Notice of Privacy Practices – 180, Turning Lives Around, Inc.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Your health record contains personal information about you and your health. Any of this information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how 180 may use and disclose your PHI in accordance with applicable law. It also describes your rights regarding how you may gain access to and control your PHI.
180 is required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. This notice applies to all health and other records that are generated in or by this agency. We reserve to change the terms of this Notice of Privacy Practices at any time. Any new Notices of Privacy Practices will be effective for all PHI that we maintain at that time. 180 will provide you with a copy of any revised Notices of Privacy Practices by sending a copy to you in the mail upon request or providing one to you at your next appointment.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment: Your PHI may be used and disclosed by those who are involved in your care for the purposes of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members of 180. It also may include consultation between your counselor or case manager with other programs of 180 in order to coordinate the deliverance of other services you may need or request.
For Payment: 180 may use and disclose PHI so that we can receive payment for the treatment services provided to you. This will only be done with your authorization as agreed to by execution of this notice. Examples of payment-related activities are: making a determination of eligibility of coverage for insurance benefits, processing claims with your insurance company, or contact with a third party you may designate for payment of treatment services.
Required by Law: Under the law, 180 must make disclosures of your PHI to you upon request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy rule.
Without Authorization: Applicable law and ethical standards permit 180 to disclose information about you without your authorization only in a limited number of situations. The types of uses and disclosures that may be made without your authorization are those that are:
- Required by Law, such as the mandatory reporting of suspected child abuse or neglect to DYFS, or mandatory government agency audits or investigations by professional licensing boards or the health department
- Required by Court Order signed by a Judge
- Necessary to prevent or lessen a serious threat to the health or safety of you, another person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
Verbal Permission: 180 may use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
With Authorization: Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding PHI 180 maintains about you. To exercise any of these rights, please submit your request in writing to 180:
- Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy your PHI that may be used to make decisions about your care. You right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you. 180 may charge a reasonable, cost-based fee for copies.
- Right to Amend. If you feel that your PHI 180 has about you is incorrect or incomplete, you may ask 180 to amend the information although we are not required to agree to the amendment.
- Right to an Accounting of disclosures. You have the right to request an accounting of the disclosures that we make of your PHI. 180 may charge you a reasonable fee if you request more than 1 accounting in any 12-month period.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. 180 is not required to agree with your request.
- Right to Request Confidential Communications. You have the right to request that 180 communicate with you about medical matters in a certain way or at a certain location.
- Right to a copy of this Notice. You have the right to a copy of this notice.
If you believe that 180 has violated your privacy rights, you have the right to file a complaint in writing to 180’s privacy officer or to the Secretary of Health and Human Services at 200 Independent Ave., S.W., Washington, DC 20201. 180 will take no retaliatory action against you if you file a complaint about our privacy practices.
180’s Privacy Officer: Jo Ann Palumbo, LCSW, Privacy Officer
180, Turning Lives Around, Inc.
1 Bethany Road, Bldg #3, Suite #42
Hazlet, NJ 07730