A.
WE HAVE A LEGAL DUTY TO PROTECT HEALTH INFORMATION ABOUT
YOU.
We are required
to protect the privacy of health information about you and that can
be identified with you, which we call “protected health
information,” or “PHI” for short. We must give you notice of our
legal duties and privacy practices concerning PHI:
§
We
must protect PHI that we have created or received about your past,
present, or future health condition, health care we provide to you,
or payment for your health care.
§
We
must notify you about how we protect PHI about you.
§
We
must explain how, when and why we use and/or disclose PHI about you.
§
We
may only use and/or disclose PHI as we have described in this
Notice.
We are required to
follow the procedures in this Notice. We reserve the right to change
the terms of this Notice and to make new notice provisions effective
for all PHI that we maintain by first:
§
Posting the revised notice in our offices;
§
Making copies of the revised notice available upon request (either
at our offices or through the contact person listed in this Notice);
and
§
Posting the revised notice on our website at
www.oceanmed.net
B.
WE MAY USE AND DISCLOSE PHI ABOUT YOU WITHOUT YOUR
AUTHORIZATION IN THE FOLLOWING CIRCUMSTANCES.
1.
We may use and disclose PHI about you to provide health
care treatment to you.
We may use and
disclose PHI about you to provide, coordinate or manage your health
care and related services. This may include communicating with other
health care providers regarding your treatment and coordinating and
managing your health care with others. For example, we may use and
disclose PHI about you when you need a prescription, lab work, an
x-ray, or other health care services. In addition, we may use and
disclose PHI about you when referring you to another health care
provider.
EXAMPLE:
Your counselor may share medical information about you with
another health care provider. For example, if you are referred to
another clinic, that clinic will need to know your medication dose,
treatment plan and summary for treatment rendered as a patient at
Ocean Medical .
2.
We may use and disclose
PHI about you to obtain payment for services.
Generally, we may
use and give your medical information to others to bill and collect
payment for the treatment and services provided to you. Before you
receive scheduled services, we may share information about these
services with your health plan(s).
Sharing
information allows us to ask for coverage under your plan or policy
and for approval of payment before we provide the services. We may
also share portions of your medical information with the following:
§
Billing departments;
§
Collection departments or agencies;
§
Insurance companies, health plans and their agents which provide you
coverage;
§
Consumer reporting agencies (e.g., credit bureaus).
EXAMPLE:
If you are covered for treatment services through Medicaid and/or
New Jersey Work First Substance Abuse Initiative, we will need to
disclose PHI about you to them to receive reimbursement for eligible
services that Ocean Medical renders to you. The information is given to our
billing department and your health plan so we can be paid or you can
be reimbursed.
3.
We may use and disclose
your PHI for health care operations.
We may use and
disclose PHI in performing business activities, which we call
“health care operations”. These “health care operations” allow us to
improve the quality of care we provide and reduce health care costs.
Examples of the way use or disclose PHI about you for “health care
operations” include the following.
§
Reviewing and improving the quality, efficiency and cost of care
that we provide to you and our other patients. For example, we may
use PHI about you to develop ways to assist our staff in deciding
what medical treatment should be provided to others.
§
Improving health care and lowering costs for groups of people who
have similar health problems and to help manage and coordinate the
care for these groups of people. We may use PHI to identify groups
of people with similar health problems to give them information, for
instance, about treatment alternatives, classes, or new procedures.
§
Reviewing and evaluating the skills, qualifications, and performance
of health care providers taking care of you.
§
Providing training programs for students, trainees, health care
providers or non health care professionals (for example, billing
clerks or assistants, etc.) to help them practice or improve their
skills.
§
Cooperating with outside organizations that assess the quality of
the care we and others provide. These organizations might include
government agencies or accrediting bodies such as the Joint
Commission on Accreditation of Healthcare Organizations.
§
Cooperating with outside organizations that evaluate, certify or
license health care providers, staff or facilities in a particular
field or specialty. For example, we may use or disclose PHI so that
one of our nurses may become certified as having expertise in a
specific field of nursing, such as addiction treatment nursing.
§
Assisting various people who review our activities. For example, PHI
may be seen by doctors reviewing the services provided to you, and
by accountants, lawyers, and others who assist us in complying with
applicable laws.
§
Planning for our organization’s future operations, and fundraising
for the benefit of our organization.
§
Conducting business management and general administrative activities
related to our organization and the services it provides, including
info.
§
Resolving grievances within our organization.
§
Reviewing activities and using or disclosing PHI in the event that
we sell our business, property or give control of our business or
property to someone else.
§
Complying with this Notice and with applicable laws.
4.
We may use and disclose PHI under other circumstances without
your authorization.
We may use and/or
disclose PHI about you for a number of circumstances in which you do
not have to consent, give authorization or otherwise have an
opportunity to agree or object. Those circumstances include:
§
When
the use and/or disclosure is required by law. For example, when a
disclosure is required by federal, state or local law or other
judicial or administrative proceeding.
§
When
the use and/or disclosure is necessary for public health activities.
For example, we may disclose PHI about you if you have been exposed
to a communicable disease or may otherwise be at risk of contracting
or spreading a disease or condition.
§
When
the disclosure relates to victims of abuse, neglect or domestic
violence.
§
When
the use and/or disclosure is for health oversight activities. For
example, we may disclose PHI about you to a state or federal health
oversight agency, which is authorized by law to oversee our
operations.
§
When
the disclosure is for judicial and administrative proceedings. For
example, we may disclose PHI about you in response to an order of a
court or administrative tribunal.
§
When
the disclosure is for law enforcement purposes. For example, we may
disclose PHI about you in order to comply with laws that require the
reporting of certain types of wounds or other physical injuries.
§
When
the use and/or disclosure relates to decedents. For example, we may
disclose PHI about you to a coroner or medical examiner for the
purposes of identifying you should you die.
§
When
the use and/or disclosure relates to cadaveric organ, eye or tissue
donation purposes.
§
When
the use and/or disclosure relates to medical research. Under certain
circumstances, we may disclose PHI about you for medical research.
§
When
the use and/or disclosure is to avert a serious threat to health or
safety. For example, we may disclose PHI about you to prevent or
lessen a serious and eminent threat to the health or safety of a
person or the public.
§
When
the use and/or disclosure relates to specialized government
functions. For example, we may disclose PHI about you if it relates
to military and veterans’ activities, national security and
intelligence activities, protective services for the President, and
medical suitability or determinations of the Department of State.
§
When
the use and/or disclosure relates to correctional institutions and
in other law enforcement custodial situations. For example, in
certain circumstances, we may disclose PHI about you to a
correctional institution having lawful custody of you.
§
In
making any disclosures, Ocean Medical is also bound to abide by Federal
Confidentiality Regulation 42CFR.
5.
You can object to certain uses and disclosures.
Unless you object,
we may use or disclose PHI about you in the following circumstances:
§
In
accordance with Federal Confidentiality Regulation 42CFR, PHI
disclosures without patient consent are limited to medical
emergencies, Tarasoff Law – Duty to Warn, suspected child and/or
elder abuse, and court orders.
§
In
accordance with Federal Confidentiality Regulation 42CFR, Ocean
Medical may
only share with a family member, relative, friend or other person
identified by you through a Release of Information, PHI information
that you specifically identify on that Release of Information. You
have the right at any point in your treatment to revoke a Release of
Information for disclosure, but said revocation must be in writing
and must include an effective date and your signature.
§
We
may share your PHI with a public or private agency (for example,
parole, probation, mental health agency) for case management and/or
referral that you have signed an Ocean Medical Release of Information for
disclosure for specifying contact name, agency, purpose of
disclosure, and expiration date. You have the right at any point in
your treatment to revoke a Release of Information, but said
revocation must be in writing and must include an effective date and
your signature.
If you would like
to object to our use or disclosure of PHI about you in the above
circumstances, please call our contact person listed on the cover
page of this Notice.
6.
We may contact you to provide appointment reminders.
We may use and/or
disclose PHI to contact you to provide a reminder to you about an
appointment you have for treatment or medical care.
7.
We may contact you with information about treatment,
services, products or health care providers.
We may use and/or
disclose PHI to manage or coordinate your healthcare. This may
include telling you about treatments, services, products and/or
other healthcare providers. We may also use and/or disclose PHI to
give you gifts of a small value.
EXAMPLE: If you are diagnosed with HIV/AIDS, we may tell you about
medical and other counseling services that may be of interest to
you.
8. We may contact you for
post-discharge follow-up.
We may use PHI to
contact you after you are discharge from our program as a follow-up
to your treatment for the purpose of our Performance Improvement
activities. Contact will either be through postal mail (with no
markings on the outside of the envelope identifying it as
originating from Ocean Medical or telephone.
In
accordance with Federal Confidentiality Regulation 42CFR, PHI
disclosures without patient consent are limited to medical
emergencies, Tarasoff Law – Duty to Warn, suspected child and/or
elder abuse, and court orders.
** ANY OTHER USE OR DISCLOSURE OF PHI
ABOUT YOU REQUIRE YOUR WRITTEN
AUTHORIZATION**
Under any
circumstances other than those listed above, we will ask for your
written authorization before we use or disclose PHI about you. If
you sign a written authorization allowing us to disclose PHI about
you in a specific situation, you can later revoke your authorization
in writing. If you revoke your authorization in writing, we will not
disclose PHI about you after we receive your revocation, except for
disclosures, which were being processed before we received your
revocation.
C.
YOU HAVE SEVERAL RIGHTS REGARDING PHI ABOUT YOU.
1.
You have the right to request restrictions on uses and
disclosures of PHI about you.
You have the right
to request that we restrict the use and disclosure of PHI about you.
In accordance with Federal Confidentiality Regulation 42CFR, PHI
disclosures without patient consent are limited to medical
emergencies, Tarasoff Law – Duty to Warn, suspected child and/or
elder abuse, and court orders. All other disclosures outside of
Ocean Medical
must be authorized by you through an executed Release of
Information. We are not, however, required to agree to your
requested restrictions to use of PHI within Ocean Medical .
2. You have the right to request
different ways to communicate with you.
You have the right
to request how and where we contact you about PHI. For example, you
may request that we contact you at your work address or phone number
or by email. Your request must be in writing. We must accommodate
reasonable requests, but, when appropriate, may condition that
accommodation on your providing us with information regarding how
payment, if any, will be handled and your specification of an
alternative address or other method of contact. You may
request alternative communications by submitting the request in
writing to your counselor. The request will be reviewed with a
response within one week.
3.
You have the right to see and copy PHI about you.
You have the right
to request to see and receive a copy of PHI contained in clinical,
billing and other records used to make decisions about you. Your
request must be in writing. We may charge you related fees. Instead
of providing you with a full copy of the PHI, we may give you a
summary or explanation of the PHI about you, if you agree in advance
to the form and cost of the summary or explanation. There are
certain situations in which we are not required to comply with your
request. Under these circumstances, 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. You may
request to see and receive a copy of PHI by submitting the request
in writing to your counselor. The request will be reviewed with a
response within one week.
4.
You have the right to
request amendment of PHI about you.
You have the right
to request that we make amendments to clinical, billing and other
records used to make decisions about you. Your request must be in
writing and must explain your reason(s) for the amendment. We may
deny your request if: 1) the information was not created by us
(unless you prove the creator of the information is no longer
available to amend the record); 2) the information is not part of
the records used to make decisions about you; 3) we believe the
information is correct and complete; or 4) you would not have the
right to see and copy the record as described in paragraph 3 above.
We will tell you in writing the reasons for the denial and describe
your rights to give us a written statement disagreeing with the
denial. If we accept your request to amend the information, we will
make reasonable efforts to inform others of the amendment, including
persons you name who have received PHI about you and who need the
amendment. You may request an amendment of you PHI by submitting the
request in writing to your counselor. The request will be reviewed
with a response within one week.
You have the right to a listing of
disclosures we have made.
If you ask our
contact person in writing, you have the right to receive a written
list of certain of our disclosures of PHI about you. You may ask for
disclosures made up to six (6) years before your request (not
including disclosures made prior to April 14, 2003). We are not
required to include disclosures:
§
For
your treatment
§
For
billing and collection of payment for your treatment
§
For
our health care operations
§
Requested by you, that you authorized, or which are made to
individuals involved in your care
§
Allowed by law when the use and/or disclosure relates to certain
specialized government functions or relates to correctional
institutions and in other law enforcement custodial situations
(please see subsection 4 in the section above and
§
As
part of a limited set of information which does not contain certain
information which would identify you.
The list will
include the date of the disclosure, the name (and address, if
available) of the person or organization receiving the information,
a brief description of the information disclosed, and the purpose of
the disclosure. If you request a list of disclosures more than once
in 12 months, we can charge you a reasonable fee. You may request a
listing of disclosures by submitting the request in writing to your
counselor. The request will be reviewed with a response within one
week.
5.
You have the right to a copy of this Notice.
You have the right
to request a paper copy of this Notice at any time by submitting the
request in writing to your counselor. The request will be reviewed
with a response within one week. We will provide a copy of this
Notice no later than the date you first receive service from us
(except for emergency services, and then we will provide the Notice
to you as soon as possible).
D.
YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES.
If
you think your privacy rights have been violated by us, or you want
to complain to us about our privacy practices, you can contact the
person listed below:
·
The Director
Ocean Medical Services, Inc.
2001 Route 37 East
Toms River, NJ
Telephone:- 732-288-9322
You may also send
a written complaint to the United States Secretary of the Department
of Health and Human Services. If you file a complaint, we will not
take any action against you or change our treatment of you in any
way.
