Effective date: 4/9/03
NOTICE OF PRIVACY PRACTICES
OF UNITED CEREBRAL PALSY OF NEW YORK CITY, INC.
THIS NOTICE DESCRIBES
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED TO OTHERS AND HOW
TO GET ACCESS TO THIS INFORMATION.
PLEASE READ IT
CAREFULLY.
TABLE OF CONTENTS
IMPORTANT SUMMARY
INFORMATION
DETAILED INFORMATION
What health
Information is protected
Specific information only for consumers in OMRDD services
Your rights to access and control your health information
IMPORTANT SUMMARY INFORMATION
INTRODUCTION
UCP/NYC has a legal
duty to protect health information about you. This Privacy Notice tells you how
medical information about you and other consumers may be used and disclosed
(given) to others. This notice also tells you, your guardians and/or personal
representatives how you can get access to this information.
When the word “you”
is used in this document, it is referring to the consumer. Guardians and
personal representatives may use this information to assist the consumer.
We are required by
law to protect the privacy of health information that may reveal your identity,
and to provide you with a copy of this notice which describes the health
information privacy practices of our agency, its staff, and affiliated health
care providers that jointly provide treatment, and perform payment activities
and business operations, with our agency.
A copy of our current notice will always be posted in our reception
area. You will also be able to obtain a
copy by accessing our website at www.ucpnyc.org
or calling our office at (212)677-7400 X
128, or asking for one at the time of your next visit.
QUESTIONS
If you have any questions about this notice or would like
further information, please contact the Privacy Officer at (212)677-7400 X 128.
REQUIREMENT FOR
WRITTEN AUTHORIZATION
We will generally obtain your written
authorization before using your health information or sharing it with others
outside the agency. You may also
initiate the transfer of your records to another person by completing an
authorization form. If you provide us
with written authorization, you may revoke that authorization at any time,
except to the extent that we have already relied upon it. To revoke an authorization, please write to
the Privacy Officer.
EXCEPTIONS TO
AUTHORIZATION REQUIREMENT
There are some
situations when we do not need your written authorization before using your
health information or sharing it with others.
They are:
·
Exception For Treatment, Payment, And
Agency Operations. We may use your
health information to treat your condition, collect payment for that treatment,
and run our agency’s normal business operations. We also may disclose your health information to another provider
or a payor for its payment activities, and for certain of its business operations
if it also has or had a treatment or payment relationship with you and the
information pertains to that relationship.
Exception For Disclosure To Friends And
Family Involved In Your Care. We
will ask you whether you have any objection to sharing information about your
health with your friends and family involved in your care.
·
Exception In Emergencies Or Public Need. We may use or disclose your health
information in an emergency or for important public needs. For example, we may share your information
with public health officials at the New York State or City health departments
who are authorized to investigate and control the spread of diseases.
·
Exception If Information Does Not Identify
You. We may use or disclose your
health information if we have removed any information that might reveal who
your identity.
HOW TO ACCESS YOUR
HEALTH INFORMATION
You generally have
the right to inspect and copy your health information.
HOW TO CORRECT YOUR
HEALTH INFORMATION
You have the right to
request that we amend your health information if you believe it is inaccurate
or incomplete.
HOW TO KEEP TRACK OF
THE WAYS YOUR HEALTH INFORMATION HAS BEEN
SHARED WITH OTHERS
You have the right to
receive a list from us, called an “accounting list,” which provides information
about when and how we have disclosed your health information to outside persons
or organizations. Many routine
disclosures we make will not be included on this accounting list, but the accounting
list will identify non-routine disclosures of your information.
HOW TO REQUEST
ADDITIONAL PRIVACY PROTECTIONS
You have the right to
request further restrictions on the way we use your health information or share
it with others. We are not required to
agree to the restriction you request, but if we do, we will be bound by our
agreement.
HOW TO REQUEST MORE
CONFIDENTIAL COMMUNICATIONS
You have the right to
request that we contact you in a way that is more confidential for you, such as
at work instead of at home. We will try
to accommodate all reasonable requests.
HOW SOMEONE MAY ACT
ON YOUR BEHALF
You have the right to
name a personal representative who may act on your behalf to control the
privacy of your health information.
Parents and guardians will generally have the right to control the
privacy of health information about minors unless the minors are permitted by
law to act on their own behalf.
HOW TO LEARN ABOUT
SPECIAL PROTECTIONS FOR HIV, ALCOHOL AND SUBSTANCE ABUSE, MENTAL HEALTH AND
GENETIC INFORMATION
Special privacy
protections apply to HIV-related information, alcohol and substance abuse
treatment information, mental health information, and genetic information. Some parts of this general Notice of Privacy
Practices may not apply to these types of information. If your treatment involves this information,
you will be provided with separate notices explaining how the information will
be protected. To request copies of
these other notices, please contact the Privacy Officer, (212)677-7400 X 128.
You have the right to
a paper copy of this notice. You may
request a paper copy at any time, even if you have previously agreed to receive
this notice electronically. To do so,
please call the Privacy Officer, (212)677-7400 X 128.
You
may also obtain a copy of this notice from our website at www.ucpnyc.org or by requesting a copy
at your next visit.
HOW TO OBTAIN A COPY
OF PRIVACY NOTICE, WHEN IT CHANGES
We may change our
privacy practices from time to time. If
we do, we will revise this notice so you will have an accurate summary of our
practices. The revised notice will
apply to all of your health information, and we will be required by law to
abide by its terms. We will post any
revised notice in our agency reception area.
You will also be able to obtain your own copy of the revised notice by
accessing our website at www.ucpnyc.org,
calling our office at (212)677-7400 X128, or asking for one at the time of your
next visit. The effective date of the notice will always be noted in the top
right corner of the first page.
HOW TO FILE A
COMPLAINT
If you believe your
privacy rights have been violated, you may file a complaint with us or with the
Secretary of the Department of Health and Human Services. To file a complaint with us, please contact
the Privacy Officer at (212)677-7400 X 128, UCP/NYC, 122 E. 23 St., NY, NY,
10010.
REQUIREMENT FOR WRITTEN AUTHORIZATION
We will generally obtain your written
authorization before using your health information or sharing it with others
outside the agency. You may also
initiate the transfer of your records to another person by completing an
authorization form. If you provide us
with written authorization, you may revoke that authorization at any time,
except to the extent that we have already relied upon it. To revoke an authorization, please write to
the Privacy Officer.
WHAT HEALTH INFORMATION IS PROTECTED
We are committed to
protecting the privacy of information we gather about you while providing
health-related services. Some examples
of protected health information are:
- the fact that you are a
participant at, or receiving treatment or health-related services from,
our agency;
- information about your health
condition (such as a disease you may have);
- information about health care
products or services you have received or may receive in the future (such
as a medication or treatment); or
- information about your health care
benefits under an insurance plan (such as whether a prescription is
covered);
When combined with:
- geographic information (such as
where you live or work);
- demographic information (such as
your race, gender, ethnicity or marital status);
- unique numbers that may identify
you (such as your social security number, your phone number, or your
driver’s license number); and
- other types of information that
may identify who you are.
ACCORDING TO LAW, WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR WRITTEN AUTHORIZATION
1. Treatment, Payment And Agency Business
Operations
The agency and its staff may use your health information
or share it with others in order to treat your condition, obtain payment for
that treatment, and run the agency’s normal business operations. Your health information may also be shared
with affiliated agencies so that they may jointly perform certain payment
activities and business operations along with our agency. Your health information also may be
disclosed to another health care provider for its treatment and payment
activities, and for certain limited business operations by it. Below are further examples of how your
information may be used and disclosed by our agency.
Treatment (45
C.F.R. §§164.506(1)&(2)). We may
share your health information with doctors, nurses, therapists, aides and other
health care professionals at the agency who are involved in providing services
to you, and they may in turn use that information to diagnose or treat you, or
to develop a plan of services for, you.
A health care professional at our agency may share your health
information with another health care professional inside our agency, or with a
health care professional at another agency, to determine how to diagnose or
treat you. Your health care
professional may also share your health information with another agency or
provider to whom you have been referred for further health care. Finally, we may share your health
information with others outside the agency as necessary to carry out your
treatment plan; for example, we may disclose certain information about your
health to a prospective employer in connection with a job placement or training
program.
Payment We may use
your health information or share it with others so that we obtain payment for
your health care services. For example,
we may share information about you with your health insurance company in order
to obtain reimbursement after we have provided services to you. In some cases, we may share information
about you with your health insurance company to determine whether it will cover
your services. We might also need to
inform your health insurance company about your health condition in order to
obtain pre-approval for your services, such as care provided at a residential
treatment facility. Finally, we may
share your health information with other providers and payors for their payment
activities.
Business Operations (We
may use your health information or share it with others in order to conduct our
normal business operations. For
example, we may use your health information to evaluate the performance of our
staff in caring for you, or to educate our staff on how to improve the care they
provide for you. We may also share your
health information with another company that performs business services for us,
such as billing companies. If so, we
will have a written contract to ensure that this company also protects the
privacy of your health information.
Finally, we may share your health information with other providers and
payors for certain of their business operations if that other party also has or
had a treatment or payment relationship with you, and in that event we will
only share information that pertains to that relationship.
Appointment Reminders, Treatment Alternatives, Benefits And
Services. We may use your
health information when we contact you with a reminder that you have an
appointment for treatment or services at our facility. We may also use your health information in
order to recommend possible treatment alternatives or health-related benefits
and services that may be of interest to you.
Fundraising (We
may use demographic information about you, including information about your age
and gender, and where you live or work, and the dates that you received
treatment, in order to contact you to raise money to help us operate. We may also share this information with a
charitable foundation that will contact you to raise money on our behalf. If you do not want to be contacted for these
fundraising efforts, please write to Director of Development, UCP/NYC, 80
Maiden Lane, NY, NY.
2. Friends
And Family
We
may share your health information with
friends and family involved in your care, without your written
authorization or other written permission.
We will always give you an opportunity to object unless there is
insufficient time because of a medical emergency (in which case we will discuss
your preferences with you as soon as the emergency is over). We will follow your wishes unless we are
required by law to do otherwise.
If
you do not object, we may share your health information with a family member,
relative or close personal friend who is involved in your care or payment for
that care. We may also notify a family
member, personal representative, or another person responsible for your care
about your location and general condition here at our facility, or about the
unfortunate event of your death. In
some cases, we may need to share your information with a disaster relief
organization that will help us notify these persons.
Incidental Disclosures. While we will take reasonable steps to
safeguard the privacy of your health information, certain disclosures of your
health information may occur during or as an unavoidable result of our
otherwise permissible uses or disclosures of your health information. For example, during the course of a
treatment session, other consumers in the treatment area may see, or overhear
discussion of, your health information.
3. Public
Need
We
may use your health information, and share it with others, in order to meet
important public needs. We will not be
required to obtain your written authorization, consent or any other type of
permission before using or disclosing your information for these reasons.
As Required By Law. We may use or disclose your health
information if we are required by law to do so. We also will notify you of these uses and disclosures if notice
is required by law.
Public Health Activities.
We may disclose your health information to authorized public health officials
(or a foreign government agency collaborating with such officials) so they may
carry out their public health activities.
For example, we may share your health information with government
officials that are responsible for controlling disease, injury or
disability. We may also disclose your
health information to a person who may have been exposed to a communicable disease
or be at risk for contracting or spreading the disease if a law permits us to
do so. And finally, we may release some
health information about you to your employer if your employer hires us to
provide you with a physical exam and we discover that you have a work-related
injury or disease that your employer must know about in order to comply with
employment laws.
Victims Of Abuse, Neglect Or Domestic Violence. We may release your
health information to a public health authority that is authorized to receive
reports of abuse, neglect or domestic violence. For example, we may report your information to government
officials if we reasonably believe that you have been a victim of abuse,
neglect or domestic violence. We will
make every effort to obtain your permission before releasing this information,
but in some cases we may be required or authorized to act without your
permission.
Health Oversight Activities. We may release your
health information to government agencies authorized to conduct audits, investigations,
and inspections of our facility. These
government agencies monitor the operation of the health care system, government
benefit programs such as Medicare and Medicaid, and compliance with government
regulatory programs and civil rights laws.
Product Monitoring, Repair And Recall. We may disclose your
health information to a person or company that is required by the Food and Drug
Administration to: (1) report or track product defects or problems; (2) repair,
replace, or recall defective or dangerous products; or (3) monitor the performance of a product
after it has been approved for use by the general public.
Lawsuits And Disputes. We may disclose your health information if
we are ordered to do so by a court or administrative tribunal that is handling
a lawsuit or other dispute.
Law Enforcement. We may disclose your health information to
law enforcement officials for the following reasons:
- To comply with court orders or
laws that we are required to follow;
- To assist law enforcement officers
with identifying or locating a suspect, fugitive, witness, or missing
person;
- If you have been the victim of a
crime and we determine that: (1) we have been unable to obtain your
consent because of an emergency or your incapacity; (2) law enforcement
officials need this information immediately to carry out their law
enforcement duties; and (3) in our professional judgment disclosure to
these officers is in your best interests;
- If we suspect that your death
resulted from criminal conduct;
- If necessary to report a crime
that occurred on our property; or
- If necessary to report a crime
discovered during an offsite medical emergency (for example, by emergency
medical technicians at the scene of a crime).
To Avert A Serious Threat To Health Or Safety. We may use your
health information or share it with others when necessary to prevent a serious
threat to your health or safety, or the health or safety of another person or
the public. In such cases, we will only
share your information with someone able to help prevent the threat. We may also disclose your health information
to law enforcement officers if you tell us that you participated in a violent
crime that may have caused serious physical harm to another person (unless you
admitted that fact while in counseling), or if we determine that you escaped
from lawful custody (such as a prison or mental health institution).
National Security And Intelligence Activities Or Protective
Services. We may disclose your health information to
authorized federal officials who are conducting national security and
intelligence activities or providing protective services to the President or
other important officials.
Military And Veterans. If you are in the Armed Forces, we may
disclose health information about you to appropriate military command
authorities for activities they deem necessary to carry out their military
mission. We may also release health
information about foreign military personnel to the appropriate foreign
military authority.
Inmates And Correctional Institutions. If you are an
inmate or you are detained by a law enforcement officer, we may disclose your
health information to the prison officers or law enforcement officers if
necessary to provide you with health care, or to maintain safety, security and
good order at the place where you are confined. This includes sharing information that is necessary to protect
the health and safety of other inmates or persons involved in supervising or
transporting inmates.
Workers’ Compensation. We may disclose your health information for
workers’ compensation or similar programs that provide benefits for
work-related injuries.
Coroners, Medical Examiners And Funeral Directors In the unfortunate event of your death, we may disclose
your health information to a coroner or medical examiner. This may be necessary, for example, to
determine the cause of death. We may
also release this information to funeral directors as necessary to carry out
their duties
Organ And Tissue Donation. In the unfortunate
event of your death, we may disclose your health information to organizations
that procure or store organs, eyes or other tissues so that these organizations
may investigate whether donation or transplantation is possible under
applicable laws.
Research. In most cases, we will ask for your written authorization
before using your health information or sharing it with others in order to
conduct research. However, under some
circumstances, we may use and disclose your health information without your
authorization if we obtain approval through a special process to ensure that
research without your authorization poses minimal risk to your privacy. Under no circumstances, however, would we
allow researchers to use your name or identity publicly. We may also release your health information
without your authorization to people who are preparing a future research
project, so long as any information identifying you does not leave our
facility. In the unfortunate event of
your death, we may share your health information with people who are conducting
research using the information of deceased persons, as long as they agree not
to remove from our facility any information that identifies you.
THIS SECTION ONLY RELATES TO THE HEALTH AND CLINICAL INFORMATION MAINTAINED FOR CONSUMERS IN
RESIDENCES AND ADULT DAY PROGRAMS LICENSED BY THE NEW YORK STATE OFFICE OF
MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES (OMRDD)
For
consumers in UCP/NYC residences and day program which are licensed by OMRDD,
there a few additional reasons, mandated by law, when the OMRDD licensed
programs must disclose your health information without written authorization:
1.
When we are
communicating with other mental retardation/developmental disabilities agencies
which are currently providing services to you or working with us to plan for
services for you, if this communication is about treatment, payment, or agency
operations.
2.
To a personal
representative who is authorized to make health care decisions on your behalf
3.
To appropriate
government authorities to locate a missing person or conduct a criminal
investigation as permitted under Federal and State confidentiality laws.
4.
To other licensed agency emergency services as permitted under Federal and State confidentiality laws.
5.
To the Mental
Hygiene Legal Services offered by New York State
6.
To an attorney representing you in an involuntaryhospitalization or medication proceeding (We will not disclose clinical information about you to an attorney for any other reason without your authoriazation).
FOR ALL UCP/NYC CONSUMERS:
YOUR RIGHTS TO ACCESS AND CONTROL
YOUR HEALTH INFORMATION
We want you to
know that you have the following rights to access and control your health
information. These rights are important
because they will help you make sure that the health information we have about
you is accurate. They may also help you
control the way we use your information and share it with others, or the way we
communicate with you about your medical matters.
1. Right
To Inspect And Copy Records
You
have the right to inspect and obtain a copy of any of your health information
that may be used to make decisions about you and your treatment for as long as
we maintain this information in our records.
This includes medical and billing records. To inspect or obtain a copy of your health information, please
submit your request in writing to the Privacy Officer. If you request a copy of the information, we
may charge a fee for the costs of copying, mailing or other supplies we use to
fulfill your request. The standard fee
is $0.75 per page and must generally be paid before or at the time we give the
copies to you.
We
will respond to your request for inspection of records within 10 days. We ordinarily will respond to requests for
copies within 30 days if the information is located in our facility, and within
60 days if it is located off-site at another facility. If we need additional time to respond to a
request for copies, we will notify you in writing within the time frame above
to explain the reason for the delay and when you can expect to have a final
answer to your request.
Under
certain very limited circumstances, we may deny your request to inspect or
obtain a copy of your information. If
we do, we will provide you with a summary of the information instead. We will also provide a written notice that
explains our reasons for providing only a summary, and a complete description
of your rights to have that decision reviewed and how you can exercise those
rights. The notice will also include
information on how to file a complaint about these issues with us or with the
Secretary of the Department of Health and Human Services. If we have reason to deny only part of your
request, we will provide complete access to the remaining parts after excluding
the information we cannot let you inspect or copy.
2. Right To Request Amendment of Records
If
you believe that the health 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 in our records. To
request an amendment, please write to the Privacy Officer.. Your request should include the reasons why
you think we should make the amendment.
Ordinarily we will respond to your request within 60 days. If we need additional time to respond, we
will notify you in writing within 60 days to explain the reason for the delay
and when you can expect to have a final answer to your request.
If
we deny part or all of your request, we will provide a written notice that
explains our reasons for doing so. You
will have the right to have certain information related to your requested
amendment included in your records. For
example, if you disagree with our decision, you will have an opportunity to
submit a statement explaining your disagreement, which we will include in your
records. We will also include
information on how to file a complaint with us or with the Secretary of the
Department of Health and Human Services.
These procedures will be explained in more detail in any written denial
notice we send you.
3. Right
To An Accounting Of Disclosures
After
April 14, 2003, you have a right to request an “accounting of disclosures”
which is a list that contains certain information about how we have shared your
information with others. An accounting
list, however, will not include any information about:
- Disclosures we made to you;
- Disclosures we made because of
your authorization;
- Disclosures we made for treatment,
payment or health care operations;
- Disclosures made to your friends
and family involved in your care or payment for your care;
- Disclosures made to federal
officials for national security and intelligence activities;
- Disclosures that were incidental
to permissible uses and disclosures of your health information;
- Disclosures for purposes of
research, public health or our normal business operations of limited
portions of your health information that do not directly identify you;
- Disclosures about inmates to
correctional institutions or law enforcement officers; or
- Disclosures made before April 14,
2003.
To
request this accounting list, please write to the Privacy Officer. Your request
must state a time period within the past six years (but after April 14, 2003)
for the disclosures you want us to include.
For
example, you may request a list of the disclosures that we made between January
1, 2004 and January 1, 2005. You have a
right to receive one accounting list within every 12 month period for
free. However, we may charge you for
the cost of providing any additional accounting list in that same 12 month
period. We will always notify you of any
cost involved so that you may choose to withdraw or modify your request before
any costs are incurred.
Ordinarily
we will respond to your request for an accounting list within 60 days. If we need additional time to prepare the
accounting list you have requested, we will notify you in writing about the
reason for the delay and the date when you can expect to receive the accounting
list. In rare cases, we may have to
delay providing you with the accounting list without notifying you because a
law enforcement official or government agency has asked us to do so.
4. Right To Request Additional Privacy
Protections
You
have the right to request that we further restrict the way we use and disclose
your health information to treat your condition, collect payment for that
treatment, or run our agency’s normal business operations. You may also request that we limit how we
disclose information about you to family or friends involved in your care. For example, you could request that we not
disclose information about a surgery you had.
To request restrictions, please write to the Privacy Officer. Your
request should include (1) what information you want to limit; (2) whether you
want to limit how we use the information, how we share it with others, or both;
and (3) to whom you want the limits to apply.
We
are not required to agree to your request for a restriction, and in some cases
the restriction you request may not be permitted under law. However, if we do agree,
we will be bound by our agreement unless the information is needed to provide
you with emergency treatment or comply with the law. Once we have agreed to a
restriction, you have the right to revoke the restriction at any time. Under some circumstances, we will also have
the right to revoke the restriction as long as we notify you before doing so;
in other cases, we will need your permission before we can revoke the
restriction.
5. Right
To Request Confidential Communications
You
have the right to request that we communicate with you about your medical
matters in a more confidential way by requesting that we communicated with you
by alternative means or at alternative locations. For example, you may ask that we contact you by fax instead of by
mail, or at work instead of at home. To
request more confidential communications, please write to the Privacy
Officer. We will not ask you the reason for your request, and we will try to
accommodate all reasonable requests.
Please specify in your request how or where you wish to be contacted,
and how payment for your health care will be handled if we communicate with you
through this alternative method or location.
(End of Privacy
Notice)
