Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW 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 NOTICE, PLEASE CONTACT:
HCRS PRIVACY OFFICER
390 RIVER STREET
SPRINGFIELD, VT 05156
PHONE 802 886 4500
WHO WILL FOLLOW THIS NOTICE
- All divisions and programs of Health Care & Rehabilitation Services of Southeastern Vermont (HCRS)
- All members of our workforce, which includes all employees, contracted providers, interns and volunteers.
- All HCRS entities, sites and locations follow the terms of this notice, as do members of our workforce working in community settings.
OUR PLEDGE REGARDING HEALTH INFORMATION
We understand that health information about you and your health is personal. We are committed to protecting your privacy and health information about you.
We create a record of the care and services you receive at HCRS. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by HCRS, or received by HCRS from others involved in your care.
This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
We are required by law to:
- Make sure that health information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices with respect to health information about you; and
- Follow the terms of the notice that is currently in effect;
- Comply with any state law that is more stringent or provides you greater rights than this Notice.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
You have specific rights about how your health information is used. Your rights are detailed below beginning on page 5.
- For Treatment. We may use health information about you to provide you with treatment or services. We may disclose information about you to doctors, nurses, clinicians, case managers, interns, or other members of the HCRS workforce who are involved in providing services to you. For example, a clinician seeing you for a mental health problem may talk with one of our psychiatrists or another clinician who has specialized training that will help them assist you. We may also disclose information about you to people outside HCRS who may be involved in your health care.
- For Payment. We may use and disclose health information about you so that the services you receive at HCRS may be approved by, billed to, and payment collected from a third party such as an insurance company or developmental services funding committee. For example, we may need to give your health plan information about counseling you received at HCRS so your health plan will pay us or reimburse you for a counseling session. We may also tell your health plan about services we are planning to provide you in order to obtain their prior approval.
- For Health Care Operations. We may use and disclose health information about you for HCRS health care operations. These uses and disclosures are necessary to run HCRS and make sure that all individuals receiving services from us receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in serving you. We may also disclose information to doctors, nurses, clinicians, case managers, interns and other HCRS personnel for review and learning purposes.
We may also combine the health information we have with health information from other mental health agencies to compare how we are doing and see where we can make improvements in the services we offer. We will remove information that identifies you from this set of health information so others may use it to study health care and health care delivery without learning who the specific clients are.
- Department of Developmental and Mental Health Services. HCRS is a Vermont designated Community Mental Health Agency and is obligated under its contract with the Vermont Department of Developmental and Mental Health Services to provide certain services. As a result, the Department may access health information related to these contracted services for the purpose of obtaining treatment for clients, making payment or for its health care operations.
- Appointment Reminders. We may use and disclose information to contact you as a reminder that you have an appointment.
- Alternative Treatment and Benefits and Services. We may use and disclose information about you in order to obtain and/or recommend to you other treatment options and available services as well as other health-related benefits or services.
- Marketing and Fundraising Activities. If HCRS wishes to use your picture, comments made by you, or information about your care to advertise our services or raise funds, we would first obtain your permission. No information would be released for these purposes without your authorization. For example, if HCRS was creating a brochure advertising the agency and picture of or comments from persons served were desired, HCRS would inquire whether or not you would be willing to participate. Participation would be voluntary and if you agreed, you would be asked to give us written authorization for this specific purpose.
- Research. Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all consumers who received one medication to those who received another for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with consumer’s need for privacy of their health information.
Before we use or disclose health information for research, the project will have been approved through this research approval process, but we may, however, disclose health information about you to people preparing to conduct a research project, for example, to help them look for consumers with specific health needs, so long as the health information they review does not leave HCRS. We will always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or if that person will be involved in your care at HCRS.
- As Required by Law. We will disclose information about you when required to do so by federal, state or local law. For example HCRS and members of its workforce are mandated by Vermont law:
- to report child abuse or neglect;
- to report abuse, neglect or exploitation of vulnerable adults;
- when a child under the age of 16 is the victim of a crime;
- any firearm related injuries
Under certain circumstances, the Department of Developmental and Mental Health Services is mandated access to health information in order to carry out its responsibilities.
- To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat or to provide safety to an individual at risk.
- Military Personnel and Veterans. If you are a member of the armed forces, we may release health information about you as required by military command authorities.
- Workers’ Compensation. If the services you receive from us are as the result of a work related injury or illness being covered by Worker’s Compensation or a similar program, we may release information about you to that program.
- Public Health Risks. We may disclose health information about you for mandated public health activities. These activities generally include the following:
- Mandated reporting to prevent or control specified diseases, injuries or disabilities;
- To report deaths;
- To report serious adverse reactions to medications or problems with products;
- To notify individuals of recalls of products they may be using;
- To notify an individual who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- Health Oversight Activities. We may disclose health information to a health oversight agency, such as the Department of Developmental and Mental Health Services, for activities authorized by law. These oversight activities include, but are not limited to, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with laws.
- Legal Proceedings and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order.
- Public Health Officials and Funeral Home Directors. If needed, we may release information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or help determine the cause of death. We may also release health information to funeral directors thereby permitting them to carry out their duties.
- Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You will need to understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the services that we provided to you.
YOUR RIGHTS REGARDING INFORMATION ABOUT YOU
Special Note: If you need assistance with writing, or with contacting the appropriate individual in HCRS to exercise any of your rights, we will be pleased to provide it to you upon request.
You have the following rights regarding information we maintain about you:
- Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations.. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member. For example, you could ask that we not use or disclose information about a counseling session your received.
Staff in every office have the form you should use to request a restriction, and a written description of the process that will be followed to review your request. You may also contact the HCRS Privacy Officer, whose address and phone number are listed on the first page of this Notice. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.
- Right to Request Communications by Alternate Means. You have the right to request that we communicate with you about health matters in a certain way or at a certain location other than your usual mailing address. For example, you can ask that we only contact you at work or by mail sent to a relative’s house.
Staff in every office have the form you should use to file such a request, and a written description of the process that will be followed to review your request. You may also contact the HCRS Privacy Officer, whose address and phone number are listed on the first page of this Notice. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to Review and Copy. You have the right to review and obtain a copy of health information that may be used to make decisions about your care. This may include both health and billing records.
Staff in every office have the form you should use to request a review and/or obtain a copy of health information that may be used to make decisions about you. You may also contact the HCRS Privacy Officer, whose address and phone number are listed on the first page of this Notice. If you request a second copy of the information within one year, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
We may deny or limit access to your request to inspect and obtain a copy in certain very limited circumstances. If you are denied or limited access to health information, you may request that the decision be reviewed. Another health care professional chosen by HCRS will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for HCRS. Staff in every office have the form you should use to request an amendment, and a written description of the process that will be followed to review your request. You may also contact the HCRS Privacy Officer, whose address and phone number are listed on the first page of this Notice. You must provide a reason for your request.
We may deny your request for an amendment if it is not in writing or does not include a reason for that request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the designated record set kept by or for HCRS;
- Is not part of the information which you would be permitted to inspect and copy; or,
- Is determined accurate or complete by HCRS.
- Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures. This is a list of the disclosures we made of health information about you that were made without your express advance knowledge or authorization.
Staff in every office have the form you should use to request this list or accounting of disclosures. You may also contact the HCRS Privacy Officer, whose address and phone number are listed on the first page of this Notice. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003 (the day this law went into effect.) Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you for the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice at any time upon request. You may ask us to give you a copy of the current notice at any time.
Staff in every office will be pleased to give you a paper copy of this Notice. You may also obtain a copy of this notice at our website, www.HCRS.org . You may also obtain a paper copy of this notice by contacting the HCRS Privacy Officer, whose address and phone number are listed on the first page of this Notice.
SECURITY OF HEALTH INFORMATION
Due to the nature of community based human service practices, HCRS representatives may possess individually identifiable information beyond the physical security of the Agency. For example, staff working with you in a school setting or in the community may carry with them individually identifiable information about you. In these cases, Agency representatives will ensure the security and confidentiality of the information in a manner that meets Agency policy, State and Federal Law.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in all HCRS facilities as well as on the HCRS website. The notice will contain on each page, in the lower right-hand corner, the effective date. In addition, should we make a material change to this notice, we will, prior to the change taking effect, publish an announcement of the change at every HCRS facility, on its website and in the following newspapers: Brattleboro Reformer, The Message, The Eagle Times, The Valley News.
If you believe your privacy rights have been violated, you may file a complaint with HCRS or with the Secretary of the federal Department of Health and Human Services.
To file a complaint with HCRS, contact:
HCRS Privacy Officer
390 River Street
Springfield, VT 05156
802 886 4500
All complaints must be submitted in writing. Complaint forms are available at each location. You will not be penalized for filing a complaint.
The Secretary of the federal Department of Health and Human Services can be contacted through their regional office at:
Office of Civil Rights
U.S. Department of Health and Human Services
Government Center, J.F. Kennedy Federal Building – Room 1875
Boston, Massachusetts 02203
voice phone (617) 565-1340 fax (617) 565-3809 TDD (617) 565-1343.