HIPAA Notice of Privacy Practices

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.

This Notice of Privacy Practices (“Notice”) applies to the use and disclosure of health information of clients of Privatus Care Solutions, Inc. (“Privatus”) and all records maintained by Privatus that contain such information.  This Notice applies to Privatus’s workforce (employees and contractors) as well as service providers of Privatus (known as “business associates”) who receive or have access to health information of Privatus’ clients.

Your “health information” or “medical information” for purposes of this Notice is information about you created and received by Privatus, including demographic information, that may reasonably identify you and that relates to your past, present or future physical or mental health or condition, or payment for the provision of your health care and certain related services from Privatus.

We are required by law to maintain the privacy of your health information and to notify you in the event that there is a breach of your unsecured health information.  We are also required by law to provide you with this Notice of our legal duties and privacy practices with respect to your health information and to abide by the terms of the Notice that are currently in effect.  We may change the terms of this Notice at any time.  The new revised Notice will apply to all of your health information maintained by us.

You will also be asked to acknowledge receipt of this Notice by Privatus from time to time.

I. HOW PRIVATUS MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION

Generally, Privatus will not disclose your health information without a written authorization, except as described in this Notice or as otherwise required by law.  The following categories describe different ways Privatus may use and disclose your information, but even if not specifically listed below Privatus may use and disclose your health information as required by law or in accordance with a signed authorization.

Plan of Care/Treatment. Privatus may use and disclose your health information to provide you with health treatment, including for your plan of care.

For example, information obtained by a nurse/therapist will be recorded in your record and used to determine the course of treatment. Your nurse/therapist and other health care professionals will communicate with one another personally and through the case record to coordinate care provided. You may receive more than one service (program) during your treatment period with such information shared between programs.  Privatus may also share your information with outside providers who are treating you.

Payment. Privatus may use or disclose your health information in order to bill and receive reimbursement for services provided to you, including to third party payment sources.  For example, we may need to give a third party guarantor of payment information about your treatment so that the guarantor can pay Privatus for the services.

Health Care Operations. Privatus may use your health information for health care operations of Privatus, including for quality assurance and improvement activities, to review the competence and qualifications of health care professions, medical review, legal services and auditing functions, and general administrative activities of Privatus.  For example, Privatus nurses, therapists, field staff, field staff, supervisors and support staff may use information in your case record to assess the care and outcomes of your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of services we provide. Regulatory and accrediting organizations may review your case record to ensure compliance with requirements.

Business Associates. There may be some services provided by outside entities under contract with Privatus to provide certain services involving the use of health information (known as “business associates”), such as a billing service, transcription company or legal or accounting consultants.  We may disclose your health information to our business associates so that they can perform the job we have contracted with them to do.  To protect your health information, we require our business associates to enter into a written contract that requires them to appropriately safeguard your information and report any breaches of health information to us.

Individuals Involved in Your Care or Payment of Your Care. Unless you object, we may disclose your health information to a family member, a relative, a close friend or any other person you identify, if the information relates to the person’s involvement in your health care or payment for your health care.  In addition, we may disclose your health information to a public or private entity authorized by law to assist in a disaster relief effort.  If you are unable to agree or object to such a disclosure, including in emergency circumstances, we may disclose such information if we determine that it is in your best interest based on our professional judgment or if we reasonably infer that you would not object.

Personal Representatives. You may designate an individual (a health care representative) to exercise certain medical decision-making on your behalf, or one may be designated by a court (e.g., a legal guardian) or by law (e.g., a parent if you are a minor).  Privatus will undertake efforts to make sure the person has authority to act on your behalf as your personal representative, provided that we may not treat the person as your personal representative in certain circumstances.

Appointment Reminders. We may use and disclose health information to contact you as a reminder that you have an appointment with Privatus.

Treatment Alternatives and Other Health-Related Benefits and Services.  We may use and disclose health information to tell you about or recommend possible treatment options or alternatives and to tell you about health related benefits, services, or medical education classes that may be of interest to you.

Workers’ Compensation. Privatus 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 the law.

Public Health Activities. As required by federal and state law, Privatus may disclose your health information to public health or legal authorities for public health purposes, including for purposes of preventing or controlling disease, injury or disability, to report child abuse or neglect, to report vital events, for quality, safety or effectiveness of products regulated by the Food and Drug Administration, to notify a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition, to an employer about a work-related illness or injury if we provide care at the employer’s request, or to provide proof of immunization to a school.

Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, accreditation, licensure and disciplinary actions.

Required by Law. As required by federal and state law, Privatus may use or disclose your health information.  For example, Privatus may disclose health information about victims of abuse, neglect or domestic violence, or for judicial and administrative proceedings, or for certain law enforcement purposes notify authorities of alleged abuse/neglect; and risk or threat of harm to self or others.

Respond to Lawsuits and Legal Actions. Privatus may use or disclose health information about you in response to a court or administrative order, or in response to a subpoena, or to defend such action brought by you or on your behalf.

Duty to Warn. Privatus may use and disclose health information about you when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of the public or another person

Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Coroners, Medical Examiners and Funeral Directors. 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 release medical information about patients to funeral directors as necessary to carry out their duties.

Government Functions. Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Research. We may use your health information for research purposes when an institutional review board or privacy board has approved the research after it has reviewed the research proposal and established protocols to ensure the privacy of your medical information.

Authorized Uses and Disclosures. Uses and disclosures of your medical information for purposes not described in this Notice may only be made with your permission using a written authorization or as permitted under applicable State and Federal law.  If you choose to sign such authorization to disclose information, you can revoke that authorization to stop any future uses and disclosures but a revocation will not affect uses or disclosures made in reliance on the authorization before its revocation.  For example, Privatus will not share your health information unless you give written authorization in the following circumstances (except as indicated):

Psychotherapy Notes. We must obtain your authorization for most uses or disclosures of your psychotherapy notes. Under certain circumstances, your authorization is not required. For example, we may use or disclose your psychotherapy notes to carry out specific treatment, payment, or health care operations. In addition, we may use or disclose your psychotherapy notes for specific health oversight activities and when required by law.

 Marketing. We must obtain your authorization for any use or disclosure of your medical information for marketing purposes, except face-to-face communications between us or when we provide you with a promotional gift of nominal value.

Sale of Medical Information. We must obtain your authorization for any disclosure of your medical information that is a sale of medical information.

Additionally, certain types of medical information receive heightened confidentiality protections under Federal or State law, and therefore may not be used or disclosed – even for treatment, payment, or health care operations purposes – without a written authorization. For example, HIV test results, records of substance use disorder treatment at a specialized program (as discussed below), psychotherapy notes, and certain genetic test results may be subject to heightened confidentiality protections under the law, and you may be required to provide a specific written authorization prior to any use or disclosure of these types of medical information.  We generally may not disclose this specially protected information in response to a subpoena, warrant or other legal process unless you sign a specific authorization or a court orders the disclosure.

II. INDIVIDUAL RIGHTS

You have the following rights with respect to your health information:

Right to Request Restrictions. You may request in writing that Privatus not use or disclose your information for treatment or administration purposes or to persons involved in your care except when specifically authorized by you, when required by law, or in emergency situations.  Privatus will consider your request; however, Privatus is not legally required to accept it unless the request pertains to restricting disclosure of your medical information to a health plan for purposes of payment or health care operations and the information pertains solely to a health care item or service that you have paid for out of pocket and in full.  You have the right to request that your health information be communicated to you in a confidential manner such as sending mail to an address other than your home.  To request restrictions, you must make your request in writing to the appropriate contact at Privatus listed in this Notice.

Right to Inspect and Copy. You have the right to inspect and obtain a copy your health information. If you request copies, Privatus will charge you a reasonable amount for the cost of copying, mailing, or other supplies associated with your request, as allowed by statute. Privatus may deny your request to inspect and copy in certain very limited circumstances, and you may be permitted to appeal such a denial.

Right to Amend. If you believe that information in your record is incorrect or if important information is missing, you have the right to submit a request to Privatus to amend your protected health information by correcting the existing information or adding the missing information.  Privatus may deny your request for amendment if the information is not maintained by Privatus, or Privatus determines that your record is accurate. You may submit a written statement of disagreement if Privatus decides not to amend your record.

Right to an Accounting Disclosures. You have the right to receive an accounting of disclosures of your protected health information made by Privatus for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to the Privacy Officer. The request should specify the time period for the accounting starting on or after April 14, 2013. Accounting request may not be made for periods of time in excess of six (6) years. Privatus would provide the first accounting you request during any 12-month period without charge. Subsequent accounting request may be subject to a reasonable cost based fee.

Right to a Paper Copy of This Notice. You may obtain a paper copy of this Notice upon request to Privatus, even if you have agreed to receive the Notice electronically.

Right to a Personal Representative. You may designate an individual (e.g., a health care agent) to exercise rights on your behalf concerning uses and disclosures of your health information, or one may be designated by a court (e.g., a legal guardian) or by law (e.g., a parent if you are a minor).  Privatus may take steps to make sure the person has authority to act on your behalf as your personal representative, and Privatus may not treat the person as your personal representative in certain circumstances.

III. PRIVATUS’ DUTIES

Privatus is required by law to maintain the privacy of health information and to provide individuals with notice of its legal duties and privacy practices with respect to health information.

Privatus is required to abide by the terms of this Notice of its duties and privacy practices, as may be amended from time to time.

Privatus reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains.  Prior to making any significant changes in our policies, we provide you with a copy.  You can also request a copy of our Notice at any time.  For more information about our privacy practices, please contact your local Privatus office.

IV. COMPLAINTS

If you are concerned that Privatus has violated your privacy rights, or you disagree with a decision Privatus made about access to your records, you may contact your local office. You may also send a written complaint to the Federal Department of Health and Human Services. Privatus Care Solutions, Inc. office staff can provide you with the appropriate address upon request. Under no circumstances will you be retaliated against or penalized for filing a complaint.

CONTACT INFORMATION

If you have any questions or complaints, please contact:

In Connecticut:

Executive Director/Privacy Officer
15 Valley Drive, Suite 306
Greenwich, CT 06831
Phone: (203) 987-6870

Connecticut Department of Public Health
Division of Health Systems Regulations
410 Capitol Avenue, MS# 12 HSR
Hartford, CT 06134
Phone: (860) 509-7552

In Massachusetts:

Executive Director/Privacy Officer
420 Bedford Street, Suite 350
Lexington, MA 02420
Phone: (617) 275-4050

Ombudsmen
Office of the Attorney General
Health Care Division
One Ashburton Place
Boston, MA 02108
Phone: (888) 830-6277

In New Jersey:

Executive Director/Privatus Officer
Privatus Care Solutions, Inc.
299 Market Street, Suite 145
Saddle Brook, NJ 07663
Phone: (201) 546-5580

New Jersey Office of the Attorney General
Division of Consumer Affairs
PO Box 45025
Newark, NJ 07101
Phone: (973) 504-6200

Community Health Accreditation Partner (CHAP)
1275 K Street NW
Washington, DC 20005
Phone: (202) 862-3413

In New York:

Long Island
Executive Director/Privacy Officer
Privatus Care Solutions, Inc.
1325 Franklin Avenue, Suite 375
Garden City, NY 11520
Phone: (516) 253-2920

New York State Department of Health
Metropolitan Area Regional Office
90 Church Street
New York, New York 10007
Phone: (212) 417-5888
Phone: (212) 643-3565

New York City
Executive Director/Privacy Officer
Privatus Care Solutions, Inc.
767 Third Avenue, Suite 20A
New York, NY 10017
Phone: (212) 564-0304

New York State Department of Health
Metropolitan Area Regional Office
90 Church Street
New York, New York 10007
Phone: (212) 417-5888
Phone: (212) 643-3565

Westchester County
Executive Director/Privacy Officer
Privatus Care Solutions, Inc.
430 Bedford Road, Suite 204
Armonk, NY 10504
Phone: (914) 940-4360

New York State Department of Health
Metropolitan Area Regional Office
90 Church Street
New York, New York 10007
Phone: (212) 417-5888
Phone: (212) 643-3565