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PRIVACY POLICY
FOUNDATIONS BEHAVIORAL HEALTH MEDICAL INFORMATION
NOTICE
Effective Date: March 2003
Purpose of this Notice. This Notice describes
Foundation’s
privacy practices, specifically how we use and disclose your
medical information as well as the rights you have with respect
to this information.
a) You should read this Notice carefully
before signing it. Please contact the FBH Privacy Officer,
who is listed on
the signature page of this document, to discuss any Foundations
privacy practice or this Notice.
The Use and Disclosure
of Medical Information for Treatment, Payment and Health
Care Operations. By law Foundations is
allowed to use and disclose your medical information for
most treatment, payment and healthcare operations purposes.
a) Treatment means provision, coordination
or management of health care and related services by or
involving Foundations,
such as the coordination of consultations and referrals.
Foundations can share most medical information regarding
your health condition with another provider as part of
a consultation. Also, related to your treatment, Foundations
may contact you to remind you of any appointments that
may
have been scheduled for you or to notify you regarding
treatment alternatives or other health-related benefits
and services
that may be of interest to you.
b) Payment primarily means
Foundations’ activities
related to getting reimbursed for services provided to
you. However, payment can also cover activities to determine
your
eligibility for services with your insurer, coordination
of benefits with other insurers, billing, claims management,
collection, medical necessity review activities, utilization
review activities, and disclosure to consumer reporting
agencies. For instance, we can disclose to your health
plan medical
information that is required by the plan to determine
whether the services we have provided to you are medically
necessary.
c) Health care operations means a range
of Foundations activities that are necessary to Foundations’ operations.
They may be performed by Foundations or, in some cases,
by third-party
contractors. They include quality assessment and improvement
activities; peer review; credentialing and licensing;
training programs; legal and financial services; business
planning
and development; management activities related to Foundations
privacy practices; customer services; internal grievances;
creating de-identified information for data aggregation
or other purposes; and due diligence activities.
The
Use and Disclosure of Medical Information Without Your
Consent, Authorization or Other Permission. Under
certain
circumstances, Foundations may use or disclose your
medical information without a Consent, Authorization or
other
written permission from you. These circumstances are
as follows:
a) As Required by Law. State, federal and
local laws permit or require certain uses and disclosures
of medical
information.
Foundations may disclose medical information for
Judicial Proceedings, as required by a Court Order. Foundations
may also release medical information to police
or other
law enforcement
officials as required by a court administrative
order. However, Foundations may only use or disclose your
medical information
to the extent authorized by law.
b) To a Public
Health Authority. Foundations may
be asked or required by law to divulge medical
information to
a public health authority under the following
circumstances:
i) to report a birth, death, disease or
injury, as required by law;
ii) as part of a public health investigation;
iii) to report child or adult abuse or neglect,
or domestic violence, as authorized by law;
iv) to report adverse events (such as product
defects), to track products or assist in product
recalls or
repairs or
replacements, or to conduct post-marketing
surveillance, as required by the Food and Drug
Administration;
v) to notify a person about exposure to a possible
communicable disease, as required by law.
c) For Health Oversight Activities. Health
oversight activities include audits, government
investigations,
inspections,
disciplinary proceedings, and other administrative
and judicial actions
undertaken by the government (or their
contractors) by law to oversee the health care system.
Foundations may
be asked
or required to share medical information
with a health oversight agency for these activities.
d)
To Coroners, Medical Examiners and Funeral Directors.
Foundations may release information
regarding a decedent
as required by law or in order to facilitate
funerary activities.
e) To Avert a Serious
Threat to Health and Safety. Foundations may use or disclose
your
medical
information to avert
a serious and imminent threat to a
person's or the public's health
and safety.
Authorizations for Other
Uses and Disclosures of Your Medical Information. We
are permitted or required
to
use your medical
information for the reasons listed
above. We must obtain your Authorization
for
any other
disclosure
or use
of your medical information. An Authorization
is a written
permission
that specifically identifies the
information that we seek to use or disclose, and
to whom and for what
purpose
we
seek to use or disclose it. For instance,
if you are applying for acceptance
into an educational
institution,
Foundations
must obtain your Authorization to
share your medical information with the institution.
You
may revoke
an
Authorization at
any time except to the extent we
have already used or disclosed information
in reliance
on your Authorization.
Individual
Rights. You have a number of rights
with respect to your medical
information.
They
are as
follows:
a) Restrictions. You have
the right to restrict how Foundations uses
and discloses
your medical
information
for treatment,
payment or operations purposes,
and other individuals involved
in your
health care.
We are bound
by an agreement to restrict
the use or disclosure of your
information except in emergency circumstances.
However, we do
not have to
agree to a
restriction if we do not believe
we can or should comply with
it. Also,
we can ask you to revoke a
restriction. Please direct any request for
a restriction to the
Health Information
Services
Department or the Privacy Officer.
b) Confidential Communications. You have
the right to request that Foundations
restrict the way in which
we
communicate
information regarding your
health,
health
care
services, or payment. For
instance, you may ask that we communicate
with you only at your home,
not at your work. Assuming that we
receive
your request
in writing,
we will
do our best to
reasonably accommodate it.
Please contact the Health Information
Services Department
to obtain
and complete
a written request
for confidential communications.
c) Access. You have the right to inspect
most of the medical information
maintained
by Foundations.
Normally,
we will
provide you with access
within thirty (30) days of
your request. We may charge
a reasonable copying fee.
In certain
limited
instances, we may deny
you access (mental health treatment
records
must be reviewed
by a treating
psychiatrist
prior to release to patients/family
members) and you may appeal
the denial. Any request
to inspect or receive copies
of medical
information
should be
made to the Health
Information Department.
d) Amendment. You have the right to ask
Foundations to amend written
medical
information. For instance,
you
can request
that we correct any incorrect
treatment date in you
records. We will generally
amend your
information
within sixty
(60) days of you request,
and will notify
you when we have amended
your information. We
can deny your request only
in
certain
circumstances,
such as
when we believe
that
the information
is accurate and complete,
and you can appeal our
denial. Please
direct
any
request to
amend your medical
information
to the Health Information
Department.
e) Accounting.
You have the right
to request
an accounting
from
Foundations of certain
disclosures made by
us during the six (6) years
prior to your
request. We will generally
provide you with your
accounting within sixty
(60) days
of your request. These
disclosures
do not include
those
made
for certain purposes
including treatment,
payment or operations.
Please forward
any accounting
request to
the Health Information
Department.
f) Paper
Notice. If you have obtained this
Notice
electronically,
you
may obtain a
paper copy by
asking the Health
Information Department or any staff
member.
g) Complaints.
If you believe any right
with
respect
to your medical
information
has been
violated by
Foundations, its
employees or its
agents, you may
complain to
Foundations and/or
the Secretary
of the Federal
Department of
Health and Human
Services. If you
wish to file a
complaint, please
contact the Health
Information Department
who will provide
you with the appropriate
complaint
form.
Under no circumstances
will Foundations
take any retaliation
against
you
for filing a complaint.
Foundations
Duties. Foundations
is
required by law
to
maintain the
privacy of your
medical information
and
to provide
you with this
Notice of our legal duties
and privacy
practices with
respect to
your medical
information. We must
comply with the
Notice currently
in effect.
We will revise
the Notice if
we materially
change
any privacy practice
stated in
this Notice.
If
we revise a
Notice, copies
will be available
by
asking the Health
Information Department
or any Foundations
staff member.
We may choose
to apply
a change in
a privacy practice
to information
that
we created
or
received prior
to issuing a revised
Notice.
FBH Privacy Officer: Linda Zan, Director of Health Information
Services 215-345-0444 Ext. 150
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