Harbor Hall, Inc. must obtain your written consent before it can disclose
information about you for payment purposes. For example, Harbor Hall, Inc.
must obtain your written consent before it can disclose information to your
health insurer in order to be paid for services. Generally, you must also
sign a written consent before Harbor Hall, Inc. can share information for
treatment purposes or for health care operations. However, federal law
permits Harbor Hall, Inc. to disclose information without your written permission:
1. Pursuant to an agreement with a business associate;
2. For research, audit or evaluations;
3. To report a crime committed on Harbor Hall, Inc.'s premises or against Harbor Hall's personnel;
4. To medical personnel in a medical emergency;
5. To appropriate authorities to report suspected child abuse or neglect
6. As allowed by a court order
For example, Harbor Hall, Inc. can disclose information without your
consent to obtain legal or financial services, or to another medical facility
to provide health care to you, as long as there is a business associate agreement
in place.
Before Harbor Hall, Inc. can use or disclose any information about your health
in a manner which is not described above, it must first obtain your specific
written consent allowing it to make the disclosure. Any such written consent
may be revoked by you in writing.
Your Rights
Under HIPAA you have the right to request restrictions on certain uses and
disclosures of your health information. Harbor Hall, Inc. is not required
to agree to any restrictions you request, but if it does agree then it is
bound by that agreement and may not use or disclose any information which
you have restricted except as necessary in a medical emergency.
You have the right to request that we communicate with you by alternative
means or at an alternative location. Harbor Hall, Inc. will accommodate
such requests that are reasonable and will not request an explanation from
you. Under HIPAA you also have the right to inspect and copy your own
health information maintained by Harbor Hall, Inc., except to the extent
that the information contains psychotherapy notes or information compiled
for use in a civil, criminal or administrative proceeding or in other
limited circumstances. Under HIPAA you also have the right, with some
exceptions, to amend health care information maintained in Harbor Hall, Inc.'s
records, and to request and receive an accounting of disclosures or your
health related information made by Harbor Hall, Inc. during the six years
prior to your request. You also have the right to receive a paper copy of this notice.
Harbor Hall Inc.'s Duties
Harbor Hall is required by law to maintain the privacy of your health
information and to provide you with notice of its legal duties and privacy
practices with respect to your health information. Harbor Hall, Inc. is
required by law to abide by the terms of this notice. Harbor Hall, Inc.
reserves the right to change the terms of this notice and to make new
notice provisions effective for all protected health information it
maintains. Until such amendment is made, Harbor Hall, Inc. is required by
law to comply with this Notice. Harbor Hall, Inc. will provide written
notice to each patient of it's intent to make revisions in the privacy policy.
Complaints and Reporting Violations
You may complain to Harbor Hall, Inc. and the secretary of the United States
Department of Health and human Services if you believe that your privacy
rights have been violated under HIPAA. You will not be retaliated against
for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected
violations of the Confidentiality Law may be reported to the United States
Attorney in the district where the violation occurs.
Complaints about your Privacy rights, or how Harbor Hall, Inc. has handled
your health information should be directed to Terrance Lee Newton by calling this office at (888) 880-5511. If Terrance Lee Newton is not available, you may make an appointment for a personal conference in person or by telephone within two working days.
If you are not satisfied with the manner in which this office handles your
complaint, you may submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
Contact
For further information, contact, Terrance Lee Newton, Executive Director
and Privacy Officer
at 231-347-5511 or 888-880-5511.
Effective Date: March 31, 2003
|
