CCN095
A. GENERAL
INFORMATION
Community Council of Nashua, NH, is
committed to preserving the privacy and confidentiality of your health
information that is created and/or maintained at our clinic. Information regarding your health care
is protected by two federal laws:
The Health Insurance Portability and Accountability Act of 1996
(“HIPPA”), 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, Community Council of
Nashua, NH (CCN) may not say to a person outside of CCN that you attend services
at CCN, nor can we disclose any information identifying you as an mental health
consumer or drug and alcohol patient, or disclose any other protected
information except as permitted by federal law.
Community Council of Nashua, NH must obtain your written
consent before it can disclose information about you for payment purposes. For example, CCN must obtain your
written consent before it can disclose information to your health insurer in
order to be paid for services.
Generally, you must also sign a written consent before CCN can share
information for treatment purposes or for health care operations. However, federal law permits CCN to
disclose information without your written
permission:
1.
As required by
law. We may
disclose your health information when required by federal, state, or local law
to do so. For example, we are
required by the Department of Health and Human Services (DHHS) to disclose your
health information in order to allow DHHS to evaluate whether we are in
compliance with the federal privacy regulations.
2.
Public Health
Activities. We may disclose your health information to public health
authorities that are authorized by law to receive and collect health information
for the purpose of preventing or controlling disease, injury, or disability; to
report births, deaths, suspected abuse or neglect, reactions to medications; or
to facilitate product recalls.
3.
Health Oversight
Activities. We may
disclose your health information to a health oversight agency that is authorized
by law to conduct health oversight activities, including audits, investigations,
inspections, or licensure and certification surveys. These activities are necessary for the
government to monitor the persons or organizations that provide health care to
individuals and to ensure compliance with applicable state and federal laws and
regulations.
4.
Judicial or
administrative proceedings. We may disclose your health information
to courts or administrative agencies charged with the authority to hear and
resolve lawsuits or disputes. We
may disclose your health information pursuant to a court order or other lawful
process issued by a judge or other person involved in the dispute, but only if
efforts have been made to (i) notify you of the request for disclosure or (ii)
obtain an order protecting your health information.
5.
Worker’s
Compensation. We may
disclose your health information to worker’s compensation programs when your
health condition arises out of a work-related illness or
injury.
6.
Law Enforcement
Official. We may
disclose your health information in response to a request received from a law
enforcement official to respond to a court order.
7.
Research. We may use or disclose your health
information for research purposes under certain limited circumstances. Because all research projects are
subject to a special approval process, we will not use or disclose your health
information for research purposes until the particular research project for
which your health information may be used or disclosed has been approved through
this special approval process.
However, we may use or disclose your health information to individuals
preparing to conduct the research project in order to assist them in identifying
patients with specific health care needs who may qualify to participate in the
research project. Any use or
disclosure of your health information that is done for the purpose of
identifying qualified participants will be conducted onsite at our
facility. In most instances, we
will ask for your specific permission to use or disclose your health information
if the researcher will have access to your name, address, or other identifying
information.
8.
To Avert a
Serious Threat to Health or Safety. We may use or disclose your health
information when necessary to prevent a serious threat to the health or safety
of you or other individuals.
9.
Inmates. If you are an inmate of a correctional
institution or under the custody of a law enforcement official, we may use or
disclose your health information to the correctional institution or to the law
enforcement official as may be necessary (i) for the institution to provide you
with health care; (ii) to protect the health or safety of you or another person;
or (iii) for the safety and security of the correctional
institution.
B. USES
AND DISCLOSURES PURSUANT TO YOUR WRITTEN
AUTHORIZATION.
Except for the purposes identified in Section A, we will
not use or disclose your health information for any other purposes unless we
have your specific written authorization.
You have the right to revoke a written authorization at any time as long
as you do so in writing.
However, if you are referred by an element of the Criminal Justice
System, and have substance abuse issues as part of your medical record, you may
not revoke a release until the purpose for which it has been sought is met. If you revoke your authorization, we
will no longer use or disclose your health information for the purposes
identified in the authorization, except to the extent that we have already taken
some action in reliance upon your authorization.
Under HIPPA you have the following rights regarding your health information. You may exercise each of these rights, in writing, by providing us with a completed form that you can obtain from each receptionist, or your healthcare provider. In some instances, we may charge you for the cost(s) associated with providing you with the requested information. Additional information regarding how to exercise your rights, and the associated costs, can be obtained from your healthcare provider.
1.
Right to Inspect
and Copy. You have
the right to inspect and copy health information that may be used to make
decisions about your care except to the extent that the information was compiled
for use in a civil, criminal or administrative proceeding. We may deny your request to inspect and
copy your health information in certain limited circumstances. If you are denied access to your health
information, you may request that the denial be reviewed.
2.
Right to Amend. You have the right to request an
amendment of your health information that is maintained by or for our clinic and
is used to make health care decisions about you. We may deny your request if it is not
properly submitted or does not include a reason to support your request. We may also deny your request if the
information sought to be amended:
(a) was not created by us, unless the person or entity that created the
information is no longer available to make the amendment; (b) is not part of the
information that is kept by or for our clinic; (c) is not part of the
information which you are permitted to inspect and copy; or (d) is accurate and
complete.
3.
Right to an Accounting of Disclosures. You have
the right to request an accounting of the disclosures of your health information
made by us. This accounting will
not include disclosures of health information that we made pursuant to a written
authorization that you have signed.
4.
Right to Request Restrictions. You have
the right to request a restriction or limitation on certain uses and disclosures
of your health information. We are
not required to agree to your request.
If we do agree, that agreement must be in writing and signed by you and
us.
5.
Right to Request Confidential Communications. You have
the right to request that we communicate with you about your health care in a
certain way or at a certain location.
For example, you can ask that we only contact you at work or by
mail.
6.
Right to a Paper Copy of this Notice. You have
the right to receive a paper copy of this Notice. You may ask us to give you a copy of
this Notice at any time. Even if
you have agreed to receive this Notice electronically, you are still entitled to
a paper copy of this Notice.
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D.
COMMUNITY COUNCIL OF NASHUA, NH
DUTIES |
We will abide by the terms of this Notice, including any future revisions that we may make to the Notice as required or authorized by law. We reserve the right to change this Notice and to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice, which will identify its effective date, in our clinic and on our website at www.ccofnashua.org.
The privacy practices described in this Notice will be followed by:
1. Any health care professional authorized to enter information into your medical record created and/or maintained at our clinic;
2. All employees, students, residents, and other service providers who have access to your health information at our clinic; and
3. Any member of a volunteer group that is allowed to help you while receiving services at our clinic.
The individuals identified above will share your health information with each other only for purposes described in the Notice.
If
you have any questions regarding this Notice or wish to receive additional
information about our privacy practices, please contact Monica Collins, MA, MBA,
Privacy Officer, at (603) 889-6147, extension 3423.
If you believe your privacy rights have been violated, you may file a
complaint with our clinic or with the Secretary of the DHHS. To file a complaint
with our clinic, contact Monica Collins, MA, MBA, Privacy Officer at Community
Council of Nashua, NH, 7 Prospect Street, Nashua, NH 03060. All complaints must
be submitted in writing. You will
not be penalized for filing a complaint.