| This Notice describes your rights in regards to the protection of your health information and how you may exercise those rights. The Notice also gives you the names of contacts should you have questions or comments about the policies and procedures PBH uses to protect the privacy of your health information.
Understanding Your Medical Record / Health Information
Each time you visit a healthcare provider; a record of your visit is made. Typically, this record contains your symptoms, assessment, diagnosis, treatment plan, and treatment recommendations. This health information, often referred to as your medical record, serves as a basis for planning your treatment and a means to communicate between service providers involved in your care. It also serves as a legal document that assures you and/or a third party payer that the services billed were provided. It can also be used as a source of data to assure that we are continuously monitoring the quality of services and measuring outcomes. Understanding what is in your medical record and how, when and why we use the information helps you make informed decisions when authorizing disclosure to others.
Our Responsibilities
We are required to protect the privacy of health information about you and that identifies you, which we call Protected Health Information (PHI), and provide you with a Notice of our legal duties and privacy practices associated with your health information. We must protect health information that we have created or received about your past, present, or future health condition, health care we provide to you, or payment for your health care. We are only allowed to use and disclose health information in the manner described in this Notice. We will provide you a paper copy of this Notice prior to or the first time you receive a service from us. We reserve the right to revise or change the terms of this Notice at any time and to make the new revisions effective for all health information we maintain. Whenever there are changes to this Notice we will inform you by:
- Posting the revised notice in our offices;
- Making copies of the revised Notice available upon request (either at our offices or through the Privacy Officer listed in this Notice); and
- Posting the revised Notice on our website.
How We May Use and Disclose Health Information About You
- To Provide Health Care Treatment
We may use and disclose health information about you to provide, coordinate, and/or manage your health care and related services. This may include communicating with other health care providers internally, or externally, regarding your treatment. For example, we may share health information about you when you need a prescription filled, or when we consult with another health care provider about your care, or to emergency treatment providers when you need emergency services.
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To Obtain Payment for Services
Before providing treatment or services, we may share details with your health plan(s) and utilization management companies who authorize your services that you are scheduled to receive. This allows us to ask for approval or authorization before we provide the services. We will request that you sign a Financial Agreement or authorization, giving us permission to give health information to your insurance company so that we can bill and collect payment for the treatment and services provided to you. The information on or accompanying the bill may include information that identifies you as well as your diagnosis and treatment plan.
If you refuse to sign the Financial Agreement allowing us to release health information for the purpose of billing and receiving payment from your insurance company, you will be personally responsible for paying the same amount that your insurance company would have paid us for your services.
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To Perform Business Health Care Operations
We may use and disclose health information in performing our business activities called “health care operations.” These health care operations allow us to improve the quality of care we provide and reduce health care costs. For example, we may share health information in the following health care operations:
- Training programs for students, health care providers, or non-health care professionals (any trainee) to help them practice or improve their skills, such as a medication training for nurses on how to give medications or a billing process training for billing clerks and assistants. Trainees are not allowed to release any information obtained from their training.
- Internal Quality Review to assess and evaluate the skills, qualifications, and performance of health care providers taking care of you. This may involve review of your health information by our Quality Improvement Staff or the Supervisor of your provider to assess the overall care provided and progress in treatment. This information will then be used in an effort to continually improve the quality and effectiveness of the services we provide.
- External Quality Review by cooperation and participation in evaluations of our health care providers, staff or facilities by outside organization to assess the quality of care we provide. We may share health information to a government agency, such as Medicare and Medicaid, or to a national accrediting organization, such as the Council on Accreditation.
- Other Reviews to assist various external individuals or internal staff who review our activities. For example, health information may be reviewed by accountants and lawyers who make certain that we comply with various laws; to appropriate staff to plan for the future, to determine the best way to limit costs, or to audit your file to make sure that no information about you was given to someone in a way that violates this Notice.
- To communicate with other Service Providers who have Business Contracts with PBH. These include therapeutic foster families, residential group homes, and community based service providers. When these services are contracted, we may disclose your health information to our business associates so that they can provide you services and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
- We may use your health information for research purposes. For example: We may disclose information to researchers but only when an Institutional Review Board has reviewed the research proposal and have approved their research. The researchers must have established protocols to ensure the privacy of your health information.
- To non-professional staff who need to know your health information to perform their duties.
- To remind you about an appointment you have for treatment or medical care.
Additional Use and Disclosure of Health Information without your Authorization
State and Federal laws require or allow that we share your health information with others in specific situations in which you do not have to give consent, authorize or have the opportunity to agree or object to the use and disclosure. Prior to disclosing your health information, we will evaluate each request to ensure that only necessary information will be disclosed. These situations include, but are not limited to the following:
A. When receiving substance abuse services, Federal law allows disclosure in the following situations:
- To report abuse, neglect or domestic violence,
- To respond to a court order and subpoena,
- To qualified personnel for research, audit, and program evaluation,
- To a health care provider who is providing emergency medical services,
- If we believe that you are likely to commit a crime at the program or against program personnel,
- For the purpose of internal communications, as outlined above, and
- To qualified service organization agencies when appropriate. (These agencies agree to abide by the Federal law.)
B. When receiving services other than substance abuse, State law requires disclosure in specific situations that include, but are not limited to:
- To report certain type of wounds or other physical injuries,
- To report a communicable disease or risk of contracting or spreading a disease or condition,
- To response to a court order and subpoena,
- To report suspected child abuse / neglect or disabled adult abuse / neglect,
- Upon request of the next of kin or other family member or designee who has a legitimate role in therapeutic services offered or other person designated by the client/legally responsible person, the responsible treatment provider shall release the following information after the client is notified that the request has been made:
- notification of the client’s admission to this agency,
- transfer to another facility,
- decision to leave this agency against medical advice,
- discharge from this agency, and
- referral and appointment information after discharge.
- To PBH’s attorney,
- For the purpose of filing a petition for involuntary commitment or adjudication of incompetency,
- To the extent necessary to fulfill responsibilities when a client is examined or committed for outpatient treatment,
- When there is imminent danger to the health or safety of the client or another individual; or when there is likelihood of the commission of a felony or violent misdemeanor.
C. When participating in NC-TOPPS Assessments – Confidentiality of consumer-identifying information is protected under Federal regulations 42 CFR Part 2 and HIPAA, 45 CFR Parts 160 and 164. NC-TOPPS falls under the audit or evaluation exception of these laws. Consumer identifying information may be disclosed without consumer consent to the DMH/DD/SAS and to its authorized evaluation contractors under the audit and evaluation exception. The DMH/DD/SAS or its NC-TOPPS evaluation contractors may re disclose any individual consumer-identifying information only to the designated provider facility and to the consumer’s assigned LME for which this information has been submitted.
Your Rights
- Your health information will not be disclosed without your authorization unless required by State and Federal law regulations.
- Although your health information is the physical property of PBH, the information belongs to you. You have the right to request, in writing, certain uses and disclosures of your health information.
- If you sign a written authorization allowing us to use and disclose your health information in a specific situation other than this Notice, you may, at any time, revoke or cancel your authorization in writing, and we will stop any use and disclosure of your health information which would occur after we receive your written cancellation. But we cannot cancel any disclosures that were made before we received your written cancellation.
- You may request restrictions on the use and disclosure of your health information outlined in this Notice, however, we are not required to comply with your request.
- You have the right to request, in writing, to review and receive copies of your health information. There may be a charge for making copies of your requested health information. There are certain situations where we will be unable to grant your request to review records.
- You have the right to request, in writing, to amend existing information that is part of your health information. There are certain situations where we will be unable to grant your request to amend the health information.
- You have the right to request, in writing, a list of disclosures we have made regarding your health information. Your first request for a list will be provided to you free of charge. However, if you request a list of disclosures more than once in a 12 month period, you may be charged a reasonable fee. We will inform you of the cost incurred and you may choose to withdraw or modify your request at that time, before any costs are incurred. There are certain exceptions that apply.
- You have a right to request, in writing, to be contacted at a different address or phone number or other appropriate ways about your health information or bills. We will grant your request if reasonable.
- You have the right to receive a copy of the PBH “Notice of Privacy Practices.”
How To Complain About Our Privacy Practices
If you believe your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures; or if you have questions and would like additional information, you may write or call our Privacy Officer at:
Privacy Officer
245 LePhillip Court, NE
Concord, NC, 28025
Phone: 704-721-7000.
You may also file a written complaint, by mail or fax, to the Secretary of the Department of Health and Human Services (DHHS) at:
Office for Civil Rights
U.S. Department of Health and Human Services
61 Forsyth Street, SW – Suite 3B70
Atlanta, GA. 30323
Phone: 404-562-7886
TDD: 404-331-2867
Fax: 404-562-7881
- The complaint to the Secretary must be filed in writing, either on paper or electronically.
- The complaint must include the name “PBH”, and describe the acts or omissions believed to be in violation of the Privacy Rules.
- The complaint must be filed within 180 days of when you knew or should have known that the act or omission occurred.
- We will provide you with assistance and/or a form to file the complaint.
If you file a complaint with our Privacy Officer or the Secretary of DHHS, we will not take any action against you or change our treatment of you in any way.
PBH History of Notice of Privacy Practices:
April 14, 2003 (HIPAA)
Revised – June 23, 2005 (added updates)
Revised – August 29, 2005 (added NC-TOPPS)
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