SHORT PRIVACY NOTICE This notice briefly describes Yates ARC's privacy practices and the privacy rights of people we serve. A longer Privacy Notice required by the Federal HIPAA Privacy Rule is available. The HIPAA Privacy rule DOES NOT CHANGE the way you receive services from Yates ARC, or the privacy rights you have always had under State Mental Hygiene law. The Privacy rule adds some details about how you can exercise your rights. This notice becomes effective April 14, 2003. If you have any questions about this notice please contact the Privacy Officer, at (315) 536-7447. Our Privacy Commitment to You At Yates ARC, we are committed to protecting your privacy and sharing information about you only with those who need to know and are allowed to see the information-to assure that you get quality services. Your Clinical Information Rights: - You have a right to look at your clinical records and get a copy.
- If we deny your request to see your clinical records, you may ask for a review of that denial.
- You may ask Yates ARC to change or amend your clinical record if you believe it is incorrect or incomplete.
- In certain cases, you may ask for a list of the people who have received clinical information about you from Yates ARC.
- You may ask Yates ARC not to use or share your clinical records in some cases.
- You may ask Yates ARC to communicate with you in a way that keeps your information confidential.
- You may ask for a paper copy of this notice.
How Yates ARC Will Use and Disclose Clinical Information About You - Treatment: To provide you with treatment and services. We may disclose health/clinical information about you to doctors, nurses, psychologists, social workers, qualified mental retardation professionals (QMRP's), aides, your service coordinator, other Yates ARC personnel, volunteers or interns who provide you with care, to other providers outside of Yates ARC who provide you with services identified in your individualized Service Plan, or to other providers to obtain new services for you.
- Payment: To bill and collect payment from either: you, a third party, an insurance company, Medicare or Medicaid, or other government agencies.
- Health Care Operations: For Yates ARC administrative operations, such as: for quality improvement to review our treatment and services; to obtain legal services through Counsel; to conduct fiscal audits; and for fraud, abuse and detection.
- Other reasons allowed by law: Besides disclosure for treatment, payment, and health care operations, Yates ARC may also use health information 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.
Use and Disclosure that Require Your Agreement or Authorization If you have no objections, Yates ARC may disclose health/clinical information about you to: - Family members and friends who are involved in your care, if the information is relevant to their involvement.
Your authorization Is Required For All Other Uses and Disclosures For all other types of uses and disclosures, Yates ARC will use or disclose health/clinical information about you only with a written authorization signed by you. Changes to this Notice We may change this notice in the future. If we do, we will provide you with a copy at your request after we change the notice. Complaints If you believe your privacy rights have been violated you can file a complaint with: - Yates ARC Privacy Officer, (315) 536-7447.
- The Secretary of the Federal Department of Health and Human Services, 200 Independence Avenue S.W. Washington, DC 20210, phone (877) 696-6775.
- The Federal Office of Civil Rights, 200 Independence Avenue SW Room 509F, HHH Building, Washington, DC 20210, phone (866) OCR-PRIV; or TTY 886-4989.
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