Devereux Cleo Wallace - HIPAA
Notice Effective Date: September 23, 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.
Please Review it Carefully
Questions about this notice should be directed to the Center or Corporate Privacy Officer at (407) 857-3491
Who Will Follow This Notice
This notice describes Devereux Advanced Behavioral Health’s privacy practices and that of:
- Any health care professional authorized to enter information into Devereux Advanced Behavioral Health records containing your personal medical information (the term ‘medical information’ used throughout this Notice includes all health-care related information).
- All departments and units of Devereux Advanced Behavioral Health Treatment Centers and Devereux Advanced Behavioral Health Corporate.
- All employees, staff and other workforce members who are not employees but who are under Devereux Advanced Behavioral Health's control while they are working at Devereux Advanced Behavioral Health's facilities.
The Devereux Advanced Behavioral Health Foundation has many Treatment Centers. All of our Treatment Centers follow the terms of this notice. Additionally, our Treatment Centers may share your medical information with each other for the treatment, payment and operations purposes described in this notice.
Our Pledge Regarding Your Medical Information
Devereux Advanced Behavioral Health is dedicated to protecting your personal medical information. When you receive care at Devereux Advanced Behavioral Health we create a record set necessary for:
- your treatment,
- our payment actions related to your treatment, and
- management of our health care operations related to your treatment.
Health records may be created by Devereux Advanced Behavioral Health personnel or by a doctor or other licensed professional who treats you at Devereux Advanced Behavioral Health but who is not a Devereux Advanced Behavioral Health employee. Non-employee doctors and other licensed professionals may have different policies or notices regarding use and disclosure of your medical information created in their private offices or clinics. They are responsible to provide you with their Notice of Privacy Practices.
Required by Law
This notice applies to how we may use and disclose your medical records while you are receiving care at Devereux Advanced Behavioral Health. It also describes your rights with respect to your personal medical information. We are required by law to:
- make sure that medical information that identifies you is kept private;
- give you this notice that describes why and how we may use or share your medical information
- have you sign a form signifying you received a copy of the notice; and
- follow the terms of this notice on its effective date and thereafter until modified.
How We May Use and Disclose Medical Information About You
The following categories describe different ways we use and disclose medical information. For each category of uses or disclosures we explain what we mean and give some examples. All of the ways we use and disclose information will fall within one of the categories.
- For Treatment: We may use and disclose medical information about you to another party on your behalf so that we can get paid for the treatment and services your receive at Devereux Advanced Behavioral Health. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other Devereux Advanced Behavioral Health personnel who are involved in taking care of you. For example, a doctor treating you for depression may need to know if you have other health conditions that might be related to your depression. Also, different departments of Devereux Advanced Behavioral Health may share your medical information in order to coordinate the different things you need, such as prescriptions and lab work. We also may disclose medical information about you to people outside Devereux Advanced Behavioral Health who may be involved in your health care after you leave Devereux Advanced Behavioral Health, such as family members or others we use to provide services that are part of your care.
- For Payment: We may use and disclose medical information about you so that the treatment and services you receive at Devereux Advanced Behavioral Health may be billed to and payment collected from you or another party on your behalf. For example, we may need to give your health plan information about treatment that you received at Devereux Advanced Behavioral Health so your health plan will pay us for the treatment. We also may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
- For Health Care Operations: We may use and disclose your medical information for Devereux Advanced Behavioral Health operations. Such uses and disclosures are necessary to run Devereux Advanced Behavioral Health and to make sure 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 also combine medical information about many Devereux Advanced Behavioral Health clients to decide what additional services we should offer, what services are not needed, and if certain new treatments are effective. We also may disclose information to doctors, nurses, technicians, medical students, and other Devereux Advanced Behavioral Health personnel for review and learning purposes. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without knowing that your information is included.
- Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment at Devereux Advanced Behavioral Health.
- Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
- Fundraising Activities and Communication: We may use or disclose your information in order to contact you for fundraising activities. If you do not wish to receive fundraising requests from Devereux Advanced Behavioral Health, please email your notice to firstname.lastname@example.org or call (888) 672-6759 and leave us a message with your name and number. There is no requirement that you agree to accept fundraising communication from us, and we will honor your request not to receive any future fundraising communications or materials from us after the date we receive your decision.
- Individuals Involved in Your Care or Payment for Your Care: We may release medical information about you to designated parties who are involved in your care. We also may give information to someone who helps pay for your care. You have the right to restrict disclosures of protected health information to your health plan if you have paid for services out of pocket in full. In addition, 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.
- 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 all clients with the same condition who received one medication to those who received another medication. All research projects are subject to a special approval process. This process evaluates a proposed research project and its use of medical information to ensure client medical information is only used and disclosed as necessary for the research project. Normally we use or disclose medical information for research only after the project has been approved through the research approval process. However, we may disclose medical information about you to researchers to help them identify clients with specific medical needs. In these pre-research actions, we will not allow researchers to copy or otherwise transmit your medical information outside Devereux Advanced Behavioral Health. Also we will most often ask for your authorization if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at Devereux.
- As Required By Law: We will disclose medical information about you when required to do so by federal, state or local law.
- To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you 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 able to help prevent the threat.
- The following uses and disclosures will be made only with authorization from you. If authorization is given, it may later be revoked in writing:
- uses and disclosures for marketing purposes
- uses and disclosures that constitute the sale of PHI
- most uses and disclosure of psychotherapy notes
Special Situation for Release of Medical Information
- Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We also may disclose medical information about you to the Department of Veterans Affairs upon your separation or discharge from military services. This disclosure may be necessary for the Department of Veterans Affairs to determine if you are eligible for certain benefits.
- Workers' Compensation: We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Public Health Risks: We may disclose medical information about you for public health activities. These activities generally include the following:
ü to prevent or control disease, injury or disability;
ü to report births and deaths;
ü to report child abuse or neglect;
ü to report reactions to medications or problems with products;
ü to notify people of recalls of products they may be using;
ü 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;
ü 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 when required or authorized by law or if you authorize such disclosure.
- 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, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
- Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court 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 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:
ü In response to a court order, subpoena, warrant, summons or similar process;
ü To identify or locate a suspect, fugitive, material witness, or missing person;
ü About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
ü About a death we believe may be the result of criminal conduct;
ü About criminal conduct at Devereux Advanced Behavioral Health; and
ü 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.
- Coroners, Medical Examiners and Funeral Directors: We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about a deceased person 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.
- Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
- Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary for the following:
ü for the institution to provide you with health care
ü to protect your health and safety or the health and safety of others; or
ü for the safety and security of the correctional institution.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your prior, fully informed, written authorization. If you provide us authorization to use or disclose medical information about you, you may revoke the authorization at any time by giving us written instructions to revoke. If so instructed, we will no longer use or disclose medical information about you for the reasons covered by the authorization you revoke. We will be unable to take back any disclosures already made prior to the authorization being revoked. We also are required to retain in your medical records such disclosures as may have been made during the time the authorization was in effect.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:
- Right to Inspect and Copy: You have the right to inspect and copy your medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include any psychotherapy notes maintained by your provider. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Center or Corporate Privacy Officer. If you request a copy of the information, Devereux Advanced Behavioral Health 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 your medical information in certain very limited circumstances. If you are denied access to your medical information you may appeal the denial. Your appeal will be considered by a licensed health care professional chosen by Devereux Advanced Behavioral Health and not previously involved in the denial of your original request for inspection and copy. Devereux Advanced Behavioral Health will abide by the decision of the appeal reviewer.
- 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. You have the right to request an amendment for as long as the information is kept by or for Devereux Advanced Behavioral Health. To request an amendment, you must make it in writing and submit it to the Center or Corporate Privacy Officer. You must provide justification and documentation that supports your amendment request. We may deny your request for an amendment if it is not in writing or does not include justification and documentation to support the request. In addition, we may deny your request if you ask us to amend information that:
ü Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
ü Is not part of the information kept by or for Devereux;
ü Is not part of the information which you would be permitted to inspect and copy; or
ü Is accurate and complete.
- Right to an Accounting of Medical Information Disclosures: We keep a record of every time we share your medical information for purposes other than treatment, payment and operations. We generally classify these types of disclosures as “non-routine” and we control and track such disclosures. You will be notified in the event of a breach of your Protected Health Information. We do not maintain a record of disclosures made when you have given written authorization for such disclosures. To request an accounting of these “non-routine” disclosures, you must submit your request in writing to Center or Corporate 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 also should indicate in what form you want the accounting (for example, on paper, electronically). The first accounting you request within a twelve (12) month period will be provided free of charge. For additional accountings within the same twelve (12) month period, we may charge you for the costs of providing the accounting. 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.
- 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, payment or operations. You also have the right to request a limit on the medical 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. For example, you could ask that we not use or disclose information about your treatment at Devereux Advanced Behavioral Health to your family members. To request restrictions, you must make your request in writing to the Center or Corporate Privacy Officer. In your request, you must tell us:
ü what information you want to limit;
ü whether you want to limit our use, disclosure or both; and
ü to whom you want the limits to apply, for example, disclosures to your family.
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 emergency treatment to you.
- Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the Center or Corporate Privacy Officer. Your request must specify how or where you wish to be contacted. You do not have to provide the reason for your request. Devereux Advanced Behavioral Health will accommodate all reasonable requests.
- Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain another paper copy of this notice, contact the Center or Corporate Privacy Officer. You may obtain an electronic copy of this notice at our website, www.devereux.org. Even if you have an electronic version of the Notice, you are still entitled to a paper copy if you want one.
Changes to This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any medical information we create in the future. We will post a copy of the current notice at appropriate client access points in our treatment facilities. The notice will contain its effective date on the top of the first page. In addition, each time you register at or are admitted to Devereux Advanced Behavioral Health for treatment or health care services as an inpatient or outpatient, we will ask you if you want a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the Devereux Advanced Behavioral Health Treatment Center Privacy Officer or with the Secretary of the Department of Health and Human Services.
To file a complaint with Devereux Advanced Behavioral Health, contact the Center Privacy Officer or the Corporate Privacy Officer at:
5850 T.G. Lee Blvd., Suite 470
Orlando, FL 32822
Telephone # (407) 857-3491
All complaints must be submitted in writing and the Treatment Center Privacy Officer will advise you about how to submit the complaint. Your complaint actions will be held in the strictest confidence. Devereux Advanced Behavioral Health will not take any actions to discourage you from filing a complaint nor will we act against you in any way because of filing a complaint.