Philhaven Behavioral Healthcare
NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATION
Effective Date: 4/14/03
Revision Date: 12/30/13
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.
OUR LEGAL DUTY
We are required by law to restrict the uses and disclosures of your health information. We are also required to give you this Notice about our privacy practices, our legal duties and your rights concerning your health information. We will follow the privacy practices that are described in this Notice while it is in effect. Our privacy practices, as described in this Notice, will remain in effect until we change this Notice.
We are required to notify you of any breach or inadvertent disclosure of your health information.
We reserve the right to change our privacy practices and the terms of this Notice, at any time, as may be permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make significant change to our privacy practices, we will change this Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about or privacy practices, or for additional copies of this Notice, please contact us by using the information listed at the end of this Notice.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
Certain health information is considered “highly confidential” and we discuss that later in this Notice. The following lists describe our uses and disclosures of health information that is not “highly confidential.”
Health Information About You for Treatment, Payment and our Healthcare Operations May be Used or Disclosed Without Your Written Authorization in the Following Circumstances:
For Treatment. We may use or disclose your health information to a physician or other healthcare provider to provide you with treatment and services. For example, we will make a record of the treatment and services we provide to you, and those members of the treatment team involved in your care will have access to that information.
For Payment. We may use or disclose your health information to obtain payment for services that we provide to you. For example, in order for us to receive payment from your insurance company, we will need to tell your insurance company about the services we have provided to you. Please note that if you are receiving services for drug and alcohol treatment, we will obtain your authorization to disclose health information to the insurance company that is paying for your treatment.
For Health Care Operations. We may use and disclose your health information for our operational purposes. Some of the ways in which we use your health information include monitoring the quality of care we deliver; checking compliance with laws and other legal obligations; education of our staff; health care contracting; business planning and development; and business management and administration.
To Our Business Associates. We may disclose your health information to organizations or individuals who carry out certain key functions or processes for us, such as accreditation, auditing, and legal services. Before we disclose your health information under these circumstances, we will require the “business associate” to which we make such a disclosure to give us written assurance that it will take reasonable measures to safeguard and protect the privacy of your health information. Also, our Business Associates have legal obligation to protect your health information.
Appointment Reminders. We may use your health information to provide you with appointment reminders (such as voicemail messages, postcards or letters).
Treatment Alternatives; Health-Related Benefits and Services. We may use your health information to tell you about or recommend possible treatment options or alternatives or about health-related benefits or services that may be of interest to you.
Development and Fundraising Activities. We may contact you to provide information to you about Philhaven-sponsored activities, including fundraising programs and events. For this purpose, we only would use contact information, such as your name, address and phone number and the dates you received treatment or services at Philhaven. You have no obligation to respond to these communications, and you will be given the opportunity to opt-out of receiving such communications in the future.
Marketing and Sale of PHI: We may request your authorization for disclosure to third-parties for marketing purposes when receiving financial remuneration. Also, we may request your authorization prior to making a disclosure of your health information before receiving any direct or indirect remuneration from or on your behalf, cash or in-kind for the disclosure.
We may disclose your health information to a disaster relief agency in the event of a disaster, so that your family can be notified about your condition, status and location. When it is practical to do so, we will give you the opportunity to agree or object, in writing, to this disclosure.
Health Information About You may be Used or Disclosed Without Your Authorization or Without Giving You an Opportunity to Agree or Object in the Following Circumstances:
As Required by Law. We will disclose your health information when we are required to do so by law.
Research. Philhaven is a research institution. Your health information may be important to further research efforts and the development of new knowledge. Although we will generally only use your health information in connection with research when we have first received your authorization to do so, we may use your information for research purposes without first obtaining your authorization when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.
To Avert A Serious Threat to Health or Safety. We may use and disclose your health information when necessary to prevent or lessen 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 or lessen the threat.
Military and Veterans. If you are or were a member of the armed forces, we may release your health information to military command authorities as required by law. We may also release health information about foreign military personnel to the appropriate foreign military authority as required by law.
Workers’ Compensation. We may use or disclose your health information for workers’ compensation or similar programs as permitted or required by law. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your health information for public health purposes, including the prevention and control of disease, injury or disability; reporting vital events such as births and deaths; reporting abuse, neglect or domestic violence; and reporting adverse events or surveillance related to food, medications, or defects and other problems with products; notifying persons of recalls, repairs or replacements of products they may be using.
Health Oversight Activities. We may disclose your health information to governmental, licensing or auditing agencies for activities authorized by law.
Lawsuits and Other Legal Actions. We may disclose your health information in response to a court or administrative order.
Law Enforcement. If asked to do so by a law enforcement official, and in accordance with state and federal law, we may release your health information in order to assist law enforcement officials to carry out their responsibilities.
Coroners or Medical Examiners. In most circumstances, we may disclose your health information to a coroner or medical examiner, for example, to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities. As required by law, we may disclose your health information to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law, or so they may provide protection to the President and other domestic and foreign high-ranking officials, or to conduct special investigations.
Inmates. If you are an inmate of a correctional institution under the custody of law enforcement officials, we may release your health information to the correctional institution, if required by law.
Highly Confidential Health Information
Certain information is considered “highly confidential” because Federal and State laws give it special protection. In Pennsylvania, Highly Confidential Health Information includes (1) information about your mental health treatment and/or psychotherapy notes; (2) treatment information about drug or alcohol abuse or dependence; (3) HIV-related information; and (4) sexual assault counseling records. Under Pennsylvania state law, we must generally get your authorization to disclose Highly Confidential Health Information about you, but we may disclose it without first getting your authorization in the following circumstances:
Mental health treatment. We may disclose information from your mental health treatment records to those who are providing you with treatment. We may also disclose information from your mental health treatment records to someone you identify as being responsible for paying for your care, such as an insurance company, but we will only disclose the limited amount of information necessary for our payment purposes. We may disclose information from your mental health treatment records to the County Mental Health Administrator, a Mental Health Review Officer or to an attorney representing you at a commitment hearing. We may disclose information from your mental health treatment records when we are required to do so by law, such as to meet our requirement to report suspected child abuse. Regulators such as licensing agencies may review our organization from time to time, and they may have access to your mental health treatment records during those reviews. Other legally authorized reviewers may also review the care and services we have provided, and they may need to have us disclose information from your mental health records to them. We may disclose information from your mental health treatment records if we are ordered by a court to do so. If you are older than 14 but younger than 18, we may need to release your mental health treatment records to your parent or guardian, if you need medical care that they must agree to. In an emergency, we may release information from your mental health treatment records in order to prevent someone (including you) from being harmed.
Drug and alcohol treatment records. We may disclose information from your drug and alcohol treatment records to a judge who has sentenced you, if your being in treatment is a condition of the sentence. We may also disclose information from your drug and alcohol treatment records to a judge who has assigned you to a drug and alcohol treatment program under a pre-sentence conditional release program. We may also disclose information from your drug and alcohol treatment records to your probation or parole officer, if your probation or parole is conditioned on you being in treatment. In all other cases, we will get your authorization before we release information from your drug and alcohol treatment records. But if you have a medical emergency, we may release information from your drug and alcohol treatment records to proper medical authorities so that they may provide medical treatment to you.
HIV-related information. If you are HIV-positive, we will generally not disclose information about you that would identify you as being HIV-positive. Certain medications, for example, are typically only given to HIV-positive persons. If you were receiving such a medication, that information would not generally be disclosed by us without your authorization. We may, however, without your authorization, disclose HIV-related information to a physician who ordered an HIV test, or to health care or social service providers who are providing you with care and services. We may disclose your HIV-related information to your health insurer, so that we can get paid for the care and services we are providing to you. We may disclose HIV-related information to persons or organizations who review our services for peer review, accreditation, licensure, or other oversight activities. We may disclose HIV-related information about you when we are required to do so by law—for instance, to the Department of Health. We may disclose your HIV-related information to a person so named in a court order. In the event of your death, we may disclose your HIV-related information to the funeral director who will receive your body. If we are pursuing youth residential placement for you, we may also disclose your HIV-related information to certain county agencies or facilities to help coordinate this placement.
Sexual assault counseling records. If we provide you with sexual assault victim counseling, we will not release or disclose those records without your authorization.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
The medical record that we create about you is the property of Philhaven. You have the following rights, however, regarding health information we maintain about you in paper or electronic format.
Right to Inspect and Copy. With certain exceptions, you have the right to inspect and/or receive a copy of your health information. To inspect and/or receive a copy of your health information, you must submit your request in writing to the person whose name appears at the end of this Notice. If you request a copy of the information, we may charge a fee.
We may deny your request to inspect and/or to receive a copy in certain limited circumstances. If you are denied access to your health information, we will explain the reason(s) to you. In most cases you may have the denial reviewed. Another licensed health care professional chosen by us will review your request and the denial. The person conducting the review will not be the person who first denied your request. We will comply with the outcome of the review.
Right to Request an Amendment or Addendum. You have the right to request that we amend your health information, if you believe that the health information we have about you is incorrect or incomplete. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.
Right to an Accounting of Disclosures. You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than treatment, payment, healthcare operations and the other reasons listed above, for the past six (6) years (but not before April 14, 2003). If you request this accounting more than once in a 12-month period, we may charge you a fee for responding to these additional requests.
Right to Request Restrictions. You have the right to request that we restrict or limit some of our uses and disclosures of your health information. We are not required to agree to these restrictions, but if we agree, we will abide by our agreement.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you only at work or by mail. Your request must be in writing, and must specify the alternative means or location, and provide satisfactory explanation of how payments will be handled under the alternative means or location you request.
Right to Request a Required Restriction: You have the right to request that your treatment information not to be reported to your insurance company; if you pay for that encounter in full out-of pocket. In some cases, we may not require to comply with your request and we will explain the reason to you.
Right to a Paper Copy of This Notice. If you received this Notice on our website or by electronic mail (e-mail), you are entitled to receive this Notice in written form. To obtain a paper copy of this Notice, use the contact information at the end of this Notice.
COMPLAINTS AND FURTHER INFORMATION
If you believe your privacy rights have been violated, you may file a complaint with Philhaven or with the Secretary of the United States Department of Health and Human Services. To file a complaint with Philhaven, or to receive further information on our privacy practices or the content of this Notice, contact:
Director of Health Information Management/HIPAA Privacy Office
Philhaven Behavioral Healthcare
283 South Butler Road
P.O. Box 550
Mt. Gretna, PA 17064
Phone: (717) 273-8871 ext. 1220 or 2406
Toll Free: 800-932-0359
All complaints to Philhaven must be in writing.
You will not be penalized for filing a complaint.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of your health information not covered by this Notice or the laws that apply to us will be made only with your written permission, including disclosures to your family. If you provide us with permission to use or disclose health information about you, you may revoke that permission, in writing, under certain circumstances. If you revoke your permission, we are unable to take back any disclosures we have already made with your permission.