Notice of Privacy Practices - Mental Health Programs

Hockanum Valley Community Council, Inc.
NOTICE OF PRIVACY PRACTICES
Mental Health Programs 

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. 

Hockanum Valley Community Council, Inc. is federally mandated to maintain the privacy of your medical information and wants you to know about our practices for protecting your health information.  

Hockanum Valley Community Council, Inc. is required to abide by the terms of this notice.  The medical information we maintain may come from any of the providers from whom you have received services.  The medical information we record and maintain is known as Protected Health Information, or PHI.  We will not use or disclose your PHI without your permission, except as described in this notice. 

We reserve the right to change our practices and to make the new provisions effective for all medical information we maintain.  Should our medical information practices change, we will amend this notice and post a notice of the changes, which will be made available to anyone upon request.  This notice is effective as of April 14, 2003.

USES AND DISCLOSURES:

In general, it is our policy to obtain written authorization for release of information prior to making a disclosure. You may revoke an authorization at any time, except to the extent that we have already acted on it. 

We may use your Protected Health Information (PHI) without authorization for: 

  • Treatment, e.g., share information with other providers involved in your care 

  • Payment, e.g., to the state Department of Administrative Services to bill for your healthcare services 

  • Healthcare operations, e.g., to internal staff for evaluation of the quality of services provided 

  • Reminding you of appointments

Other permitted disclosures of your Protected Health Information (PHI) without authorization might include the following: 

  • Disclosures required by law, e.g., to the Department of Children and Families when a law requires that we report suspected abuse or neglect 

  • For research, audit or evaluations 

  • Public Health, e.g., mandated reporting of disease, injury or vital statistics 

  • To avert a serious threat to the health or safety of you or others 

  • As a response to a court order, e.g. a judge orders specific portions of your record as a result of a legal matter 

  • If deceased, limited information to coroners, medical examiners or funeral directors 


WHAT ARE YOUR RIGHTS?  YOU HAVE THE RIGHT TO: 

  • Request restrictions on certain uses and disclosures of your Protected Health Information (PHI) 

  • Receive reasonable confidential communication of PHI, e.g. contact you at a place of your choosing 

  • Inspect and copy your medical record by written request, with some exceptions. Hockanum Valley Community Council, Inc. reserves the right to deny the request, to which you may make a further appeal. 

  • Request an amendment of your medical record. Hockanum Valley Community Council, Inc. reserves the right to deny the request, to which you may make a further appeal.

  • Receive an accounting of Hockanum Valley Community Council, Inc. disclosures of your PHI during the six years prior to your request. Accountings of disclosures start as of April 14, 2003 and are unavailable prior to that time.

  • Receive a paper copy of this notice. 

For help with these rights during normal business hours contact: Insurance Specialist – 860-872-9825

HOW YOU CAN REPORT A PROBLEM? 

If you feel your privacy rights have been violated, you may file a complaint with the Hockanum Valley Community Council, Inc. Privacy Officer: Director of Counseling Services, 860-872-9825, the State of Connecticut, Department of Mental Health and Addiction Services (DMHAS), Office of HealthCare Information (OHI) at (860) 418-6901, or the Secretary of the United States Department of Health and Human Services (DHHS), Office for Civil Rights (OCR) at:  U.S. DHHS, OCR, J.F. Kennedy Federal Building – Room 1875, Boston, Massachusetts 02203.  Voice phone: (617) 565-1340.  TDD: (617) 565-1343.  FAX: (617) 565-3809. 

There will be no retaliation for filing a complaint. 

WOULD YOU LIKE MORE INFORMATION? 

If you have questions and would like more information, you may contact the Hockanum Valley Community Council, Inc. Privacy Officer: Director of Counseling Services at 860-872-9825, or the DMHAS Office of Healthcare Information (OHI) at (860) 418-6901.