Notice to Consumer Regarding Protected Health Information
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.
All information that is provided during the screening, admission,
and services/treatment process is considered confidential by the employees,
interns, and volunteers of all Freedom House programs. We are required
to protect the privacy of health information about you, and the disclosure
of protected health information will be governed by North Carolina
General Statute 122C, federal law regarding substance abuse records
42 CFR Part 2, and the Health Insurance Portability and Accountability
Act of 1996, as well as any other applicable federal or state laws.
Exchange and use of protected health information between Freedom
House staff and/or Freedom House programs for the purpose of services/treatment,
payment, or healthcare operations will be permitted and based on "need
to know" guidelines, and positional authority. For example:
- Information obtained about you by a counselor, case manager, doctor,
nurse or other member of your services/treatment team will be recorded
in your record and used to determine the course of services/treatment
that should work best for you.
- Services/treatment team members will also be expected to discuss
your progress in services/treatment on a routine basis.
- Information about the services you receive will be submitted
and processed by the billing department so that we can be reimbursed.
- Your medical record may also be pulled for Quality Improvement
review in preparation for an audit or for other internal review
to improve the quality and effectiveness of the services we provide.
Disclosure of protected health information outside of Freedom House
is permitted when you or your legal representative signs a written
authorization, or gives verbal authorization in an emergency situation.
Any authorization for disclosure may be revoked at any time, except
to the extent that action has been taken in reliance on it.
You have the right to request restriction of the disclosure of your
health information, except when Freedom House is required to do so.
Under the following specific conditions, disclosure of information
outside of Freedom House is permitted and/or required by law and professional
ethics without your specific authorization:
- When there is a medical or psychiatric emergency involving
your health or safety or the safety of others.
- When Freedom House is required by law to report instances
of neglect or abuse of a child or disabled adult.
- When the disclosure is for judicial or administrative proceedings
and Freedom House is responding to an order of a court or administrative
tribunal.
- When Freedom House is required by North Carolina Administrative
Code to disclose physician information due to an incident which would
cause health risk to other persons.
- When Freedom House authorizes research for the purpose of program
planning and evaluation of services through the use of statistical
information that can not be linked to any individual.
Freedom House uses computerized records to meet statistical, financial,
and medical record requirements. Freedom House will comply with expected
norms for security of electronic records and will make every effort
to secure any identifying information that is transmitted outside
of the organization.
You also have other rights related to the use and disclosure of health
information in your medical record. These rights include:
- Right to request your medical record be designated as a "Secure/Hot
File".
All medical records are considered to be secure and confidential.
However, if special circumstances exist (ex. you are the neighbor
of a Freedom House employee) you may request that your record be filed
as a "Secured/Hot File". We will make every effort to accommodate
your request, but we are not required to do so.
- Right to inspect and request a copy of your medical record.
If you would like to inspect or receive a copy of your health information,
please contact the manager of the program serving you for instructions
on how to submit a written request. We may deny your request in very
limited circumstances. If we deny your request, we will respond to
you in writing, stating why we will not grant your request and describing
any rights you may have to request a review of our denial. If your
request is approved, we may charge a reasonable fee for the costs
of copying, mailing or other supplies associated with any request
for copies.
- Right to request amendment of any section of your medical record.
If you feel that we have information that is inaccurate or incomplete,
you have the right to request that your record be amended. If we deny
your request we will notify you in writing of our reason and will
describe your rights to provide a written statement disagreeing with
our denial.
- Right to receive an accounting of disclosures that have occurred.
Each disclosure of protected health information will be documented
in the medical record. You have the right to request an accounting
of these disclosures for the previous six years beginning April 14,
2003.
- Right to request an alternative method of contact.
Freedom House may call you or mail information to you regarding appointment
reminders, billing information, or other information about services/treatment
alternatives or services that might be of interest to you. If you
like to request an alternative method of contact please notify your
service provider. We will accommodate reasonable requests, but may
condition our accommodation on your providing us with information
regarding how payment, if any, will be handled.
- Right to a copy of this Notice.
You have the right to receive a paper copy of this Notice. Freedom
House reserves the right to change this notice and to make the new
notice effective for all protected health information that is maintained
in hard copy or electronic format. Revisions to the NOTICE OF PRIVACY
PRACTICES will be made available at each facility for distribution
to all consumers.
Freedom House recognizes the importance of confidentiality, and your
right to be fully informed of all regulations regarding protected
health information. If you feel that your privacy rights have been
violated you may contact Freedom House's Executive Director at 942-2803
to file a complaint. Or you may contact the Secretary of the North
Carolina Department of Health & Human Services, 2001 Mail Service
Center, Raleigh, North Carolina 27699-2001, or 919-733-4534; or the
U.S. Secretary of Health & Human Services, 200 Independence Avenue
SW, Washington, DC 20201, or 1-877-696-6775. Provision of services
will not be affected by the filing of any complaint.