we will honor your request unless the restricted health information is needed to provide you with emergency treatment.
E. Right to Request Confidential Communications.
You have the right to request that we communicate with you about your health care only in a certain location or through a certain method. For example, you may request that we contact you only at home or by e-mail.
To request such a confidential communication, you must make your request in writing to the Privacy Officer at 605 E. Baltimore Pike, Media, PA 19063. We will accommodate all reasonable requests. You do not need to give us a reason for the request; but your request must specify how or where you wish to be contacted.
F. Right to a Paper Copy of this Notice.
You have the right to obtain a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this Notice of Privacy Practices electronically, you may still obtain a paper copy. To obtain a paper copy, contact our Privacy Officer at 605 E. Baltimore Pike, Media, PA 19063.
V. Confidentiality of Substance Abuse Records
For individuals who have received treatment, diagnosis or referral for treatment from any drug or alcohol abuse programs operated by us, the confidentiality of drug or alcohol abuse records is protected by federal law and regulations. As a general rule, we may not tell a person outside the programs that you attend any of these programs, or disclose any information identifying you as an alcohol or drug abuser, unless:
- you authorize the disclosure in writing; or
- the disclosure is permitted by a court order; or
- the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation purposes; or
- you threaten to commit a crime either at the drug abuse or alcohol program or against any person who works for our drug abuse or alcohol programs.
A violation by us of the federal law and regulations governing drug or alcohol abuse is a crime. Suspected violations may be reported to the Unites States Attorney in the district where the violation occurs.
Federal law and regulations governing confidentiality of drug or alcohol abuse permit us to report suspected child abuse or neglect under state law to appropriate state or local authorities.
Please see 42 U.S.C. § 290dd-2 for federal law and 42 C.F.R., Part 2 for federal regulations governing confidentiality of alcohol and drug abuse patient records.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact our office responsible for receiving complaints at CareLink Community Support Services, 605 E. Baltimore Pike, Media, PA 19063. All complaints must be submitted in writing.
Our Privacy Officer, who can be contacted at the same address, will assist you with writing your complaint, if you request such assistance. We will not retaliate against you for filing a complaint.We reserve the right to change the terms of our Notice of Privacy Practices. We also reserve the right to make the revised or changed Notice of Privacy Practices effective for all health information we already have about you as well as any health information we receive in the future. We will post a copy of the current Notice of Privacy Practices at our main office and at each site where we provide services. You may also obtain a copy of the current Notice of Privacy Practices by accessing our website at www.carelinkservices.org or by calling us at (610) 632-8156 and requesting that a copy be sent to you in the mail or by asking for one at any CareLink site or office.
VII. Changes to this Notice
1. For Treatment.
CareLink may use or disclose your PHI to the extent that such use or disclosure is required or authorized by law. These uses and disclosures will be made only to the person or agency authorized to receive such disclosure. With your authorization, we will use and disclose your health information to coordinate and manage your health care and related services. For example, we may need to disclose information to a case manager who is responsible for coordinating your care. We will ask you to sign our Authorization to Release Information form whenever we need to disclose information about you to any outside agency or person. This Authorization is voluntary on your part and may be revoked by you at any time. In addition, we may disclose your health information with your authorization to another health care provider (e.g., your physician) working outside of CareLink Community Support Services for purposes of your treatment. We may also, without separate authorization from you, disclose your health information among CareLink staff involved in your care, such as residential counselors (RC), clinicians and staff other than your RC or principal clinician. For example, our staff may discuss your care at a case conference.