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NOTICE OF PRIVACY PRACTICES T H E R I V E R D A L E M E N T A L H E A L T H A S S O C I A T I O N, I N C. The mission of RMHA is to provide a range of high quality mental health and substance abuse services to our clients. In order to fulfill this mission we must maintain a commitment to ensure that all individuals who are involved in our services are treated with respect and that all information is treated with the utmost confidentiality and privacy. As such, this notice is designed to inform you about RMHA’s Privacy Practices. These privacy practice are followed by our employees. We are required by law to give you this notice. This notice will describe how we may use and disclose information that is called “protected health information” (PHI). PHI is any information oral, recorded, or demographic data that may identify you (i.e. name, address, diagnosis) or that may relate to your past, present or future mental health and/or substance abuse condition and services. We will also outline your rights and our obligations regarding the use and disclosure of that information. RMHA is required to abide by the terms of this Notice of Privacy Practices which go into effect as of April 14, 2003 Any changes to this notice will be posted at RMHA and will be available on our website If you have any questions/issues in regard to this notice please contact:
Riverdale Mental Health Association, Inc. 5676 Riverdale Avenue Bronx, New York 10471 718-796-5300
PERMITTED USES: RMHA may use and disclose your protected health information for the following purposes: · Treatment We may use protected health information about you to better serve your treatment/services needs. We may disclose this information in an attempt to coordinate or manage your care and any related services. This may include sharing information with other mental health, substance or healthcare providers to better assist you in achieving your personal goals. It is also important for you to be aware that at times your case record may be reviewed by specific agency staff as part of an on-going process to ensure that RMHA is providing quality service and care. · Payment RMHA may disclose protected health information about you in order to obtain payment for health care services. For example, we may need to give your health plan information about a service, your diagnosis, your name/address, or type of treatment received in an effort to secure payment from your insurance. We may also need to tell your health plan about a treatment you are going to receive to obtain prior approval, or to determine whether your plan will cover the treatment. · Health Care Operations We may use and disclose health information about you to staff responsible for agency operations and make sure that you and other individuals involved with RMHA receive quality care. For example, RMHA may use your health information to evaluate the performance of our staff in caring for you. We may also need to share PHI with our attorneys, consultants and others in order to ensure that RMHA is in compliance with applicable NYS Laws. · Appointment Reminders RMHA may use PHI in an effort to notify you or remind you about an upcoming or scheduled appointment for treatment. · Treatment Alternatives RMHA may use and disclose PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you. · Serious Threat to Health As required by law and standards of ethical conduct, we may release your health information or Safety to the proper authorities if we believe, in good faith, that such release is necessary to prevent or minimize a serious and approaching threat to you or the public’s health or safety. · Required by Law RMHA will disclose health information about you when required to do so by federal, state or local law. · Workers’ Compensation RMHA may release your protected health information in order to comply with the laws related to similar programs. These · Public Health Matters RMHA may be required to report your health information to authorities to help prevent or control disease, injury, or disability. This may require RMHA to report information about births, deaths, or suspected child/elder abuse or neglect. · Health Oversight Activities RMHA may disclose health information to individuals/agencies for the purpose of audits, investigations, spections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor RMHA and ensure compliance with government and civil rights laws. · Research At this time RMHA is not involved in any formal research activities. Should this status change RMHA would notify you that RMHA may use or disclose your PHI to help conduct research. Any research project would first require approval from the RMHA Board of Directors to ensure that it meets the mission and ethical standards of the agency and · Military, Veterans, If you are or were involved with the military, national security or intelligence activity, RMHA may be asked by military National Security or government authorities to release protected health information about you to the proper authorities so they may carry out their duties under the law. · Law Enforcement/Lawsuits RMHA may release protected health information if asked to do so by a law enforcement official in response to a Court Services court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements. · Inmates We may use or disclose your protected health information if you are an inmate of a correctional facility so the proper authorities may carry out their duties under the law. · Victims of Abuse, Neglect or RMHA may notify the appropriate government authorities if we believe a client has been the victim of abuse, Domestic Violence neglect or domestic violence. Such a disclosure will only be made if you agree or when required or authorized by law. · Death/Organ Donation RMHA may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose your health information to people involved with obtaining, storing or transporting organs or tissue donations. · Emergencies RMHA may use or disclose your protected health information in an emergency treatment situation. · Family/Friends If people such as family members, relatives, or close personal friends are helping care for you, RMHA may release Caregivers/Payment important Health information about you to those people. RMHA may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. You have the right to object to such disclosure, unless you are unable to function or there is an emergency. In addition, RMHA may release your health information to organizations authorized to handle disaster relief efforts so those who care for you can receive information about your location or health status. RMHA may allow you to agree or disagree orally to such release, unless there is an emergency.
OTHER USES AND DISCLOSURE OF HEALTH INFORMATION Except for the above outlined areas, RMHA would require your written Authorization to release protected health information (PHI). At any time during your treatment or care with RMHA, you may revoke our Authorization, in writing. If you would like to withdraw your Authorization please submit your request in writing to the RMHA Privacy Officer, Riverdale Mental Health Association, 5676 Riverdale Avenue, Bronx, New York 10471. YOUR RIGHTS You have the following rights regarding the protected health information RMHA maintains about you: Right to Inspect and Copy You have the right to inspect and copy your health information, such as medical and billing records, that we use to make decisions about your care. You must submit your request in writing to the RMHA Privacy Officer, Riverdale Mental Health Association, 5676 Riverdale Avenue, Bronx, New York 10471. RMHA may charge a fee for the costs of copying, mailing or other associated supplies. RMHA may also deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your health information, you may ask that the denial be reviewed. Right to Make Changes If you believe RMHA has health information about you that is incorrect or incomplete, you may ask RMHA to correct the information by contacting the RMHA Privacy Officer in writing. You must state what information needs to be changed and why. RMHA may deny your request if you ask us to amend information that RMHA did not create, or if RMHA believes the information is complete and accurate. Right to Accounting of Disclosures You have the right to request an “accounting of disclosures.” This is a list of the disclosures RMHA made of health information about you for purposes other than treatment, payment and health care operations, national security, law enforcement corrections, and certain health oversight activities. To obtain this list, you must submit your request in writing to the RMHA Privacy Officer. Please include time frames, which may not be longer than six years and may not include dates before April 14, 2003. RMHA will review all requests individually and will comply with your request within 30 days, unless you agree to a 30-day extension. RMHA may charge a nominal fee for this list if a request is made more than one time annually. You will be notified of all charges prior to completion of your request. Right to Request Restrictions You have the right to request a restriction or limitation on the protected health information RMHA uses, or discloses about you for treatment, payment or health care operations. You also have the right to request a limit on the health information RMHA discloses about you to someone who is involved in your care or the payment for it, like a family member or friend. However, RMHA is not required to agree in all circumstances to your requested restriction. Such a request should be submitted in writing to the RMHA Privacy Officer. Right to Request Confidential You have the right to request that we communicate with you in Communications a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Such requests should be submitted in writing to the RMHA Privacy Officer. Right to a Paper Copy of This Notice You have the right to a paper copy of this notice even if you earlier agreed to receive it electronically. COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. If you would like to file a complaint please contact the RMHA Privacy Officer.
NOTIFICATION DE LAS PRACTICAS DE PRIVACIDAD T H E R I V E R D A L E M E N T A L H E A L T H A S S O C I A T I O N, I N C. La mision de RMHA es proveer una serie de servicios de salud mental y abuso de sustancias de alta calidad a nuestros clients. Para poder cumplir esa mision, tenemos que comprometernos y asegurar que todos los individuos que estan envueltos en nuestros servicios sean tratados con respeto y que toda la informacion sea mantenida en la mas absoluta confidencialidad y privacidad. Asi que, esta notificacion esta designada para informarles acerca de las Practicas de Privacidad de RMHA. Estas practicas son seguidas por nuestros empleados. Por ley, estamos obligados a darles esta notificacion. Esta notificacion describe como nosotros usamos y compartimos la informacion llamada “Informacion de salud protegida” (PHI). PHI es toda informacion oral, grabada o escrita que lo identifique. (ejemplo: nombre, direccion, diagnostico) o algo relacionado con su salud mental en el pasado, presente o futuro y/o su condicion de abuso de drogras y servicios recibidos. Nosotros le explicaremos sus derechos y nuestras obligaciones acerca de como se usa y se comparte esta informacion. RMHA esta supuesta a regirse por los terminos de esta Notificacion de Practicas de Privacidad que estaran en efecto a partir del 14 de Abril del 2003 Cualquier cambio hecho a esta notificacion sera puesto en RMHA y estara disponible en nuestra pagina de internet
Si tiene alguna pregunta/o tema acerca de esta notificacion por favor contacte a: Oficial de Privacidad de RMHA Riverdale Mental Health Association Inc. 5676 Riverdale Avenue Bronx, New York 10471 718- 795-5300 USOS PERMITIDOS: RMHA podria usar y compartir informacion sobre su salud por los siguientes propositos: · Tratamiento Podriamos usar la informacion de salud para servirle mejor con su tratamiento/servicios que necesite. Podriamos compartir esta informacion en un intento de coordinar o manejar su cuidado o cualquier otro servicio relacionado. Esto puede incluir compartir informacion de salud mental, abuso de drogas o cuidado de su salud con otros proveedores para asistirlo mejor en el logro de sus metas. Tambien es importante que usted sepa que muchas veces su expediente es revisado por personas de agencias especificas como parte de un proceso para asegurar que RMHA esta proveyendo servicios y cuidados de calidad. · Pago RMHA podria compartir informacion sobre su salud para recibir pagos por los servicios rendidos. Por ejemplo, podriamos darle informacion a su plan de salud acerca de los servicios, diagnostico, nombre/direccion, o tipo de tratamiento recibido en un esfuerzo por asegurar el pago de su seguro. Es posible que tengamos que decirle a su plan de salud el tratamiento que va a recibir para poder obtener con anterioridad autorizacion o determinar si su plan cubre el tratamiento. · Operaciones del Cuidado de Salud Es posible que usemos y compartamos informacion de su salud con personas responsable de las operaciones de la agencia, y asegurarnos que usted y otros individuos envueltos con RMHA reciban un servicio de calidad. Por ejemplo, RMHA podria usar la informacion de su salud para evaluar el trabajo de nuestro personal con referencia a su cuidado. Podriamos tambien compartir informacion con nuestros abogados, consultores y otros para asegurar que RMHA esta cumpliendo con las leyes que se aplican en el Estado de New York. · Recordatorio de citas RMHA podria usar PHI en un esfuerzo de notificarle o recordarle sobre una proxima cita o sobre una cita dada para tratamiento. · Alternativas de Tratamiento RMHA podria usar y compartir PHI para decirle o recordarle opciones o alternativas que le puedan interesar para su tratamiento .· Serias Amenazas contra su Salud y Seguridad
· Requerida por ley RMHA podra dar informacion sobre su salud cuando es · Compensacion de Trabajadores RMHA podra dar informacion sobre su salud para cumplir con Estos programas proveen beneficios relacionados con enfermedades o heridas de trabajo. · Asuntos de Salud Publica RMHA podra ser requerida reportar informacion sobre su salud a las autoridades para ayudar a prevenir o controlar enfermedades heridas o incapacidad. RMHA puede ser requerida a reportar na-cimientos, muertes o abuso de niños o ancianos. · Actividades Inadvertidas RMHA puede revelar informacion a individuos/agencias con el proposito de auditorias, investigaciones, inspecciones o con el
· Investigaciones En este momento RMHA no esta envuelta en ninguna investiga-cion formal. Si este estatus cambiara, RMHA le notificaria que RMHA podria usar o revelar su PHI para ayudar a conducir una investigacion. Cualquier proyecto de investigacion, primero requiere la aprobacion de la junta Directiva para asegurar que cumple con la mision y las reglas de etica de la agencia y que es con el mejor interes para los individuos que RMHA sirve. · Seguridad National Militares, Veteranos Si usted es o estuvo envuelto co el ejercito, seguridad nacional o actividades de inteligencia, RMHA podria ser requerida por el ejercito o autoridades gubernamentales a revelar informacion pro-tegida acerca de usted a las autoridades apropiadas para que asi ejecuten sus deberes bajo la ley. · Cumplimiento de la ley/ Demandas Servicio de Cortes RMHA puede revelar informacion si es requerida por un oficial y respondiendo a una orden de corte, citatorio, orden de detencion o procesos similares sujeto a todos los requerimientos legales. · Presos Nosotros podriamos revelar informacion sobre su salud si usted puedan ejercer sus deberes bajo la ley. · Victimas de Abuso, Negligencia o Violencia Domestica RMHA podria notificar a las autoridades apropiadas de gobierno · Muerte/Donacion
· Emergencias RMHA podria usar o revelar informacion sobre su salud en casode una situacion que necesite tratamiento de emergencia · Familia/Amigos .
Excluyendo las areas de arriba que estan subrayadas, RMHA podria requerir una Autorizacion por escrito para revelar informacion sobre su salud (PHI). En cualquier momento durante su tratamiento o cuidado en RMHA, usted puede revocar nuestra Autorizacion por escrito. Si usted quiere revocar la autorizacion, por favor sometala por escrito al Oficial de Privacidad de RMHA, Riverdale Mental Health Association, 5676 Riverdale Avenue, Bronx, New York 10471. Sus Derechos Usted tiene los siguientes derechos en cuanto a la informacion protegida de su salud que RMHA mantiene de usted: Derecho a Inspeccionar y a Copiar Usted tiene derecho a revisar y a copiar su informacion, como de su cuidado. Tiene que someter su pedidopor escrito al Oficial de Privacidad de RMHA, Riverdale MentalHealth Association, 5676 Riverdale Avenue, Bronx, New York10471. RMHA podria tener un costo para cubrir gastos de copias, correo o por otros materiales. RMHA tambien podria negarle su pedido de revisar y o copiar en ciertas circumstanciaslimitadas. Si le fue negado su pedido, usted puede pedir que su caso sea revisado. Derecho a Hacer Cambios Si usted cree que RMHA tiene informacion acerca de su salud que es incorrecta o esta incompleta, usted puede pedir a RMHAcorregirla contactando al Oficial de Privacidad de RMHA por es-crito. Usted tiene que decir que informacion necesita ser cam-biada y porque. RMHA puede negarle este pedido si usted pide que esta informacion sea arreglada si esta informacion no fue creada por RMHA, o que RMHA cree que esta correcta. Derecho a La Lista De Informacion Revelada Usted tiene derecho a pedir una “accounting of disclosure”. Esto es una lista de la informacion revelada por RMHA acerca de su salud con otros propositos como tratamiento,pagos y operaciones de cuidado de salud, seguridad nacional,aplicaciones de la ley, y otras actividades
Derecho a Pedir Restricciones Usted tiene derecho a pedir restricciones o limitaciones en la infor- macion sobre su salud que RMHA usa, o revela acerca de su tra-tamiento, pagos o cuidados de su salud. Tambien tiene el derechoa pedir que se limite la informacion sobre su salud que RMHA revelaa una persona que este involucrada en su cuidado o pago del mismo,como un familiar o amigo. Sinembargo, RMHA no esta obligada a estar de acuerdo en todas la situaciones al pedido de restriccion. Estepedido debe ser hecho por escrito al Oficial de Privacidad de RMHA. Derecho a Pedir Communicacion En Privado Usted tiene derecho a pedir que nosotros nos comuniquemos con ustedde cierta manera y en cierto lugar. Por ejemplo, usted puede pedir que nos comuniquemos con usted en su trabajo o por correo. Estos pedidosdeben hechos por escrito al Oficial de Privacidad de RMHA Derecho a una Copia De esta Notificacion Usted tiene derecho a pedir una copia en papel de esta notificacion aunque antes halla estado de acuerdo en recibir una copia electronica. Quejas Si usted cree que sus derechos de privacidad han sido violados, usted puede quejarse en nuestra oficinao en la Secretaria del Departamento de Salud y Servicios Humanos. Usted no sera penalizado for haberse quejado. Si quiere quejarse, por favor contacte al Oficial de Privacidad de RMHA.
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