The Arc of Monroe County, NYSARC, Inc.
Effective date: 4/14/03
NOTICE OF PRIVACY PRACTICES
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.
For questions about this notice, please contact the Privacy Officer. 585-271-0660, ext. 385
After hours: 585-442-3357, ext. 385 (Follow instructions)
WHO THIS NOTICE APPLIES TO AND OUR POLICY
Who this notice applies to and our policy:
This notice applies to all programs and services of The Arc of Monroe County. It applies to all employees, volunteers, contractors, business associates, students, interns, aides and assistants affiliated with The Arc.
Our Policy:
The Arc takes the privacy of the information used to provide services to you seriously. We will take reasonable steps to ensure that you have access to this information if and when you want, and to keep this information private from those who should not have access to it.
By law, we are required:
- to keep your information private and secure
- to provide you with this notice stating how we will use and disclose it within the course of providing services to you (treatment), to be reimbursed for our services (payment), and to maintain business operations; and
- to follow the terms of this notice.
WHEN AND HOW WE MAY DISCLOSE INFORMATION
When and how we may use or disclose information used to provide services to you:
In this section, we will explain some of the ways in which we will use or disclose information about you (hereafter referred to as, "your information" or "information about you"). Examples will be given. For each of the following uses or disclosures, until otherwise indicated, we are not required to obtain your authorization or permission.
- To provide services to you (for treatment):
Staff who are involved in providing you services may use your information in order to best assist you. Your information may also be disclosed to clinical professionals, interns, students, aides, business associates, and volunteers who are involved in providing services to you. For example, direct service staff may use dietary guidelines developed by a dietician to ensure that you receive the right type of food in the appropriate consistency. Similarly, we may, for example, disclose your psychological evaluation or treatment data to the psychiatrist we consult with so that he can identify the appropriate treatment to best help you.
Your information may also be disclosed to another health care provider in order to refer you to that provider, or so that the provider can provide appropriate treatment to you. For example, if you fall and hurt your leg, we may share your medical information with the hospital so that they can treat you correctly. There may also be incidental uses or disclosure. For example, during the normal course of business, secretarial staff not working directly with you or your program may see information about you.
- To receive reimbursement (payment):
We may use or disclose pieces of your information so that we can receive reimbursement for the services we provide. For example, we may need to share your Medicaid number with our finance office staff so that they can bill the government for services you receive. Similarly, we may, for example, submit a diagnosis or diagnoses to the government as a means of verifying that the services you receive are necessary so that we can receive payment.
We may use or disclose your information in order to maintain ongoing agency operations. Doing so helps us to ensure quality care and a consistent approach to the services we provide. For example, your information may be used by our Quality Assurance department as part of our internal monitoring of services and systems. Similarly, we may, for example, disclose your information to state and/or Federal auditors, surveyors, or recertifiers. Such a disclosure is necessary in order for us to maintain our required certifications and the funding associated with it.
Within our clinical services, we may use and disclose your information in order to contact you as a reminder that you have an appointment.
- Notification regarding new services or opportunities:
We may use and disclose your information in order to tell you about new services or opportunities that we are planning or developing, and which you might find of interest.
We may use or disclose your information for the purposes of marketing if we do this in a face-to-face meeting with you or if it relates to services or products of a nominal value.
WHEN AND HOW WE MAY DISCLOSE INFORMATION
When and how we may use or disclose information used to provide services to you:
We may use or disclose your information to a business associate with whom we have a contract or agreement or The Arc Foundation for the purposes of raising funds. If we do this, we will only use or disclose basic demographic information such as your name, address, phone number, and specific dates you may have received services. If you do not want The Arc to contact you for fundraising activities, you must notify the Privacy Officer, in writing.
The address is:
The Arc of Monroe County
1000 Elmwood Avenue, Suite 500
Rochester, NY 14620
- Other key individuals in your life:
We may disclose your information to key people involved in your life. Some of these disclosures may be required, meaning that you are not able to object. This may include, but is not limited to, your parents and legal guardians. Other individuals we may disclose your information to includes family members, service coordinator, or friend. We will not disclose your information to any of these individuals without first obtaining your consent or the consent of the individual who has the legal right to make such decisions for you.
- To avert a serious threat to health or safety:
We may use or disclose your information when necessary to prevent a serious threat to your health and safety, or that of another person. Such a disclosure would only be to someone who could help prevent or deal with the threat.
- To demonstrate compliance with HIPAA:
We may disclose information about you to governmental representatives in order to demonstrate that we are complying with the HIPAA regulations.
Special Situations:
- Organ and tissue donation:
If you are an organ donor, we may disclose parts of your information to organizations or individuals who handle organ procurement and transplantation.
If you are employed in our sheltered employment program, we may disclose your information for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
WHEN AND HOW WE MAY DISCLOSE INFORMATION
When and how we may use or disclose information used to provide services to you:
We may disclose information about you for public health activities. These activities generally include the following:
o to prevent or control disease, injury, or disability;
o to report births or deaths;
o to report child abuse or neglect;
o to report reactions to medications or problems with products;
o to notify people of recalls of products they may be using;
o to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
o to notify the appropriate government authority if we believe that a consumer has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
If you are involved in a lawsuit or dispute, we may disclose your information in response to a court or administrative order. We may also disclose your information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.
We may disclose your information if asked to do so by law enforcement personnel. This would generally be for one of the following reasons:
o to identify or locate a suspect, fugitive, material witness, or missing person;
o about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
o about a death we believe may be the result of criminal conduct;
o about criminal conduct which occurs within The Arc;
o in emergency circumstances to report a crime, the location or victims of a crime, and/or the identity, description, or location of someone who committed a crime;
- Medical examiners and funeral directors:
We may disclose your information to the medical examiner if necessary to identify a deceased person or to determine the cause of death. We may also disclose your information to a funeral director in order for them to fulfill their duties.
USES AND DISCLOSURES FOR WHICH WE REQUIRE YOUR AUTHORIZATION
Uses and disclosures for which we require your information:
Prior to using or disclosing your information for purposes other than those noted above, we will be required to obtain a signed authorization from you allowing us to do so. For example, if you asked us to send a copy of your clinical evaluations to another agency or service provider with whom we do not have an established business agreement, we would ask you to sign a very specific authorization which states:
- the specific information that will be used or disclosed
- the name of the person who is able to authorize the use or disclosure
- the name of the person to whom The Arc may make the requested use or disclosure
- a date by when the authorization is no longer valid
- a statement of your right to revoke the authorization in writing
- a statement that the information being released may be redisclosed by the party receiving it, and that we are not able to control such actions
- your signature or, if the authorization is signed by someone else, a description of his/her authority to sign the authorization on your behalf
If we ask you to authorize the disclosure of PHI to us from another provider, the request will include the following information:
- a statement describing why we are requesting the information
- a statement indicating that the treatment you receive will not be affected by whether or not you agree to our request
- a statement indicating that you have the right to refuse to sign this authorization if you so choose
YOUR RIGHTS REGARDING INFORMATION WE USE
Your rights regarding information we use to provide services to you:
You have the following rights regarding your information:
- The right to have access to, review and receive copies of your information:
The Arc acknowledges and supports your right to have access to, review of, and to receive copies of information contained within your formal records and charts (to use the regulation's terminology, the designated record set). In order to receive access, copies, or the opportunity to review your information, you must submit a written request to the director of the program where the records are that you wish to see. The Arc may deny your request under certain circumstances. If we do so, you will be notified in writing of the reasons why. If the information you are requesting is located in more than one program or site, we will give you access to it at the site or location where you first requested it, or from which the information was initially generated. If The Arc permits your access, it will provide such access in the form requested by you if it is readily producible in such form. If not, access will be provided in a form or format that you and The Arc both agree to.
You have the right to file a complaint regarding the denial. This should be directed to the Chief Operating Officer, and must be submitted in writing. The Chief Operating Officer's address is:
The Arc of Monroe County
1000 Elmwood Avenue, Suite 500
Rochester, NY 14620
S/he will conduct a review of the circumstances regarding the denial, and will render a final decision. The Arc will comply with this decision.
Prior to allowing you access to review, or copies of your information we reserve the right to verify your identity or the identity of your representative. This is to ensure that we are not disclosing your private information to someone who has no right to receive it.
If we do not maintain the information about you that you are requesting but we know where it is, we will tell you where you may request it.
- The right to amend your information:
If you feel that information contained within your records here at The Arc are inaccurate or incomplete, you have the right to ask that they be amended. You must make your request for amendments in writing. These request should be sent to the manager of the program where the records are that you are asking us to amend.
We may deny your request if one of the following applies:
o it was not created by The Arc
o it is not part of your chart (or to use the words in the regulation, it is not part of the designated record set)
o we consider it accurate and complete at the time we receive your request
You have the right to file a complaint regarding the denial. This should be directed to the Privacy Officer, and must be submitted in writing.
The Privacy Officer's address is:
The Arc of Monroe County
1000 Elmwood Avenue, Suite 500
Rochester, NY 14620
S/he will conduct a review of the circumstances regarding the denial, and will render a final decision. The Arc will comply with this decision.
YOUR RIGHTS REGARDING INFORMATION WE USE
Your rights regarding information we use to provide services to you:
- The right to an accounting of disclosures:
You have the right to request an "accounting of disclosures." By this, we mean that you can receive a listing of all the disclosures we have made of your information.
To request this accounting, you must submit a written request to the Privacy Officer. Inquiries should be sent to the following address:
The Arc of Monroe County
1000 Elmwood Avenue, Suite 500
Rochester, NY 14620
Your request must clearly identify the period you want the accounting for. This period cannot exceed 6 years and cannot include any dates prior to April 14, 2003.
- The right to request restrictions:
You have the right to request that we restrict the use and disclosure of your information. We are not required to agree to any request of restriction you submit.
We will terminate restrictions on use and disclosure of your information if you agree, in writing, to terminate the restriction, if you orally agree to terminate the restriction and such oral agreement is documented, or we inform you in writing that we are terminating the restriction. In this latter case, the termination would only apply to any information about you which is created or received after we have told you we are terminating the restriction.
To request a restriction on the use and disclosure of your information, you must submit a written request to the manager of the program involved. You must specify what information you want limited, whether you are asking us to limit use, disclosure, or both, and to whom the limits apply, if anyone. You will then be notified by The Arc as to whether or not the restriction is being agreed to or not.
- The right to request confidential communications:
You have the right to receive communication about your information from The Arc in ways that are comfortable and acceptable to you. For example, you can ask that we not leave a message with your mother, father, or housemate about such things as clinic appointments, or case review dates and times.
You must make your request for confidential communications to the manager of the program involved. We will not ask you to specify a reason for the request. We will accommodate all reasonable requests. You must specify how or where you wish to be contacted.
- The right to receive a copy of this notice:
You have the right to receive a paper copy of this notice at any time. To obtain a copy of this notice, please contact the Privacy Officer. S/he can be reached at 585-271-0660, ext. 385. You can also find a copy of this notice at each program site and on our website, www.arcmonroe.org.
CHANGES TO THIS NOTICE AND COMPLAINT INFOMRATION
Changes to this notice and complaints:
Changes to this notice:
We reserve the right to change this notice. We reserve the right to make the revised or changed notice apply to information we already have about you as well as any information we create or receive in the future. (The current version of our notice can be found on our website at www.arcmonroe.org.) In addition, whenever a revision to this notice occurs, you shall be informed within 60 days of a material revision to the notice. As indicated above, you are entitled to receive a copy of our notice at any time.
Complaints:
If you believe that your privacy rights have been violated, you may file a complaint with The Arc directly. This can be done by submitting your complaint in writing to the the manager of the program involved or the Privacy Officer. The address is:
The Arc of Monroe County
1000 Elmwood Avenue, Suite 500
Rochester, NY 14620
In addition, you have the right to file a complaint with the Secretary of the Federal Department of Health and Human Services.
You will not be treated differently nor will your services change based on your decision to file a complaint.