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NOTICE OF PRIVACY PRACTICES
PUTNAM FAMILY & COMMUNITY SERVICES, INC.
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.
Putnam Family & Community Services, Inc. (PFCS) is dedicated to helping people enhance their potential, better manage their lives and improve the quality of family and community living. In order to fulfill this mission we must maintain a commitment to ensure that all individuals who are involved in our services are treated with respect and that all information is treated with the utmost confidentiality and privacy. As such this notice is designed to inform you about PFCS’s Privacy Practices. These privacy practices are followed by our employees, staff and all office personnel.
We are required by law to give you this notice. This notice will describe how we may use and disclose information that is called “protected health information” (PHI). PHI is any information, oral, recorded, or demographic data that may identify you (i.e. name, address, diagnosis etc.) or that may relate to your past, present or future physical, mental health or condition and related health care services. We will also outline your rights and our obligations regarding the use and disclosure of that information.
PFCS is required to abide by the terms of this Notice of Privacy Practices, which go into effect as of
April 14, 2003
If you have any questions/issues in regards to this notice please contact:
PFCS'S Privacy Officer
Deborah Flynn-Capalbo
845-225-2700 ext. 131
YOUR RIGHTS: PFCS needs your consent/permission, in writing, to use protected health information for the follow reasons:
Treatment
We may use your protected health information to better serve your treatment/services needs. We may disclose this information in an attempt to coordinate or manage your care and any related services. This may include sharing information with other mental health or community providers to better assist you in achieving your personal goals. For example, you may ask for some assistance with securing housing, organizing your benefits or perhaps finding a new therapist or psychiatrist. With your permission we would share information in an attempt to assist you with securing the services you need. It is also important for you to be aware that at times your case record may be reviewed as part of an on-going process to ensure that PFCS is providing quality service and care. Specific agency staff is assigned to review records as part of Quality Management and they may have access to your record in an attempt to verify that agency standards are being met and that we are in compliance with all applicable state and federal laws.
Payment
PFCS may disclose protected health information about you in order to obtain payment for health care services. For example, we may need to give your health plan information about a service, your diagnosis, your name/address, or type of treatment received in an effort to secure payment from your insurance. We may also need to 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 health information about you in order to run the office and make sure that you and other individuals involved with PFCS receive quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also share PHI with our attorneys, consultants and others in order to ensure that PFCS is in compliance with applicable NYS Laws.
PFCS may use your Protected Health Information without written consent in the following circumstances:
PFCS may use PHI in an effort to notify you or remind you about an upcoming or scheduled appointment for treatment.
In an effort to provide you with the most comprehensive treatment available we may discuss with you possible treatment
options/alternatives or health related products or services that may be of interest to you. We may also use or disclose
health information about you in a way that does not personally identify you or reveal who you are.
In addition, we may use or disclose PHI about you without your permission in the following special situations:
| Serious Threat to Health or Safety | We may use and disclose protected health 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. |
| Required by Law | We will disclose protected health information about you when required to do so by federal, state or local law. |
| Workers' Compensation | We may release protected health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness. |
| Public Health Matters | PFCS may be required to report your health information to authorities to help prevent or control disease, injury, or disability. This may require PFCS to report information about births, deaths, or suspected child/elder abuse or neglect. |
| Health Oversight Activities | We may disclose health information to individuals/agencies for the purpose of audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor PFCS and ensure compliance with government and civil rights laws. |
| Research | Any research conducted at PFCS would first require approval from PFCS’s Board of Directors to ensure that it meets the mission and ethical standards of the agency and is in the best interest of the individuals we serve. Any research that may be conducted at PFCS shall not identify any individual patient in any report of that research or otherwise disclose individual identities. |
| Military, Veterans, National Security | If you are or were a member of the armed forces, or part of the national security, we may be asked by military or government authorities to release protected health information about you |
| Law Enforcement/Lawsuits Court Services | We may release protected health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements. |
| Food and Drug Administration (FDA) | We may disclose health information about you to the FDA, or to an entity regulated by the FDA for example, in order to report an adverse event or a defect related to a drug or medical device. |
| Victims of Abuse, Neglect or Domestic Violence | PFCS may notify the appropriate government authorities if we believe a client has been the victim of abuse, neglect or domestic violence. We will only make such disclosure if you agree or when required or authorized by law. |
| Death/Organ Donation | 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 disclose your health information to people involved with obtaining, storing or transplanting organs or tissue donations. |
| Emergencies | PFCS may use or disclose your protected health information in an emergency treatment situation. If an emergency occurs and treatment is given by law, your provider will notify you and will attempt to get your authorization as soon as possible. In case of a disaster we may be required to notify the appropriate disaster relief organizations, authorities, family, care givers, friends, to keep them aware of your health status, condition or location. |
| Minors | If you are an unemancipated minor under New York law, there may be circumstances in which we disclose health information about you to a parent, guardian, or other person acting in loco parentis, in accordance with our legal and ethical responsibilities. |
| Parent | If you are a parent of an unemancipated minor, and are acting as the minor’s personal representative, we may disclose health information about your child to you under certain circumstances. For example, if we are legally required to obtain your consent as your child’s personal representative in order for your child to receive care from us, we may disclose health information about your child to you. In some circumstances, we may not disclose health information about an unemancipated minor to you. For example, if child is legally authorized to consent to treatment (without separate consent from you), consents to such treatment, and does not request that you be treated as his or her personal representative, we may not disclose health information without your child’s written authorization. |
| Family/Friends/Caregivers | PFCS may disclose important health information about you to your family member, friend, caregiver, partner, relative, legal guardian or foster parent. We would make every attempt to gain your permission prior to disclosing information, but may need to notify any of the above persons responsible for your care in regards to your location, general condition, or death. In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest. In that situation, we will disclose only health information relevant to the person's involvement in your care. You have the right to object to such disclosure at any point in your care/treatment with PFCS, again unless there is an emergency. |
| Disaster Relief | We may disclose health information about you to government entities or private organizations (such as the Red Cross) to assist in disaster relief efforts. If you are available, we will provide you an opportunity to object before disclosing any such information. If you are unavailable because, for example, you are incapacitated, we will use our professional judgment to determine what is in your best interest and whether a disclosure may be necessary to ensure an adequate response to the emergency circumstances. |
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
Except for the above outlined areas, PFCS would request your written Authorization to release protected health information (PHI). At any time during your treatment or care with PFCS you may revoke your Authorization, in writing. If you would like to withdraw your Authorization please contact PFCS’S Privacy Officer who will provide you with the necessary paperwork to complete this withdrawal of authorization. Once completed, all written paperwork requests should be mailed to Privacy Officer at PFCS, 1808 Route 6, Carmel, NY 10512.
YOUR RIGHTS: You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy
You have the right to inspect and copy your health information, such as medical and billing records, that we use to make decisions about your care. If you request a copy of the information, PFCS may charge a fee for the costs of copying, mailing or other associated supplies. We may also deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your health information, you may ask that the denial be reviewed. Please contact PFCS’s Privacy Officer if you have any questions about how to access your records.
Right to Make Changes
If you believe PFCS has health information about you that is incorrect or incomplete, you may ask PFCS to make changes to correct the information. We ask that you contact PFCS’s privacy officer in writing and provide as much detail as possible as to what information needs to be changed and why. We may deny your request if you ask us to amend information that PFCS did not create, or if PFCS believes the information is complete and accurate.
Notice of Breach of Health
In the unlikely event that your health information is inadvertently acquired, accessed, used Information by or disclosed to an unauthorized person, we will provide you with written notice of such breach. The notice will be sent without unreasonable delay and in no case later than 60 calendar days after discovery of breach. The notice will be written in plain language and will contain the following information: (1) a brief description of what happened, the date of the breach, if known, and the date of discovery; (2) the type of PHI involved in the breach; (3) any precautionary steps you should take; (4) a description of what we are doing to investigate and mitigate the breach and prevent future breaches; and (5) how you may contact us to discuss the breach.
The written notice of breach will be sent by regular mail or by email if you indicated that you
prefer to receive communications from us by email. If the contact information we maintain
for you is insufficient or out-of -date, we may attempt to provide notice to you by telephone
or other permissible alternate method. We will also report the breach to the U.S.
Department of Health and Human Services.
Right to Request Restrictions
You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend.
If we do agree, we will comply with your request unless the information is needed to to Your Request provide you emergency treatment.
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 work or by mail.
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 emergency treatment.
Right to Request Confidential Communication
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 work or by mail.
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 this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. If you would like to file a complaint please contact PFCS’s Privacy Officer.
If you have any questions about this notice, please contact:
Deborah Flynn-Capalbo
Privacy Officer
1808 Route 6
Carmel, NY 10512
(845) 225-2700 ext 131
Fax# (845) 225-3207
dCapalbo@pfcsinc.org