NOTICE OF PRIVACY PRACTICES
TRAILS CAROLINA AND ITS RELATED ENTITIES
Effective Date: April 14, 2013
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.
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) is a federal law that provides privacy protections and patient rights with regard to the use and disclosure of your or your child’s Protected Health Information (referred to in this Notice as “PHI” or “health information”) for the purpose of treatment, payment, and health care operations. Under HIPAA, Trails Carolina and its related entities (collectively, “Trails”) must take steps to protect the privacy of your “protected health information”(PHI). PHI includes information that we have created or received regarding your health or payment for your health. It includes both your medical records and personal information such as your name, your child’s name, address, phone number, etc.
All programs, functions and services operated or provided by Trails are conducted through separate but related entities. Under the privacy standards contained in HIPAA, legally separate but related entities may designate themselves as a single covered entity for compliance purposes. Accordingly, this Notice constitutes notice of the privacy practices for all of the Trails-related entities, sites and locations, which will follow the terms of this Notice. In addition, these entities, sites and locations may share health information with each other for treatment, payment or health care operations purposes as described in this Notice. All Trails employees and affiliates are required to maintain the confidentiality of PHI in accordance with this Notice and receive appropriate privacy training.
RESPONSIBILITIES OF TRAILS CAROLINA AND ITS RELATED ENTITIES
We are required by law to:
– Maintain the privacy of your protected health information (“PHI”), including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information (with certain exceptions).
– Give you this Notice of our legal duties and privacy practices with respect to health information about you or your child.
– Follow the terms of this Notice that are currently in effect.
– Train our personnel concerning privacy and confidentiality.
– Implement a sanction policy to discipline those who breach privacy/confidentiality or our policies with regard thereto.
– Mitigate (lessen the harm of) any breach of privacy/confidentiality.
We will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required by law. This Notice will describe the ways in which we may use or disclose health information about you or your minor child. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION BY TRAILS THAT DO NOT REQUIRE YOUR AUTHORIZATION
Trails uses and discloses protected health information in a number of ways connected to the provision of health care treatment and services, payment for care, and our health care operations. Some examples of how we may use or disclose your health information without your authorization are listed below.
We may use or disclose your or your child’s protected health information without your authorization as follows connected to the provision of health care treatment and services:
– To physicians, nurses, and others involved in your health care or preventive health care.
– To other health care providers treating you or your child such as hospitals, pharmacies, labs, emergency room staff and specialists
We may use or disclose your or your child’s protected health information without your authorization as follows in relation to payment for care and healthcare operations:
– To administer your health benefits policy or contract.
– To bill you for health care we provide.
– To pay others who provided care to you or your child.
– To other organizations and providers for payment activities unless disclosure is prohibited by law.
– To administer and support our business activities or those of other health care organizations (as allowed by law) including providers and plans. For example, we may use your health information to review and improve the quality of care you or your child receive, to provide training, and to evaluate the performance of our staff in caring for you or your child
– To other individuals (such as consultants and attorneys) and organizations that help us with our business activities. (Note: If we share your health information with other organizations for this purpose, they must agree to protect your privacy)
We may use or disclose your or your child’s protected health information without your authorization for legal and/or governmental purposes in the following circumstances:
– As required by law– When we are required to do so by federal, state or local law.
– Serious Threat to Health or Safety – If it is determined that there is a probability of imminent physical injury by you or your child to yourself or child’s self, or others, or if there is a probability of immediate mental or emotional injury to you or others, relevant confidential mental health information may be disclosed to medical or law enforcement personnel to protect or prevent injury to you or your child or the public or of another person.
– Public health and safety – To an authorized public health authority or individual for public health and safety purposes, including to:
– Prevent or control disease, injury, or disability
– Report vital statistics such as births or deaths.
– Report reactions to medications or problems with products and notify people of recalls of products they may be using. (Food and Drug Administration)
– Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
– Notify an employer concerning work-related injuries or illnesses or workplace medical surveillance in situations where the employer has a duty under federal or state law to keep records on or act on such information.
– Abuse or neglect – To the appropriate government authority authorized to receive reports regarding abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law. However, no consent is required in cases involving child abuse or neglect. Under the privacy standards, we must disclose your health information to DHHS as necessary to determine our compliance with those standards.
– Health oversight activities – To health oversight agencies for certain activities such as audits, investigations, inspections and licensure
– Lawsuits and disputes – In the course of any legal proceeding, in response to an order of a court or administrative agency Also, in certain cases, in response to a subpoena, discovery request, or other lawful process, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested
– Law enforcement – To law enforcement officials in limited circumstances for law enforcement purposes For example disclosures may be made to identify or locate a suspect, witness, or missing person; to report a crime; or to provide information concerning victims of crimes.
– Military activity and national security -To the military (if you are a member of the armed forces), and to authorized federal officials for national security and intelligence purposes or in connection with providing protective services to the president of the US.
– Workers’ compensation – Where authorized by law in order to comply with the workers’ compensation or similar programs These programs provide benefits for work-related injuries or illness.
We may use or disclose your or your child’s protected health information without your authorization in the following miscellaneous circumstances:
– Family or close friends – Unless you object, we may disclose health information about you or your child to a family member, relative, a close friend – or any other person you identify who is directly involved in your or your child’s health care – who is involved in your or your child’s healthcare or who helps you pay for your care. If you are either not present or unable to make a health care decision for yourself or your child and we determine that disclosure is in your or your child’s best interest, we may also disclose such health information about you or your child to those persons, typically listed on your Consent for Release of Information form.
– Treatment alternatives and health-related services – To communicate with you about treatment services, options, or alternatives, as well as health-related benefits or services that may be of interest to you
– Appointment Reminders – To remind you that you have a health care appointment with us. These reminders may be made by postcard, phone, or voicemail unless you specifically ask us to communicate with you through a different method.
– Research – For research purposes provided that certain steps are taken to protect your or your child’s privacy. All research projects, however, are subject to a special approval process This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose health information about you or your child to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the facility
– De-identify information – To “de-identify” information by removing information from your health information that could be used to identify you or your child
– Disaster relief – To an authorized public or private entity for disaster relief purposes For example, we might disclose your health information to help notify family members of your location or general condition.
– Coroners and funeral directors – To coroners and funeral directors, as authorized by law.
– Correctional institution – If you or your child are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you or your child to the correctional institution or law enforcement official for certain purposes, such as (1) providing health care to you or your child by the institution; (2) protecting your health and safety or the health and safety of others; or (3) protecting the safety and security of the correctional institution.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION THAT REQUIRE US TO OBTAIN YOUR AUTHORIZATION
Except in the situations listed in the sections above, we will use and disclose your or your child’s health information only with your written authorization. If you sign an authorization (Consent for Release of Information), you may revoke it at any time in writing, although this will not affect information that we disclosed before you revoked the authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provide to you or your child.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the right to:
– Restrictions on use or disclosure – Request a restriction or limitation on the health information we use or disclose about you or your child for treatment, payment or health care operations. “Health care operations” consist of activities that are necessary to carry out the operations of the provider, such as quality assurance and peer review. The right to request restriction does not extend to uses or disclosures permitted or required under the following sections of the federal privacy regulations: § 164.502(a)(2)(i) (disclosures to you), § 164.51O(a) (for facility directories, but note that you have the right to object to such uses), or§ 164.512 (uses and disclosures not requiring a consent or an authorization). The latter uses and disclosures include, for example, those required by law, such as mandatory communicable disease reporting. In those cases, you do not have a right to request restriction. The consent to use and disclose your individually identifiable health information provides the ability to request restriction. We do not, however, have to agree to the restriction, except in the situation explained below. If we do, we will adhere to it unless you request otherwise or we give you advance notice. 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 or friend. Please note that we are not required to agree to your request. If we do agree, we will honor your limits unless it is an emergency situation. To request restrictions, you must make your request in writing to Trails. 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, for example, disclosures to your mother.
– Confidential Communications – Request that we communicate with you about health matters by another means or at another location. For example, if you want us to communicate with you at a different address. Any request must be made in writing. Your request must specify how or where you wish to be contacted. We will agree to reasonable requests.
– Inspect and copy– Inspect and copy health information that may be used to make decisions about your care. This right is not absolute. In certain situations, such as if access would cause harm, we can deny access. You do not have a right of access to the following:
– Psychotherapy notes. Such notes consist of those notes that are recorded in any medium by a health care provider who is a mental health professional documenting or analyzing a conversation during a private, group, joint, or family counseling session and that are separated from the rest of your medical record. Raw test data from psychological testing is protected by copyright laws and Ethical Standards and cannot be released to persons unauthorized to interpret them.
– Information compiled in reasonable anticipation of or for use in civil, criminal, or administrative actions or proceedings.
– Protected health information (“PHI”) that is subject to the Clinical Laboratory Improvement Amendments of 1988 (“CLIA”), 42 U.S.C. § 263a, to the extent that giving you access would be prohibited by law.
– Information that was obtained from someone other than a health care provider under a promise of confidentiality and the requested access would be reasonably likely to reveal the source of the information.
In other situations, we may deny you access, but if we do, we must provide you a review of our decision denying access. These “reviewable” grounds for denial include the following:
– A licensed health care professional, such as your attending physician, has determined, in the exercise of professional judgment, that the access is reasonably likely to endanger the life or physical safety of yourself or another person.
– PHI makes reference to another person (other than health care provider) and a licensed health care provider has determined in the exercise of professional judgment, that the access is reasonably likely to cause substantial harm to such other person.
– The request is made by your personal representative and a licensed health care professional has determined, in the exercise of professional judgment, that giving access to such personal representative is reasonably likely to cause substantial harm to you or another person
For these reviewable grounds, another licensed professional must review the decision of the provider denying access within 60 days. If we deny you access, we will explain why and what your rights are, including how to seek review. If we grant access, we will tell you what, if anything, you have to do to get access. We reserve the right to charge a reasonable, cost-based fee for making copies.
– Amend – If you feel that medical 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 Trails. To request an amendment, your request must be made in writing and submitted to the Trails Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the 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. If, as in the case of a consultation report from another provider, we did not create the record, we cannot know whether it is accurate or not. Thus, in such cases, you must seek amendment/correction from the party creating the record. If the party amends or corrects the record, we will put the corrected record into our records.
– Is not part of the medical information kept by or for Trails;
– Is not part of the information which you would be permitted to inspect and copy as discussed above; or
– Is accurate and complete to make the amendment;
If we deny your request for amendment/correction, we will notify you why, how you can attach a statement of disagreement to your records (which we may rebut), and how you can complain. If we grant the request, we will make the correction and distribute the correction to those who need it and those whom you identify to us that you want to receive the corrected information.
Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your medical record we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.
– Accounting of disclosures – Request an “accounting of disclosures.” This is a list of the disclosures we made of health information about you other than our own uses for treatment, payment and health care operations, (as those functions are described above) and for other exceptions pursuant to the law. To request this list or accounting of disclosures, you must submit your request in writing to the Trails Privacy Officer. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, electronically). We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Obtain an accounting of non routine uses and disclosures, those other than. for treatment, payment, and health care operations until a date that the federal Department of Health and Human Services will set after January 1, 20 ll. After that date, we will have to provide an accounting to you upon request for uses and disclosures for treatment, payment, and health care operations. We do not need to provide an accounting for the following disclosures:
– To you for disclosures of protected health information to you.
– For the facility directory or to persons involved in your care or for other notification purposes as provided in§ 164.510 of the federal privacy regulations (uses and disclosures requiring an opportunity for the individual to agree or to object, including notification to family members, personal representatives, or other persons responsible for your care, of the your location, general condition, or death).
– For national security or intelligence purposes under§ 164.512(k)(2) of the federal privacy regulations (disclosures not requiring consent, authorization, or an opportunity to object).
– To correctional institutions or law enforcement officials under§ 164.512(k)(5) of the federal privacy regulations (disclosures not requiring consent, authorization, or an opportunity to object).
– That occurred before April 14, 2003.
– Paper copy – Request a paper copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.
CHANGES TO PRIVACY PRACTICES
Trails may change the terms of this Notice at any time. 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. If we change any of the practices described in this Notice, we will post the revised Notice on enrollee-accessible web sites and at Trails sites. The notice will contain on the first page, in the top right-hand corner, the effective date.
If you believe your privacy rights have been violated, you may file a complaint with Trails or with the Secretary of the Department of Health and Human Services. For more information on how to file a written complaint, contact the Trails Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
If you have any questions about this Notice or would like an additional copy, please contact the contact the Trails Privacy Officer at.