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HIPAA Health Insurance Portability and Accountability Act PRIVACY NOTICE The HIPAA Privacy rule does not change the way you get services from Greystone Programs, or the privacy rights you have always had. The Privacy rule adds some details about how you can exercise your rights. A. We have a legal duty to Protect Health Information (PHI) about you. B. We may use and disclose PHI about you in the following circumstances: 1. We may use and disclose PHI about you to provide health care treatment to you. 2. We may use and disclose PHI about you to obtain payment for services. 3. We may use and disclose your PHI for health care operations. 4. We may use and disclose your PHI under other circumstances without your authorization. 5. You can object to certain uses and disclosures. 6. You may ask Greystone to change or amend your PHI if you believe it is incorrect or incomplete. 7. We may contact you to provide appointment reminders. 8. We may contact you with information about treatment, services, products or health care providers. 9. We may contact you for fundraising activities. You have several rights regarding PHI about you. You have the right to request restrictions on uses and disclosures of PHI about you. 10. You have the right to request different ways to communicate with you. 11. You have the right to see and copy PHI about you. 12. You have the right to request amendment of PHI about you. 13. You have the right to a listing of disclosures we have made. 14. You have the right to a copy of this Notice. C. You may file a complaint about our privacy practices. Greystone Programs Will Use and Disclose Information About You
Treatment: We may disclose protected health information about you to: doctors, nurses, psychologists, social workers, qualified mental retardation professionals (QMRPs) direct support professionals, your service coordinator, other personnel, volunteers or interns who provide you with care, to other providers outside of Greystone Programs who provide you with services in your Individualized Service Plan or to other providers to obtain new services for you. Payment: In order to bill and collect payment from either: you, a third party, an insurance company, Medicare or other government agencies Greystone will disclose PHI about you. Health Care Operations: In the process of conducting administrative operations, such as for quality improvement to review our treatment and services; to obtain legal services; to conduct fiscal audits; and for fraud abuse and detection Greystone Programs will disclose PHI about you. Other reasons allowed by law: Besides disclosures for treatment, payment, and health care operations, Greystone may also use PHI 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, Greystone may disclose PHI about you to:
Your Authorization Is Required For All Other Uses and Disclosures For all other types of uses and disclosures, Greystone Programs will use and disclose PHI about you only with a written authorization signed by you. If
You Have Questions Or Requests, Please Contact: Joyce Schonmann, Human Rights Officer 36 Violet Avenue Poughkeepsie, NY 12601 845-452-5772, ext. 112 jschonmann@greystoneprograms.org If
You Believe Your Privacy Rights Have Been Violated You Can File A Compliant: Office Of Mental Retardation & Developmental Disabilities 44 Holland Avenue Albany, NY 12229 518-473-6152 Taconic DDSO 26 Center Circle Wassaic, NY 12592 845-877-6821 Department of Health & Human Services 200 Independence Avenue S. W. Washington, D.C. 20201 877-696-6775 The Federal Office for Civil Rights 200 Independence Avenue S.W. Room 509F HHH Building Washington, D.C. 20201 Telephone: 866-OCR-PRIV or 866-627-7748 TTY886-4989 ************************************************************************ I acknowledge receipt and understand my Privacy Rights. ______________________________ ______________________ Signature Date Read To Me By:___________________________ _____________________________ ______________________ Signature Date ______________________________ ______________________ Legal Guardian/Parent Date |