All Faiths Receiving Home :: Albuquerque, New Mexico
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.
If you have any questions about this Notice please contact the All Faiths Receiving Home Human Resources Office at 271-0329.
This Notice of Privacy Practices describes how All Faiths may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.
“Protected health information” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. All Faiths is required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our website at allfaiths.org, calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.
Your protected health information (PHI) may be used and disclosed by our service providers, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your PHI may also be used and disclosed to pay your health care bills and to support the operation of our organization. Following are examples of the types of uses and a disclosure of your PHI that All Faiths is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our organization.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your PHI protected. For example, we would disclose your PHI, as necessary, to the Children, Youth and Families Department (CYFD) and other treatment team member agencies and personnel that are coordinating care and services to you. We will also disclose PHI to other service providers who may be treating you when we have the necessary permission from you to disclose your PHI. For example, your PHI may be provided to a service provider to whom you have been referred to ensure that the service provider has the necessary information to diagnose or treat you. In addition, we may disclose your PHI from time-to-time to another health care provider (e.g., a psychological evaluator, psychiatrist or specialist) who, at the request of your service provider, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your service provider.
Payment: Your PHI will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for group home, treatment foster care or outpatient services stay may require that your relevant PHI be disclosed to the health plan to obtain approval for the services.
Healthcare Operations: We may use or disclose, as-needed, your PHI in order to support the business activities of our organization and its service providers. These activities include, but are not limited to, quality assessment activities, employee review activities, training of students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities. For example, we may disclose your PHI to college students that see clients at our agency. In addition, we may use a sign-in sheet at the reception desk where you will be asked to sign your name and indicate your service provider. We may also call you by name in the waiting room when your service provider is ready to see you. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We will share your PHI with third party “business associates” that perform various activities (e.g., financial and clinical audits, medical records storage companies, board of directors) for the organization. Whenever an arrangement between our office and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of your PHI. We may use or disclose your demographic information and the dates that you received treatment from your service provider, as necessary, in order to contact you for fundraising activities supported by our organization. If you do not want to receive these materials, please contact our Privacy Officer and request that these fundraising materials not be sent to you.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your service provider or the organization has taken an action in reliance on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object
We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then your service provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.
Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object
We may use or disclose your PHI in the following situations without your authorization. These situations include:
Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains medical and billing records and any other records that your service provider and the organization uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny access may be reviewed. In some circumstances, you may have a right to have this decision reviewed. Please contact our Human Resources Office if you have questions about access to your medical record.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Your service provider is not required to agree to a restriction that you may request. If service provider believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If your service provider does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your service provider. You may request a restriction by contacting the Human Resources Office and documenting the request in writing with a description of the PHI and to whom you wish to restrict disclosure of your PHI.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Human Resources Office.
You may have the right to have your service provider amend your protected health information. This means you may request an amendment of PHI about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Human Resources Office to determine if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Human Resources Office of your complaint. We will not retaliate against you for filing a complaint.
You may contact our Human Resources Office at (505) 271-0329 for further information about the complaint process.
This notice was published and becomes effective on April 14, 2003. - Revised 4/7/03 KER
