Notice of Privacy Practices 2003, rev 2005, 2011, 9/13, 12/13 Page 1 of 5 pages The Life Link, Santa Fe, New Mexico 87505 NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY. If you have any questions about this notice, please contact our Privacy Officer, Raymond Anderson at (505) 438-0010 ext 11.
WHO WILL FOLLOW THIS NOTICE This notice describes the privacy practices of The Life Link, a licensed community mental health center in Santa Fe, New Mexico (referred to herein as “The Life Link”, or the “Agency”). This notice applies to: – Any health care professional authorized to enter information into your agency chart. – All departments and programs of the Agency. – Any member of a volunteer group we allow to help you while you are in treatment. – All employees, staff and other Agency personnel. – All these entities, programs and individuals follow the terms of this notice. Additionally, they may share medical information with each other for treatment, payment or health care operations purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION We understand that information about your mental health, substance use disorder, and other physical health issues are personal medical information. We are committed to protecting medical information about you. We create a record of care and services you receive at the Agency. 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 the Agency, whether made by Agency personnel or contracted physicians/providers.
This notice will tell you about the ways in which we may use and disclose medical information about you with or without your authorization. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
Your health record contains personal information about you and your health. State and federal law (Title 45, Code of Federal Regulations Parts 160 and 164) protects the confidentiality of this information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. There are additional protections regarding medical information related to HIV/AIDS, and we will follow those requirements. The confidentiality of alcohol and drug abuse patient records is specifically protected by Federal law and regulations (42 CFR Part 2). The Life Link is required to comply with these additional restrictions. 42 CFR Part 2 includes a prohibition, with very few exceptions, on informing anyone outside the program that you attended the program or disclosing any information that identifies you as an alcohol or drug abuser unless you provide written authorization. Violation of Federal laws or regulations by this program is a crime. If you suspect a violation, you may file a report to the appropriate authorities in accordance with Federal regulations.
We are required by law to: – Make sure that medical information that identifies you is kept private (with certain exceptions); – Give you this notice of our legal duties and privacy practices with respect to medical information about you; and – Follow the terms of this notice as is currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to provide an example for clarification. 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.
Disclosure at Your Request We may disclose information when requested by you. This disclosure at your request will require your written authorization. Other uses and disclosures not described in the Notice of Privacy Practices will be made only with your authorization.
For Treatment We will use medical and clinical information about you to provide you with treatment and services. Program personnel need to be able to access your medical information and communicate to diagnose and treat you, facilitate your safety, or to refer you to appropriate treatment. For example, different departments of the Agency may share information about you to coordinate the ______________________________________________________________________________________________________________ Notice of Privacy Practices , 2003, rev 2005, 2011, 9//19/13 Page 2 of 5 pages The Life Link, Santa Fe, New Mexico 87505 different things that you need such as medications, counseling, or other medical information. This information may be used and disclosed by your physician, counselor, program staff and others outside of our program that are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and any related services. This includes coordination or management of your health care with a third party, consultation with other health care providers or referral to another provider for health care treatment. We may disclose your protected health information from time-to-time to another physician, therapist, or health care provider (e.g., a specialist) who, at the request of the program, becomes involved in your care. We may contact you to remind you of an appointment as part of your treatment.
For Payment With your authorization, we may use and disclose medical information about you so that we can receive payment for the treatment services provided to you. We may also provide basic information about you and your health plan, insurance company or other source of payment to practitioners outside of the Agency who are involved in your care, to assist them in obtaining payment for services that they provide to you. If you pay in full for the services rendered, you may restrict disclosure of PHI to your health plan or sign a form to limit the information disclosed to your health plan.
For Health Care Operations We may use and disclose your protected health information (“PHI”) for certain purposes in connection with the operation of our program including, but not limited to, quality improvement activities, alumni and fundraising activities, employee review activities, training of students, licensing, and conducting or arranging other business activities. These uses and disclosures are necessary to run the Agency and make sure that all of our clients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may share your PHI with third parties that perform various business activities (e.g., billing or transcription services) for The Life Link, provided we have a written contract with the business that prohibits it from re-disclosing your PHI and requires it to safeguard the privacy of your PHI.
Medical Emergencies We may use or disclose your protected health information in a medical emergency situation to medical personnel only. Our staff will follow up with you to obtain a written authorization for such disclosure to coordinate your ongoing and care if and when you return to the The Life Link. If the emergency happens prior to receipt of this notice we will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.
Fundraising Activities Our fundraising staff may contact you in an effort to raise money for the Agency, its operations and mission. For example, you may receive letters or other publications asking you to consider making a tax deductible contribution to The Life Link. Demographic information is used for our fundraising efforts. When conducting fundraising activities, the Agency may access only your basic demographic information (such as name and contact information), the dates that you were treated at The Life Link, information about the department of service that provided treatment and the treating physician, information about your outcome, and your health insurance status. The Life Link does not sell or rent clients’ names or addresses to any organization outside of the Agency. You have the right to opt out of fundraising communications. If you do not want to be contacted please notify the privacy officer in writing.
Marketing We may contact you with information about The Life Link health-related services and products that may be beneficial to you. Such communications are a part of Health Care Operations, and examples of these communications are invitations to continuing care programs, Agency events and recovery-oriented material. At times, The Life Link may ask you to provide specific written permission to allow the Agency to use or disclose protected health information about you. The Life Link generally will not use or disclose your protected health information for marketing purposes, in exchange for remuneration, or use or disclose any psychotherapy notes about you unless the Agency receives your authorization to do so. A valid authorization may be revoked in writing at any time. Written revocation of authorization must be submitted to the Agency and addressed to the HIPAA Privacy Officer. Once the authorization is revoked, the Agency will no longer be allowed to use or disclose protected health information for the purposes described in the authorization except to the extent The Life Link entity has already taken action based upon the authorization.
Disaster Relief We may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
For Research Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of clients in our various programs. All research projects are subject to an approval process. This process evaluates a proposed research project and its use of medical information, trying _________________________________________________________________________________________________________ Notice of Privacy Practices 2003, rev 2005, 2011, 9/13, 12/13 Page 3 of 5 pages The Life Link, Santa Fe, New Mexico 87505 to balance the research needs with clients’ 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 disclose medical information about you to people preparing to conduct a research project, as long as the medical information they review does not leave the Agency.
We may disclose PHI to researchers if (a) an Institutional Review Board reviews and approves the research and a waiver to the authorization requirement; (b) the researchers establish protocols to ensure the privacy of your PHI; (c) the researchers agree to maintain the security of your PHI in accordance with applicable laws and regulations; and (d) the researchers agree not to re-disclose your protected health information, except back to The Life Link.
As Required by Law We may disclose medical information about you when required to do so by federal, state or local law. To Avert a Threat to Health or Safety We may use and disclose medical information about 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 to prevent the threat.
Health Oversight Activities We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include for example, audits, investigations, and inspections and licensure. These activities are necessary for the government to monitor the health care system, governmental programs and compliance with civil rights laws. Oversight agencies seeking this information include government agencies and peer review organizations performing utilization and quality control. If we disclose PHI to a health oversight agency, we will have an agreement in place that requires the agency to safeguard the privacy of your information.
Public Health Activities We may disclose medical information about you for public health activities. These activities generally include the following: – To report the abuse or neglect of children, elders and dependent adults; – To report reactions to medications or problems with products; – 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; – To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when we are required or authorized by law; – To notify emergency response employees regarding possible exposures to HIV/AIDS, to the extent necessary to comply with state and federal laws.
Lawsuits and Disputes If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court order or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, 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 We may release medical information if asked to do so by a law enforcement official: – In response to a court order or warrant; – To identify or locate a suspect, fugitive, material witness or missing person; – About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; – About a death we believe may be the result of criminal conduct; – About criminal conduct at the Agency; and In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime. _______________________________________________________________________________________________________ Notice of Privacy Practices , 2003, rev 2005, 2011, 9//19/13 Page 4 of 5 pages The Life Link, Santa Fe, New Mexico 87505 Coroners, Medical Examiners and Funeral Directors We may release medical information to a coroner or medical examiner. This may be necessary for example to identify a deceased person or to determine the cause of death. We may also release medical information about clients of the Agency to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU You have the following rights regarding medical information we maintain about you.
Right of Access to Inspect and Copy You have the right, which may be restricted in certain circumstances, to inspect and receive a copy of medical information that may be used to make decisions about your care. Copies of medical information will not be provided until fourteen (14) days after discharge to ensure that treatment and medical staff have entered and validated information about you. Pursuant to California law, medical records are maintained for seven (7) years after discharge. You must submit your request in writing by completing an Authorization to Release Protected Health Information form. We may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. The form is available on our website or by contacting the Health Information Department as follows: The Life Link Medical Records 2325 Cerrillos Rd. Santa Fe, New Mexico 87505 (505) 438-0010
Right to Amend If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing and submitted to the Director of Health Information Management and Quality at the address above. 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 sufficient 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; – Is not part of the medical information kept by or for the Agency; – Is not part of the information which you would be permitted to inspect and copy; or – Is accurate and complete. 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 that 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 incomplete or incorrect.
Right to an Accounting of Disclosures You have the right to request an “accounting of the disclosures.” This is a list of any disclosure that we made of medical information about you other than our own uses for treatment, payment and health care operation and with other exceptions pursuant to the law. To request the accounting of disclosures, you must submit your request in writing to The Life Link Records Department. 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 first list you request within a 12-month period will be provided at no charge. Clients treated subsequent to April 1, 2010, when the Agency transitioned to an electronic medical record (EMR), may request an accounting of disclosures that includes treatment, payment, and operations for a period not to exceed three (3) years.
Right to a Paper Copy of this Notice You have the right to obtain a copy of this notice from us. You may ask us to give you a copy of this notice at any time or you may obtain a copy of this notice at our website: http://www.thelifelink.org
Right to Request Restrictions You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, _________________________________________________________________________________________________________ Notice of Privacy Practices 2003, rev 2005, 2011, 9/13, 12/13 Page 5 of 5 pages The Life Link, Santa Fe, New Mexico 87505 payment or health care operations. You also have the right to request a limit on the medical information that we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
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 with emergency treatment. To request restrictions, you must make your request in writing to the Director of Health Information Management and Quality. 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 spouse.
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 only contact you at home or by mail. You must make your request in writing to the Director of Health Information Management and Quality at the address listed previously. We will not ask you the reason for the request. We will accommodate all reasonable requests. Your request must specify how and/or where you wish to be contacted.
Right to be Notified of a Breach You have the right to be notified of a breach of unsecured PHI if you are affected.
CHANGES TO THIS NOTICE We may change the terms of this notice at any time. If we change this notice, we may make the new notice terms effective to all protected health information that we maintain, including any information created or received prior to issuing the new notice. If we change this notice, we will post the new notice in public access areas at our service sites and on our Internet site at http://www.thelifelink.org. Upon admission to the Agency, we will provide you with a copy of the current notice in effect. You may also obtain a paper copy by contacting the Privacy Officer.
COMPLAINTS If you believe we have violated your privacy rights, you may file a complaint in writing to our Privacy Officer: Raymond Anderson The Life Link 2325 Cerrillos Rd., Santa Fe, New Mexico 87505 You may contact the Privacy Officer at (505) 438-0010; or by e-mail at email@example.com. We will not retaliate against you for filing a complaint. You may also file a complaint with the U.S. Secretary of Health and Human Services as follows: 200 Independence Avenue, S.W. Washington, D.C. 20201 (202) 619-0257