|
OUR
LEGAL DUTY & YOUR RIGHT TO ACCESS
Federal and state laws require us
to protect your medical information.
These laws also require us to inform you as to how we will
protect information, and what your rights are with regard to your access
to this information.
This notice takes effect on
April 14, 2003
and will remain in effect until we replace it.
Due to changes in federal or state laws we may be required to
change it, or we may change it as a policy of the Northeastern Center,
Inc. If changes are made,
you will be notified in the same way as is being done now.
Any changes will require a new form, like this one, given to you.
At the end of this
notice is the name of a person and a place you may contact regarding
any questions you might have regarding our privacy practices.
WHY HEALTH INFORMATION MAY BE DISCLOSED
The most common release of
information regarding your healthcare is for treatment, payment and
coordination of healthcare with other professionals.
Some examples are:
?
Treatment:
We may need to coordinate care with another physician or
other providers such as a hospital.
?
Payment:
We may disclose information to obtain payment for the
services you receive at
Northeastern
Center
.
?
Quality
Improvement: Maintaining high quality of services is important to
everyone at
Northeastern
Center
. Your healthcare
information may be used in activities and evaluations of our performance
as a healthcare provider.
?
Authorization to
Release: You may request that specific or all of your healthcare
information be released.
Northeastern
Center
staff can assist you with forms that indicate what can be released and
to whom. You can authorize
us to release information for a period of time or you can revoke that
release at any time. To
revoke a release of information, you simply present it to staff in
writing. Otherwise we cannot
release any information about your healthcare without your approval,
unless dictated by Federal or
State laws.
?
Family
Involvement: We
may disclose healthcare information to a family member or friend
to help with payment or with coordinating treatment, unless you
sign a form objecting to the release of this information.
?
Your
Right: You have the right to refuse to disclose healthcare
information if you so choose. In
the event of an emergency or your
incapacity, we reserve the right to disclose information that is
directly relevant to someone involved in your healthcare.
In these circumstances, the staff of
Northeastern
Center
will use our professional judgement and experience.
?
Marketing
Health-Related Services: We will not use your health information for
marketing communications without your consent.
?
Required Release: There
are times when for your protection or the safety of others we may
release information. These
are dictated by federal and state laws.
|
?
Abuse or Neglect: We
may disclose your health information to appropriate authorities if we
reasonably believe that you are a possible victim of abuse, neglect, or
domestic violence or the possible victim of other crimes.
We may disclose your health information to the extent necessary
to avert a serious threat to your health or safety of others.
?
National Security: We
may disclose to military authorities the health information of Armed
Forces personnel under certain circumstances.
We may disclose to authorized federal officials health
information required for lawful intelligence, counterintelligence, and
other national security activities.
We may disclose to correctional institution or law enforcement
official having lawful custody of protected health information of inmate
or patient under certain circumstances.
YOUR RIGHTS OF ACCESS
You have the right to look at or
get copies of your health information with some exceptions.
First, you must make a request in writing.
We will charge you a reasonable cost based fee for the expense of
staff time and copier use. If
you request copies, we will charge you $15.00 for the first ten pages
and 25? per page thereafter.
?
Your Right for
Disclosure Accounting: You have the right to receive a list of
instances in which we release information for seven years, but not
before
April 14, 2003
. If you request this
accounting more than once in a 12-month period, we may charge you a fee
for responding to these requests.
?
Your Right to an
Amendment: If by reading your healthcare information you disagree
with information, you may request an amendment.
You must make your request in writing and you must explain why
you believe your information should be amended.
This request will be reviewed by your Physician and your
amendment may be denied.
QUESTIONS AND COMPLAINTS
If you want more information about
our privacy practices or have questions or concerns, please contact us.
Contact Officer:
Privacy Officer or Designee
Telephone:
260-347-2453
Fax: 260-347-2456
Address:
220 S. Main St., PO Box 817
Kendallville
,
IN
46755
You may contact if:
?
You feel we have violated your
privacy rights
?
You disagree with a decision to
access your health information
?
You disagree with our decision to
not amend your healthcare information
?
Or to have us communicate with you
or another healthcare provider by alternative means
You also may submit a written
complaint to the U.S. Department of Health and Human Services.
We will provide you with the address to file your complaint
with U.S. Department of Health and Human Services upon request. We
support your right to the privacy of your health information.
We will not retaliate in any way if you choose to file a
complaint with us or with the U.S. Department of Health and Human
Services.
|
Contact
Us