Notice of Health Information Privacy Practices1
This organization is required to maintain the privacy of your health information. This statement of Citizen Advocates, Inc., and its subdivisions, practices governing use of your private health information applies to all programs and services which obtain and use personal identifying information and/or treatment information. We will not use or disclose this information without your authorization, except as described in this notice.
This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Understanding Your Treatment Record/Information
Each time you make contact with a service provider, a record of the contact is made. Typically, this record contains information about your symptoms, evaluation results, diagnoses, treatment, and a plan for your future care or treatment. This information, often referred to as your health or medical record, serves as a:
- Basis for planning your care and treatment
- Means of communication among the health professionals who contribute to your care
- Legal document describing the care you received
- Means by which you or a third-party payer can verify that the services billed were actually provided
- Tool in educating our health professionals
- Source of information for public health officials charged with improving state or national health care
- Tool with which we can assess and continually work to improve the care we give and results we
Your Health Information Rights
Although your health record is the physical property of the health care provider or facility that compiled it, the information belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your information
- Inspect, amend and/or receive a copy of your treatment record according to guidelines established in accordance with state and federal regulations, upon written request to the appropriate Citizen Advocates, Inc. program2
- Obtain an accounting of disclosures of your health information, upon written request
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken
- Request that we communicate with you by alternate means. We will accommodate such requests that are reasonable and will not request an explanation from you
- Request that we restrict disclosures of your health information to health plans, if you have paid for services out of pocket in full.
- Receive notice in the event of a breach of your health information.
We may contact you to remind you of appointments, or to give you information about treatment alternatives or health related benefits that may be of interest to you.
We will request your authorization for any use or disclosures related to marketing, or that constitute the sale of PHI.
When disclosing information, we are responsible to provide only that information that is necessary for the purpose for which the information is intended. We are required by law to disclose information in cases of endangerment to you or others. These exclusions to privacy are described later in this policy. In the event that these practices are changed, you will be given a revised notice and will have the opportunity to request restrictions or to revoke authorizations for release of information.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact the Compliance Officer at :
518-483-1251 ext. 2233; by e-mail – firstname.lastname@example.org ; or by mail addressed to: Compliance Officer, Citizen Advocates, Inc.; P.O. Box 608; Malone, NY 12953.
You may contact the Compliance Officer anonymously at: 518-354-4182.
If you believe your privacy rights have been violated, you can file a complaint with the Compliance Officer or you can contact the Secretary of Health and Human Services at 1-877-696-6775 or writing to 200 Independence Ave. SW, HHH Building Room 509H, Washington, DC 20201.
All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Examples of Disclosures for Treatment, Payment and Health Operations
Use of information for treatment: Information obtained by members of your treatment team will be recorded in your record(s) and used to recommend your course of treatment. The providers will record the actions they took and their observations. Your record documents how you are responding to treatment.
Note that certain restrictions may exist in the exchange of information between our programs. Records of application to, an interview at, counseling, or any other service or treatment that could identify you as a drug or alcohol patient are not accessible to any other related provider without your specific written authorization. Information contained in psychotherapy notes is also exempt from release without specific written authorization. Additional confidentiality restrictions apply to information which could reasonably identify you as a person who has been tested for HIV, or have an HIV related infection.3
Use of information for payment: A bill may be sent to you or to a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis and services received. Records may be reviewed by payers to determine the necessity and quality of services provided.
Use of information for regular health operations: Office personnel provide services of appointment scheduling, transcribing, filing, billing and other routine management services required to maintain the services of our programs. Clinical supervisors and quality improvement staff may use information in your record to assess care and treatment outcomes, in an effort to continually improve the quality and effectiveness of the services we provide. Reviewers from the various New York State and Federal agencies, and other qualified enforcement agencies that regulate our programs, and third party payers, conduct periodic reviews of records to assess program compliance with treatment standards.
Communication with family: Health providers may disclose to a family member, other relative, close personal friend or any other person you identify, information relevant to that person’s involvement in your care or payment related to your care.
Personal representative: Personal representatives include power of attorney, parents, or others authorized by law to act on an individual’s behalf. Providers must review each case to determine the laws that apply to release of information to personal representatives.
Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or its agents, health information necessary for your health and the health and safety of other individuals.
Court: We must release information to a court when presented with a court order issued by a judge or clerk for the court, or similarly, provide testimony in response to a subpoena when the court has found that the interests of justice significantly outweigh the need for confidentiality.
Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. We may also disclose information to researchers if the information will be protected as required by Federal Regulations.
Exclusions: We must report information necessary to protect an individual or individuals from serious and imminent danger, including suspected child abuse or maltreatment, or under a court order requiring disclosure, “upon a finding by the court that the interests of justice significantly outweigh the need for confidentiality”. We must also report a crime or a threat to commit a crime on program premises or against program personnel.
Business Associates: Citizen Advocates provides some healthcare services and related functions through the use of contracts with business associates, for example medical transcription. When these services are contracted, we may disclose your health information to business associates so they can perform their jobs. We require our business associates to protect and safeguard your health information in accordance with all applicable federal laws.
1 Health Information Portability and Accountability Act, Standards for Privacy of Individually Identifiable Health
Information, 45 CFR Parts 160 and 164.
2 We ask for written requests to provide a record of dates of requests and of the specific information requested, to assure
that responses are processed in a timely manner and in accordance with Citizen Advocates, Inc.’s policies and procedures. You
may request a copy of our policy on access or amendment of records.
3 Federal Laws 42CFR Part 2 and New York Mental Hygiene Law Section 23.05 apply to alcohol and substance abuse
records; Public Health Law Article 27-F to HIV related information.