NEW YORK FAMILIES FOR AUTISTIC CHILDREN, INC
SHORT PRIVACY NOTICE
The HIPAA Privacy Rule DOES NOT CHANGE the way you get services from NYFAC, or the privacy rights you have always had under local, state or federal laws. The Privacy Rule adds some details about how you can exercise your rights.
Our Privacy Commitment to You
At NYFAC, we are committed to protecting your privacy and sharing information about you only with those who need to know and are allowed to see the information — to assure that you get quality services.
Your Clinical Information Rights
You have a right to look at your clinical records and to get a copy.
If we deny your request to see your clinical records, you may ask for a review of that denial.
You may ask NYFAC to change or amend your clinical record if you believe it is incorrect or incomplete.
In certain cases, you may ask for a list of the people who have received clinical information about you from NYFAC.
You may ask NYFAC not to use or share your clinical records in some cases.
You may ask NYFAC to communicate with you in a way that keeps your information confidential.
You may ask for a paper copy of this notice.
How NYFAC Will Use and Disclose Clinical Information About You
NYFAC will use or share your clinical information without your consent for the following reasons:
– Treatment: To provide you with treatment and services. We may disclose health/clinical information about you: to doctors, nurses, psychologists, social workers, qualified mental retardation professionals (QMRPs), your Medicaid Service Coordinator, other NYFAC personnel, volunteers or interns who provide you with care; to other providers outside of NYFAC who provide you with services identified in your services plan or treatment record; or to other providers to obtain new services for you.
– Payment: To bill and collect payment from either: you, a third party, an insurance company, Medicare or Medicaid, or other government agencies.
– Health Care Operations: For NYFAC administrative operations, such as: for quality improvement to review our treatment and services; to obtain legal services through NYFAC’s General Counsel’s Office; to conduct fiscal audits; and for fraud abuse and detection.
– Other reasons allowed by law: Besides disclosures for treatment, payment, and health care operations, NYFAC may also use health information about you without your permission when allowed by law. Some examples are: when we are required to do so by federal or state law; for health oversight activities (including audits, investigations, surveys and inspections); for law enforcement purposes; and to prevent or lessen a serious and imminent threat to your health and safety or to someone else’s.
Uses and Disclosures that Require Your Agreement or Authorization
If you have no objections, NYFAC may disclose health/clinical information about you to:
Family members and friends who are involved in your care, if the information is relevant to their involvement.
For all other types of uses and disclosures, NYFAC will use or disclose health/clinical information about you only with a written authorization signed by you.
Changes to this Notice
We may change this notice in the future. If we do, we will provide you with a copy at your request after we change the notice. We will also post the revised notice on our website at www.nyfac.org.
If you believe your privacy rights have been violated you can file a complaint with:
Pamela Baumann or Carol Francis, Privacy Officers, NYFAC
Privacy Compliance Department – 95-16 Pitkin Avenue , Ozone Park , NY
11417; phone (718) 641-3441; fax (718) 641-4452.
The Secretary of the U.S. Dept. of Health and Human Services –
200 Independence Ave., S.W. , Washington D.C. 20210; phone (877) 696-6775.
The federal Office for Civil Rights, Region II – U.S. Dept. of Health &
Human Services, Jacob Javits Federal Building , 26 Federal Plaza, Suite 3312, New York , NY 10278 ; phone (212) 264-3313; fax (212) 264-3039; or TTY (212) 264-2355.
NEW YORK FAMILIES FOR AUTISTIC CHILDREN, INC.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW IDENTIFIABLE MEDICAL* INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
This notice is effective as of April 14, 2003 . If you have any questions about this notice, please contact: NYFAC’s Privacy Compliance Department – 95-16 Pitkin Avenue , Ozone Park , NY 11417 ; phone (718) 641-3441; fax (718) 641-4452.
Our Privacy Commitment to You
At NYFAC, we understand that information about you and your family is personal. We are committed to protecting your privacy and sharing information only with those who need to know and are allowed to see the information to assure quality services for you. This notice tells you how NYFAC uses and discloses information about you. It also describes your rights and what NYFAC responsibilities are concerning information about you.
1. Who will follow this notice:
All people who work for NYFAC in our programs and our administrative offices will follow this notice. This includes employees, persons NYFAC contracts with (contractors) who are authorized to enter information in your clinical record or need to review your record to provide services to you, and volunteers and interns that NYFAC allows to assist you.
2. What information is protected:
All information we create or keep that relates to your health or care and treatment, including your name, address, birth date, social security number, your medical information, your service or treatment plan, and other information (including photographs and other images) about your care in our programs. In this Notice, we refer to protected information as “clinical information”.
Your Clinical Information Rights
You have the following rights concerning your clinical information. When we use the word “you” in this notice we also mean your personal representative. Depending on your circumstances and in accordance with state law, this may be your guardian, your health care proxy, or your involved parent, spouse, or adult child.
• You have a right to see or inspect your clinical information and obtain a copy. Some exceptions apply, such as psychotherapy notes, records regarding incident reports and investigations, and information compiled for use in court or administration proceedings. NOTE: NYFAC may require you to make your request for records in writing.
• If we deny your request to see your clinical information, you have the right to request a review of that denial. Professionals chosen by NYFAC who were not involved in denying your request will review the record and decide if you may have access to the record.
• You have the right to ask NYFAC to change or amend your clinical information that you believe is incorrect or incomplete. We may deny your request in some cases, for example, if NYFAC did not create the record or, if after reviewing your request, we believe the record is accurate and complete.
• You have the right to request a list of the disclosures NYFAC has made of your clinical information. The list, however, does not include certain disclosures, such as those made for treatment, payment and health care operations, or disclosures made to you or made to others with your permission.
• You have the right to request a restriction on uses or disclosures of your health information related to treatment, payment, health care operations and disclosures to involved family NYFAC, however, is not required to agree to your request.
• You have the right to request that NYFAC communicate with you in a way that will help keep your information confidential.
• You have the right to receive a paper copy of this notice. You may ask NYFAC staff to give you another copy or you may obtain one from our website at www.nyfac.org.
• To request access to your clinical information or to request any of the rights listed here, you may contact the Privacy Officer NYFAC’s Privacy Compliance Department, – 95-16 Pitkin Avenue , Ozone Park , NY 11417 ; phone (718) 641-3441; fax (718) 641-4452; or email firstname.lastname@example.org
NYFAC’s Responsibilities for Your Clinical Information
NYFAC is required by law to:
• Maintain the privacy of your information in accordance with federal and state laws.
• Give you this notice of our legal duties and practices concerning the clinical information we have about you.
• Follow the rules in this notice. NYFAC will use or share information about you only with your permission except for the reasons explained in this notice.
• Tell you if we make changes to our privacy practices in the future. If significant changes are made NYFAC will give you a copy of the new notice as well as post it on our website at www.nyfac.org.
How NYFAC Uses and Discloses Clinical Information
NYFAC may use and disclose clinical information without your permission for the purposes described below. For each of the categories of uses and disclosures, we explain what we mean and offer an example. Not every use or disclosure is described, but all of the ways we will use or disclose information will fall within these categories.
• Treatment: NYFAC will use your clinical information to provide you with treatment and services. We may disclose clinical information to doctors, nurses, psychologists, social workers, qualified mental retardation professionals (QMRPs), and other NYFAC personnel, volunteers or interns who are involved in providing you care. For example, involved staff may discuss your clinical information to develop and carry out your individualized service plan (ISP) or treatment plan. Other NYFAC staff may share your clinical information to coordinate different services you need, such as medical tests, respite care, transportation, etc. We may also need to disclose your clinical information to your service coordinator and other providers outside of NYFAC who are responsible for providing you with needed services.
• Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or services at one of our locations or with another service provider.
• Payments: NYFAC will use your clinical information so that we can bill and collect payment from you, a third party, an insurance company, Medicare or Medicaid or other government agencies.
• Health Care Operations: NYFAC will use clinical information for administrative operations. These uses and disclosures are necessary to operate NYFAC programs and residences and to make sure all persons receive appropriate, quality care. For example, we may use clinical information for quality improvement to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to clinicians and other personnel for on-the-job training. We will share your clinical information with other NYFAC staff for the purposes of obtaining legal services through NYFAC General Counsel’s Office, conducting fiscal audits, and for fraud and abuse detection and compliance through our Privacy Compliance Department. We will also share your clinical information with NYFAC staff to resolve complaints or objections to your services. We may also disclose clinical information to our business associates who need access to the information to perform administrative or professional services on our behalf.
Other Uses and Disclosures That Do Not Require Your Permission
In addition to treatment, payment and health care operations, NYFAC will use your clinical information without your permission for the following reasons:
• When we are required to do so by federal or state law.
• For public health reasons, including prevention and control of disease, injury or disability, reporting births and deaths, reporting child abuse or neglect, reporting reactions to medication or problems with products, and to notify people who may have been exposed to a disease or are at risk or spreading the disease.
• To report domestic violence and adult abuse or neglect to government authorities if you agree or if necessary to prevent serious harm.
• For health oversight activities, including audits, investigations, surveys and inspections, and licensure. These activities are necessary for government to monitor the health care system, government programs, and compliance with civil rights laws. Health oversight activities do not include investigation that are related to the receipt of health care or receipt of government benefits in which you are the subject.
• For judicial and administrative proceedings, including hearings and disputes. If you are involved in a court or administrative proceeding we will disclose clinical information if the judge or presiding officer orders us to share the information.
• For law enforcement purposes, in response to a subpoena, or other legal process, to identify a suspect or witness or missing person, to provide identifying data in connection with a criminal investigation, and to the district attorney in furtherance of a criminal investigation of client abuse.
• Upon your death, to coroners or medical examiners for identification purposes or to determine cause of death, and to funeral directors to allow them to carry out their duties.
• To organ procurement organizations to accomplish cadaver, eye, tissue or organ donations in compliance with state law.
• For research purposes that involve only limited portions of your clinical information and that do not directly identify you by name.
• To prevent or lessen a serious and imminent threat to your health and safety or someone else’s.
• To authorize federal officials for intelligence and other national security activities authorized by law or to provide protective services to the President and other officials.
• To correctional institutions or law enforcement officials if you are an inmate and the information is necessary to provide you with health care, protect your health and safety or that of others, or for the safety of the correctional institution.
• To government agencies that administer public benefits if necessary to coordinate the covered functions of the programs.
• In order to contact you to raise money to help us operate or to share this information with a charitable foundation that will contact you to raise money on our behalf. If you do not want to be contact for these types of fundraising efforts, please write to: Privacy Officer, NYFAC Privacy Compliance Department, 95-16 Pitkin Avenue , Ozone Park , NY 11417 ; phone (718) 641-3441; fax (718) 641-4452; or email www.nyfac.org
Uses and Disclosures That Require Your Agreement or Authorization
NYFAC may disclose clinical information to the following persons if we tell you we are going to use or disclose it and your agree or do not object:
To family members and personal representatives who are involved in your care if the information is relevant to their involvement and to notify them of your condition and location; or
To disaster relief organizations that need to notify your family about your condition and locations should a disaster occurs.
Authorization Required for All Other Uses and Disclosures
For all other types of uses and disclosures not described in this Notice, NYFAC will use or disclose clinical information only with a written authorization signed by you that states who may receive the information, what information is to be shared, the purpose of the use or disclosure and an expiration for the authorization. Written authorizations are always required for use and disclosure of psychotherapy notes.
Note: If you cannot give permission due to an emergency, NYFAC may release clinical information if NYFAC deems the release of such information to be in your best interest. We must tell you as soon as possible after releasing the information.
You may revoke your authorization at any time. If you revoke your authorization in writing we will no longer use or disclose your clinical information for the reasons stated in your authorization. We cannot, however, take back disclosures we made before you revoked and we must retain clinical information that indicates the services we have provided to you.
Changes to This Notice
We reserve the right to change this notice. We reserve the right to make changes to terms described in this notice and to make the new notice terms effective to all clinical information that NYFAC maintains. We will post the new notice with the effective date on our website at www.nyfac.org and in our facilities. In addition, we will offer you a copy of the revised notice at your next scheduled planning meeting.
If you believe your privacy rights have been violated you can file a complaint with:
Pamela Baumann or Sherry Smith, Privacy Officers, NYFAC Privacy Compliance Department – 95-16 Pitkin Avenue, Ozone Park, NY 11417; phone (718) 641-3441; fax (718) 641-4452; or email email@example.com
The Secretary of the U.S. Dept. of Health and Human Services – 200 Independence Ave., S.W. , Washington D.C. 20210; phone (877) 696-6775.
The federal Office for Civil Rights, Region II – U.S. Dept. of Health & Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312, New York, NY 10278; phone (212) 264-3313; fax (212) 264-3039; or TTY (212) 264-2355.
All complaints must be submitted in writing. You will not be penalized for filing a complaint.