NOTICE
OF PRIVACY POLICIES
FOR
Chrysalis
Introduction
At Chrysalis, we are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. Any reference to “notice” hereafter, refers to this document. It also describes your rights as they relate to your protected health information. This Notice is effective 9/15/03, and applies to all protected health information as defined by federal regulations, including Health Insurance Portability and Accountability Act (HIPAA).
Understanding Your Health Record/Information
Each time you have contact with Chrysalis a record of your interaction is made. Typically, this record contains your behavioral health history, test results, diagnoses, releases and consents, treatment, treatment plan, evaluation and assessments, and a plan for 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 many health professionals
who contribute to your care,
· Legal document describing the care you received,
· Means by which Chrysalis or a third-party payer can verify
that services billed were actually provided,
· A tool in educating heath professionals,
· A source of information for public health officials charged
with improving the health of this state and the nation,
· A source of data for our planning and marketing,
· A tool with which we can assess and continually work to improve
the care we render and the outcomes we achieve.
Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.
Your Health Information Rights
Although your health record is the physical property of Chrysalis, the information belongs to you. You have the right to:
· Obtain a paper copy of this notice of information practices
upon request,
· Inspect and copy your health record as provided for in 45 CFR
164.524,
· Amend your health record as provided for in 45 CFR 164.528,
· Obtain an accounting of disclosures of your health information
as provided for in 45 CFR 164.528,
· Request communications of your health information by alternative
means or at alternative locations,
· Request a restriction on certain uses and disclosures of your
information as provided by 45 CFR 164.522, and
· Revoke your authorization to use or disclose health information
except to the extent that action has already been taken.
Our Responsibilities
Chrysalis is required to:
· Maintain the privacy of your health information,
· Provide you with this notice as to our legal duties and privacy
practices with respect to information we collect and maintain about
you,
· Abide by the terms of this notice,
· Notify you if we are unable to agree to a requested restriction
on uses and disclosures of your health information, and
· Accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative locations.
We reserve the right to change our practices and to make new provisions effective for the protected health information we maintain. Should our information practices change, we will make a copy available to you at your next appointment. A copy of the current privacy notice will always be available at the reception desk.
We will not use or disclose your health information without your authorization, except as described in this notice.
We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization. A copy of the current revocation/restriction form will always be available by the reception desk.
Examples of Disclosures for Treatment,
Payment and Health Care Operations
We will use your health information for treatment.
For example: Information obtained by a member of your treatment team will be recorded in your record and used to determine the course of treatment that should work best for you. Staff will document in your record his or her expectations of the members of your treatment team. Members of your treatment team will then record the actions they took and their observations. In that way, staff will know how you are responding to treatment.
Chrysalis reserves the right to share information regarding your treatment between programs within the agency.
If requested in writing, Chrysalis will send a copy of your records to a subsequent healthcare provider.
We will use your health information for payment.
For example: A bill may be sent to you or third-parties.
The information on or accompanying the bill may include information
that identifies you, as well as your diagnosis and procedures.
We will use your health information for regular health operations.
For example: Members of the treatment staff or members of the quality management team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
Business Associates: There are some services provided in our organization through contacts with business associates. Examples include funding sources, emergency services, laboratory testing, judicial and legal services and ValueOptions crisis services. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or third-parties for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or in the event of medical or legal intervention; of your location, and general condition. Pending your verbal consent, Chrysalis may contact you to provide appointment reminders or other health-related benefits and services that may be of interest to you.
Communication with family: Health professionals, using their best judgment, may disclose to a family member, close personal friend or any other person you identify, health information relevant to that person’s involvement in your treatment, payment or health care operations..
Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.
Fund raising: We may contact you as part of a fund raising effort.
Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Law enforcement: We may disclose health information for law enforcement purposes as required by law, in response to a valid subpoena or court order.
Federal law makes provisions for your health information to be released
to an appropriate health oversight agency, public health authority or
attorney, provided that a work force member or business associate believes
in good faith that we have engaged in unlawful conduct or have otherwise
violated professional or clinical standards and are potentially endangering
one or more patients, workers, or the public.
For More Information or to Report a Problem
If you have questions and/or would like additional information, you may contact the agencies’ Privacy Officer, Jacquelyn Anderson at 602.955.9059.
If you believe your privacy rights have been violated, you can file a complaint with the agencies’ Privacy Officer, or with the Office for Civil Rights (OCR), U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Chrysalis Privacy Officer or the Office for Civil Rights. The address for the OCR is listed below:
Office for Civil Rights
Department of Health and Human Services
50 United Nations Plaza Room 232
San Francisco, CA 94102
(415) 437-8310 (415) 437-8329 (Fax)
Revision 1.1