Notice of Privacy Practices - Substance Abuse Program

NOTICE OF PRIVACY PRACTICES
Substance Abuse Programs 

THIS NOTICE DESCRIBES HOW MEDICAL AND DRUG AND ALCOHOL RELATED 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 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. 

Information regarding your healthcare, including payment for healthcare, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. §1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under these laws, Hockanum Valley Community Council, Inc. may not say to a person outside Hockanum Valley Community Council, Inc. that you attend the program, nor may Hockanum Valley Community Council, Inc. disclose any information identifying you as an alcohol or drug abuser, or disclose any other PHI except as permitted by federal law. 

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: 

Hockanum Valley Community Council, Inc. must obtain your written consent before it can disclose information about you for payment purposes. Generally, you must also sign a written authorization before Hockanum Valley Community Council, Inc. can share information for treatment purposes or for healthcare operations. However, federal law permits Hockanum Valley Community Council, Inc. to disclose information without your written permission for the following: 

  • Pursuant to an agreement with a person or agency that provides services to Hockanum Valley Community Council, Inc.  

  • For research, audit or evaluation 

  • To report a crime committed on Hockanum Valley Community Council, Inc. premises or against Hockanum Valley Community Council, Inc. personnel 

  • To medical personnel in a medical emergency 

  • To appropriate authorities to report suspected child abuse or neglect 

  • As allowed by a court order 

Before Hockanum Valley Community Council, Inc. can use or disclose any information about your health in a manner which is not described above, it must first obtain your specific written authorization allowing it to make the disclosure. You may revoke any such written authorization in writing, except to the extent that we have already acted on it. 

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. Accounting of disclosures start as of April 14, 2003 and are unavailable prior to that time 

  • Receive a paper copy of this notice 

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 at  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.