Clear Brook, INC.

Notice of Information Practices

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.

 

Protected Health Information (“PHI”) means individually identifiable health information including demographics, as defined by HIPAA, that is created or received by Clear Brook and that relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and that identifies the individual or for which there is a reasonable basis to believe the information can be used to identify the individual. PHI includes information of persons living or deceased.

 

The terms of this Notice of Privacy Practices – Protected Health Information (“Notice”) applies to Protected Health Information (defined above) associated with your treatment and medical record maintained by Clear Brook Inc.  This Notice describes how Clear Brook may use and disclose Protected Health Information to carry out treatment, payment and health care operations, and for other purposes that are permitted or required by law.

 

This notice will remain in effect until we amend or replace it.  On an ongoing basis, we will review and monitor our privacy practices to ensure the privacy of our patients’ protected health information.  Due to changing circumstance, it may become necessary to revise our privacy practices and the terms of this Notice.  We reserve the right to make the changes in our privacy practices and the new terms of our Notice will become effective for all protected health information that we maintain, including protected health information we created or received before we made the changes.  Before we make a material change in our privacy practices, we will change this Notice and post it in a variety of locations throughout the facility.  In the event that we do effect a material change in our privacy practices, an announcement will be posted on our website.

This notice describes our privacy practices, which include how we may use, disclose, collect, handle, and protect our patient’s protected health information.  We will inform you of these practices the first time you become a patient at Clear Brook.  We are required by the privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) to maintain the privacy of Protected Health Information and to provide our patient’s with notice of our legal duties and privacy practices concerning Protected Health Information.

 

In the event applicable law, other than HIPAA, prohibits or materially limits our uses and disclosures of Protected Health Information, as set forth below, we will restrict our uses or disclosure of your Protected Health Information in accordance with the more stringent standard.

We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all Protected Health Information maintained by us. Copies of our current Notice may be obtained by contacting Clear Brook at the telephone number or address below.

 

WE RESERVE THE RIGHT TO CHANGE OUR PRACTICES AND TO MAKE THE NEW PROVISIONS EFFECTIVE FOR ALL INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION WE MAINTAIN.  SHOULD WE CHANGE OUR INFORMATION PRACTICES, WE WILL POST A REVISED NOTICE.

 

Uses and disclosures we are permitted or required to make

The following is a description of the types of uses and discloses of your protected health information that we are permitted or required to make. Not every use or disclosure possible is listed, but all of the ways that we are permitted to use and disclose your protected health information will fall within one of these general categories.

 

Your Authorization – Except as outlined below, we will not use or disclose your PHI unless you have signed a form authorizing/consenting to the use or disclosure. You have the right to revoke that authorization except to the extent that we have taken action in reliance upon the authorization.  Unless you give us a written authorization, we will not use or disclose your medical information for any purpose other than those described in this notice.

Other uses and disclosures of your protected health information not covered by the categories included in this Notice or applicable laws, rules or regulations will be made only with your written permission or authorization.

 

Payment

We will use and disclose your protected health information only with your proper written consent so that we may bill and payment may be collected for the health care services you receive. This includes activities such as communicating your protected health information to an insurance company or managed care company.

We may send a bill to you or to a third-party payer, such as a health insurer.  The information on or accompanying the bill may include information that identifies you, your diagnosis and treatment received.

Treatment

We will use and disclose your protected health information (with your written consent as appropriate) to provide your healthcare and any related services. This may include disclosure of your protected health information to doctors, hospitals, pharmacies and other third parties who are involved in your care. For example, we will disclose your protected health information to another physician to whom you have been referred.

We will use your PHI during our treatment plan reviews and Case Consultations which may include physicians, physician’s assistants, nurses, counselors, recreation therapists and others who are involved in your care.

With your written consent, we will also provide your physician, or continued care provider with a copy of your record to assist them in treating you post discharge from Clear Brook.

 

Healthcare Operations

We will use and disclose your protected healthcare information as necessary for healthcare operations.  For instance, we serve the region by participating in education programs. We may disclose your protected health information to the students of such programs while they are participating in one of our internship programs. We may call your name in our waiting room when your doctor or other provider is ready to see you.

Members of the medical staff, the quality improvement director, or members of the quality improvement team, may use information in your health record to assess the care and outcomes of your treatment and the competence of the caregivers.  We will use this information in an effort to continually improve the quality and effectiveness of the healthcare and services we provide.

We provide some services through contracts with business associates.  Examples include certain diagnostic tests, and the like.  When we use these services, we may disclose your health information to the business associate so that they can perform the function.  To protect your health information, however, we require the business associate to appropriately safeguard your information.

 

ALUMNI ACTIVITIES  

We may hold alumni activities such as picnics and various celebrations and holiday parties from time to time.  We may use your name, address, phone number or e-mail address to invite you, unless you tell us that you do not wish to be contacted.

Other Uses and Disclosures – We may make certain other uses and disclosures of your PHI, without your authorization.

  • We may use or disclose your PHI for any purpose required by law. For example, Clear Brook may be required by law to use or disclose your PHI to respond to a court order.
  • Unless you inform us otherwise, you will be entered into our mailing list for follow-up contact and alumni activities.
  • We may disclose your PHI for public health activities, such as reporting of disease, injury, and death, and for public health investigations.
  • We may disclose your PHI to the proper authorities if we suspect child abuse or neglect; we may also disclose your PHI if we believe you to be a victim of abuse, neglect, or domestic violence.
  • We may disclose your PHI if authorized by law to a government oversight agency (e.g., Pennsylvania Department of Drug and Alcohol Program for licensing) or The Joint Commission, when conducting audits, investigations, or civil or criminal proceedings.
  • We may disclose your PHI in the course of a judicial or administrative proceeding (e.g., to respond to a subpoena or discovery request).
  • We may disclose your PHI to the proper authorities for law enforcement purposes.
  • We may release your protected health information to those people who you indicate you would like to involve in your care, such as family members and friends (with your proper written consent, as appropriate).
  • If you are involved in a lawsuit or other dispute, we may disclose your protected health information in response to appropriate lawful requests.
  • We may release your protected health information if asked to do so by a law enforcement official in response to appropriate lawful requests.
  • We may release protected health information to a coroner or medical examiner only with your proper written consent of executor of the patient’s estate. We may also release protected health information about deceased patients to funeral directors so that they may carry out their duties (with your proper written consent, as appropriate).

We will, if required by law, release your PHI to the Secretary of the Department of Health and Human Services for enforcement of HIPAA.

 

Complaints – If you believe your privacy rights have been violated, you can file a complaint with Clear Brook in writing at the address below. You may also file a complaint in writing with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C., within 180 days of a suspected violation of your rights. Clear Brook will not initiate any retaliation for filing a complaint.

Your Rights Under the Federal Privacy Standard

Although your health records are the physical property of the healthcare provider who completed it, you have certain rights with regard to the information contained therein.

You have the right to:

  1. Request restriction on uses and disclosures of your health information for treatment, payment, and health care operations. “Health care operations” consist of activities that are necessary to carry out the operations of the provider, such as quality improvement and peer review.  The right to request restriction does not extend to uses or disclosures permitted or required under §§ 164.502(a)(2)(i) (disclosures to you), 164.510(a) (for facility directories, but note that you have the right to object to such uses), or 164.512 (uses and disclosures not requiring a consent or an authorization).  The latter uses and disclosures include, for example, those required by law, like mandatory communicable disease reporting.  In those cases, you do not have a right to request restriction.  Even in those cases in which you do have the right to request restrictions, we do not have to agree to the restrictions.  If we do, however, we will adhere to it unless you request otherwise or we give you advance notice.
  2. Request for Confidential Communications – You have the right to request that communications regarding your PHI be made by alternative means or at alternative locations. For example, you may request that messages not be left on voice mail or sent to a particular address. We are required to accommodate reasonable requests. Requests for confidential communications must be in writing, signed by you and sent to Clear Brook at the address below.
  3. Receive and keep a copy of this Notice of Information Practices. Although we have posted a copy in prominent locations throughout the facility, you have a right to a hard copy upon request.
  4. Inspect and copy your health information upon request. Again, this right is not absolute.  In certain situations, such as if access would cause harm, we can deny access.

You do not have a right of access to the following:

  1. Psychotherapy notes. Such notes comprise those that are recorded in any medium by a healthcare provider who is a mental health professional documenting or analyzing a conversation during a private counseling session or a group, joint, or family counseling session.
  2. Information compiled in reasonable anticipation of or for use in civil, criminal, or administrative actions or proceedings.
  3. Any of you PHI that is subject to the Clinical Laboratory Improvement Amendments of 1988 (“CLIA”), 42 U.S.C. § 263a, to the extent that the provision of access to the individual would be prohibited by law.
  4. Information was obtained from someone other than Clear Brook Inc. under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information. 

 

In other situations, Clear Brook Inc. may deny you access but, if it does, we will provide you with a review of the decision denying access.  These “reviewable” grounds for denial include:

  1. Licensed healthcare professional has determined, in the exercise of professional judgment, that the access is reasonably likely to endanger the life or physical safety of the individual or another person.
  2. PHI makes reference to another person (other than a healthcare provider) and a Clear Brook Representative has determined, in the exercise of professional judgment, that the access is reasonably likely to cause substantial harm to such other person.
  3. The request is made by the individual’s personal representative and a Clear Brook Representative has determined, in the exercise of professional judgment, that the provision of access to such personal representative is reasonably likely to cause substantial harm to the individual or another person.

For these reviewable grounds, within 30 days another Clear Brook professional will review the decision of denying access.  If we deny you access, we will explain why and what your rights are, including how to seek review.

If we grant access, we will tell you what, if anything, you have to do to get access.  We reserve the right to charge a reasonable, cost-based fee for making copies.

 

You have the right to request amendment/correction of your health information.  Amendments to Your PHI:

You have the right to request that PHI that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. To be considered, your amendment request must be in writing, must be signed by you and must state the reasons for the amendment and/or correction request.

 

We do not have to grant the request if:

  1. We did not create the record. If, as in the case of a consultation report from another provider, we did not create the record, we cannot know whether it is accurate or not.  Thus, in such cases, you must seek amendment/correction from the party creating the record.  If they amend or correct the record, we will put the corrected record in our records.
  2. The records are not available to you as discussed immediately above.
  3. The record is accurate and complete.

If we deny your request for amendment/correction, we will notify you why, how you can attach a statement of disagreement to your records (which we may rebut), and how you can complain.  If we grant the request, we will make the correction and distribute the correction to those who need it and those you identify to us that you want to receive the corrected information.

 

Obtain an accounting of “non-routine” uses and disclosures.

This applies to uses and disclosures other than for treatment, payment, and health care operations or of protected health information about them.  We must provide the accounting within 60 days.

We do not need to provide an accounting for:

  1. Disclosure to you.
  2. Disclosures authorized by you.
  3. Disclosures of limited data sets (partially de-identified data used for research, public health, or health care operations.
  4. The facility directory or to persons involved in the individual’s care or other notification purposes as provided in § 164.510 (uses and disclosures requiring an opportunity for the individual to agree or to object, including notification to family members, personal representatives, or other persons responsible for the care of the individual, of the individual’s location, general condition, or death).
  5. National security or intelligence purposes under § 164.512(k)(2) (disclosures not requiring consent, authorization, or an opportunity to object, see chapter 16).
  6. Correctional institutions or law enforcement officials under § 164.512(k)(5) (disclosures not requiring consent, authorization, or an opportunity to object).
  7. PHI that occurred before the effective date of this Notice.

The accounting must include:

  1. Date of each disclosure.
  2. Name and address of the organization or person who received the protected health information.
  3. Brief description of the information disclosed.
  4. Brief statement of the purpose of the disclosure that reasonably informs you of the basis for the disclosure or, in lieu of such statement, a copy of your written authorization, or a copy of the written request for disclosure.

The first accounting in any 12 month period is free.  Thereafter, we reserve the right to charge a reasonable, cost-based fee.

 

Our Responsibilities under the Federal Privacy Standard

In addition to providing you your rights, as detailed above, the federal privacy standard requires us to:

  1. Maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information.
  2. Provide you with this notice as to our legal duties and privacy practices with respect to individually identifiable health information we collect and maintain about you.
  3. Abide by the terms of this notice.
  4. Train our personnel concerning privacy and confidentiality.
  5. Implement a sanction policy to discipline those who breach privacy/confidentiality or our policies with regard thereto.
  6. Mitigate (lessen the harm of) any breach of privacy/confidentiality.

We will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required by law.

Clear Brook respects and will protect your right to privacy and protection of your health information.

 

Other Uses of Medical Information

Other uses and disclosures of your protected health information not covered by the categories included in this Notice or applicable laws, rules or regulations will be made only with your written permission or authorization.

Please be aware that we are unable to take back any uses or disclosures of your PHI that we already made with your authorization.

 

 

FOR FURTHER INFORMATION

If you have questions or need further assistance regarding this Notice, you may contact Clear Brook’s Privacy Office by writing to: Clear Brook Inc., c/o Chairman HIPAA Compliance Committee, 1100 East Northampton Street, Wilkes-Barre, Pa. 18702 or 570-823-1171 or our website: clearbrookinc.com.

Confidentiality regulations for substance abuse treatment are more restrictive than HIPAA regulations.  Releases permitted by HIPAA may be prohibited by drug and alcohol regulations.  Consult with your counselor concerning confidentiality policy/procedures relating to substance abuse treatment and PHI.

 

EFFECTIVE DATE

This Notice went into effective April 14, 2003 and has been reviewed and revised.  This current version reflects those revisions.  No material changes have occurred.