Effective Date: April 14, 2003 THIS NOTICE DESCRIBES
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN ACCESS THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
If you have questions regarding this notice,
please contact Privacy Officer @ 828-865-8210. Pavillon, PO Box 189, Mill Spring,
NC 28756
Understanding your Health Record/Information
When you receive care from
a healthcare provider such as Pavillon, a record of your stay is made. State
and federal law protects the confidentiality of this information. This “Protected
health information” typically contains demographic information that may
identify you and that relates to your past, present or future physical or mental
health or condition. Federal law and regulations specifically protect the
confidentiality of alcohol and drug abuse patient records. Pavillon is
required to comply with these additional restrictions. This prohibits,
with very few exceptions, informing anyone outside the program that you attend
the program, or disclosing any information that identifies you as an alcohol
or drug abuser. The violation of Federal laws or regulations by this program
is a crime. If you suspect a violation you may file a report to the appropriate
authorities in accordance with Federal regulations.
Your Health Information Rights
Although your health record is the physical
property of the healthcare practitioner that compiled it, the information belongs
to you. You have the right to:
- request a restriction on certain uses and disclosures
of your information
- obtain a paper copy of the notice of information
practices upon request
- inspect and obtain a copy of your health record
- amend your health record
- obtain an account of disclosures of health information
- request communication of your health information
by alternative means or at alternative locations
- revoke your authorization to use or disclose health
information except to the extent that action has already
been taken
- an accounting of disclosures (medical information
we have disclosed about you). Your request must
state a time period no longer than six years and may
not include dates before April 14, 2003.
Our Responsibilities/ This organization is required
to:
- maintain the privacy of your health information
- abide by the terms of this notice
- notify you if we are unable to agree to a requested
restriction
- accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative
locations.
We reserve the right to change our practices and to make
the new provisions effective for all protected health information
we maintain. Should our information practices change,
we will provide a revised notice for you. We will not use
or disclose your health information without your authorization,
except as described in this notice.
For More Information or to Report a Problem
If you believe your privacy
rights have been violated, you may file a complaint with the treatment facility
or with the Secretary of the Department of Health and Human Services at 200 Independence
Avenue, S.W., Washington, D.C. 20201. Phone 202-619-0257. To
file a complaint with Pavillon, contact Paula Mowery, Privacy Officer, 828-625-8210.
All complaints must be submitted in writing. There will be no retaliation for
filing a complaint.
Examples of Disclosure for Treatment, Payment and Health Operations
The
Provider will use your health information for treatment. Information obtained
by members of the treatment team will be entered in your record and used to determine
the best course of treatment for you. For the purpose of treatment, this facility
may coordinate your health care with a third party. For example, Pavillon may
share your medical information in order to coordinate the different things you
need, such as prescriptions or lab work. We may also disclose medical information
about you to people outside Pavillon who may be involved in your care after you
leave Pavillon
The Provider will use your health information for payment. We may use and disclose
medical information about you so that the treatment and services you receive
may be billed to and payment collected from you, an insurance company or a third
party. For example, we may need to give your health plan information about
treatment received at Pavillon so your health plan will pay us or reimburse you
for treatment. We may also tell your health plan about a treatment you
are going to receive to obtain prior approval or to determine whether your plan
will cover the treatment.
The Provider will use your health information for regular health care operations.
We may use and disclose medical information about you for Pavillon operations. These
uses and disclosures are necessary to run Pavillon and make sure that our clients
receive quality care. For example, we may use medical information to review our
treatment and services and to evaluate the performance of our staff. We
may also combine medical information about many clients to decide what additional
services we should offer, and if certain new treatments are effective.
We may also disclose information to doctors, nurses, technicians, medical students
and other Pavillon personnel for review and learning purposes. We may also
combine the medical information we have with medical information from other entities
to make comparisons and plan improvements. We may remove information that
identifies you from this set of medical information so others may study the information
without knowing who the specific patients are.
Health-Related Benefits and Services.
We may use and disclose medical
information to tell you about health-related benefits or services that may be
of interest to you.
Fundraising Activities.
We may use information about you to contact
you in an effort to raise money for Pavillon and its operations. We may
disclose information to a foundation related to Pavillon so that the foundation
may contact you regarding fundraising. Only contact information (name,
address, telephone number, and treatment dates) would be released. If you
do not want Pavillon to contact you for fundraising efforts, you must notify
us in writing.
Individuals Involved in Your Care or Payment for Your Care.
Pavillon,
using its best judgment, may disclose to a family member, other relative,
close personal friend or any other person you identify, health information relevant
to that person’s involvement in your care or payment related to your care.
Research
Pavillon may disclose information to researchers when that
research has established protocols to ensure the privacy of your health information. We
will ask for specific permission if the researcher is to have access to you name,
address or other information that reveals who you are.
As Required by Law.
We will disclose medical information
about you when required to do so by federal, state, or local law.
Avert a Serious Threat to Health or Safety. We may use and disclose
medical information about you when necessary to prevent a serious threat to your
health and safety or the health and safety of the public or another person.
Military and Veterans.
If you are a member of the armed forces,
we may release medical information about you as required by military command
authorities. This also applies to foreign military personnel.
Workers’ Compensation.
We may release medical information
about you for workers' compensation or similar programs. These programs
provide benefit for work-related illness or injury.
Public Health Risks .
As required by law, we may disclose your
health information to public health or legal authorities charged with preventing
or controlling disease.
Correctional Institution.
Should you be an inmate of a correctional
institution, we may disclose to the institution or agents thereof health information
for your health and the health and safety of other individuals.
Law Enforcement
We may disclose health information for law enforcement
purposes as required by law or in response to a valid court order.
Lawsuits and Disputes
If you are involved in a lawsuit or a
dispute, we may disclose medical information about you in response to a court
or administrative order, but only if efforts have been made to tell you about
the request or to obtain an order protecting the information requested.
Federal Law
makes provision for your health information to be
released to an appropriate health oversight agency, public health authority or
attorney, provided that a work force member or business associate believes in
good faith that this organization has engaged in unlawful conduct or has otherwise
violated professional or clinical standards and has potentially endangering one
or more patients, workers, or the
