This notice describes how clinical informaton about our consumers may be used and disclosed, and how our consumers, their guardians and/or their personal representatives, can get access to this information. Guardians and personal representatives should be aware that the word "You" in this notice refers to the consumer, not to the guardian. Please review it carefully.
We are committed to protecting the privacy of you and your family, and sharing information about you only with those who need to know and who are permitted by law to receive this information. We are required by both federal and state law protect the privacy and confidentiality of mental hygiene information that may reveal your identity, and to provide you with a copy of this notice which describes the clinical information privacy practices of our agency, its staff, and affiliated service providers that jointly provide services for you. A copy of our current notice will always be posted in our reception area or call us at 718-805-6796, ext. 0 or asking for one at the time of your next visit.
If you have any questions about this notice or would like further information, please contact Paul Challita at 718-805-6796, ext. 138.
Clinical information about you
may be used by our agency (or its business associates) in connection
with our duties to provide you with treatment, to obtain payment for
that treatment, or to conduct our agency’s business operations.
1. We will not disclose clinical information about
you without your consent or written authorization,
except for the following purposes:
When we are communicating with other mr/dd agencies, which are currently
providing services to you, or working with us to plan for services for
you, if this communication is about treatment, payment, or agency operations.
"treatment" means
that we may share clinical information about you inside our agency,
or with another agency, to plan for and provide services for you. If
you agree, we may also share information about you with others outside
mr/dd service system when necessary to provide other services; for example,
we may disclose certain information about you to a prospective employer
in connection with a job placement or training program.
"payment" means
that we may use clinical information about you, or share it with others,
so that we obtain payment for your services
"operations" means
that we may use clinical information about you, or share it with others,
in order to conduct our normal business operations. For example, we
may use clinical information about you to evaluate the performance of
our staff in providing services to you, or to educate our staff on how
to improve the care they provide for you.
To a personal representative
who is authorized to make health care decisions on your behalf;
To government agencies
or private insurance companies in order to obtain payment for services
we provided to you;
To comply with a court
order;
To appropriate persons
who are able to avert a serious and imminent threat to the health or
safety of you or another person;
To appropriate government
authorities to locate a missing person or conduct a criminal investigation
as permitted under Federal and State confidentiality laws;
To other licensed agency
emergency services as permitted under Federal and State confidentiality
laws;
To an attorney representing
you in an involuntary hospitalization or medication proceeding. (We
will not disclose clinical information about you to an attorney for
any other reason without your authorization, unless we are ordered to
do so by a court.)
To authorized government
officials for the purpose of monitoring or evaluating the quality of
care provided by the agency or its staff;
To qualified researchers
when such research poses minimal risk to your privacy;
To coroners and medical
examiners to determine cause of death; and
If you are an inmate, to
your correctional facility if they certify that the information is necessary
in order to provide you with health care, or to protect the health or
safety of you or any other persons at the correctional facility.
Funeral Directors.
In the event of your death, we may release this information to funeral
directors as necessary to carry out their duties.
Organ And Tissue Donation.
In the event of your death, we may disclose your health information
to organizations that procure or store organs, eyes or other tissues
so that these organizations may investigate whether donation or transplantation
is appropriate and possible under applicable laws. Your organs and/or
tissue would not be used for transplant without written consent by a
legally authorized person.
We may use or disclose
clinical information about you if we have removed any information that
might reveal who you are.
Emergencies Or Public
Need. We may use or disclose clinical information about you in
an emergency or for important public needs. For example, we may share
your information with public health officials at the New York State
or City health departments who are authorized to investigate and control
the spread of diseases.
As Required By Law.
We may use or disclose your clinical information if we are required
by law to do so, or if a court orders us to do so in a lawsuit or judicial
proceeding. We also will notify you of these uses and disclosures if
notice is required by law.
Victims Of Abuse, Neglect
Or Domestic Violence. We may release clinical information about
you to a public health authority that is authorized to receive reports
of abuse, neglect or domestic violence. For example, we may report your
information to government officials if we reasonably believe that you
have been a victim of abuse, neglect or domestic violence. We will make
every effort to obtain your permission before releasing this information,
but in some cases we may be required or authorized to act without your
permission.
National Security And
Intelligence Activities Or Protective Services. We may disclose
clinical information about you to authorized federal officials who are
conducting national security and intelligence activities or providing
protective services to the President or other important officials.
2. If you do not object, we may disclose
information about you in the following situations:
Disclosure To Friends
And Family Involved In Your Care. We will ask you whether you have
any objection to sharing clinical information about you with your friends
and family involved in your care.
Agency Directory.
We will ask you whether you have any objection to including information
about you in our Agency Directory.
Facility Directory.
Unless you object, we will include your name, where in our agency you
receive services, your general condition and your religious affiliation
in our Facility Directory while you are a consumer at our facility.
This directory information, except for your religious affiliation, may
be released to people who ask for you by name. Your religious affiliation
may be given to a member of the clergy, such as a priest or rabbi, even
if he or she doesn’t ask for you by name.
3. Special Situations
Fundraising. We
may use demographic information about you (such as your age, gender,
where you live or work, and the dates that you received services) in
order to contact you to raise money to help us operate. We may also
share this information with a charitable foundation that will contact
you to raise money on our behalf. If you do not want to be contacted
for these fundraising efforts, please write to Lola
di Bari at our office.
Research. In most
cases, we will ask for your written authorization before using clinical
information about you or sharing it with others in order to conduct
research. However, under some circumstances, we may use and disclose
your clinical information without your authorization
if we obtain approval through
a special process to ensure that research without your authorization
poses minimal risk to your privacy.
if we do not allow we allow
researchers to use your name or identity publicly.
to people who are preparing
a future research project, so long as any information identifying you
does not leave our facility. In the unfortunate event of your death,
we may share your clinical information with people who are conducting
research using the information of deceased persons, as long as they
agree not to remove from our facility any information that identifies
you.
• the fact that you are a participant at, or receiving services from, our agency;
• information about your condition;
• information about health care products or services you have received or may receive in the future (such as a medication or equipment); or
• information about your health care benefits under an insurance plan (such as whether a prescription is covered);
when combined with:
• geographic information (such as where you live or work);
• demographic information (such as your race, gender, or ethnicity);
• unique numbers that may identify you (such as your social security number, your phone number, or your Medicaid number); and
• other types of information that may identify who you are.
Incidental Disclosures. While we will take reasonable steps to safeguard the privacy of your information, certain disclosures of your information may occur during or as an unavoidable result of our otherwise permissible uses or disclosures of your information. For example, during the course of a treatment session, other consumers in the treatment area may see, or overhear discussion of, your information.
How
To Access Your Clinical Information. You generally have the right
to inspect and copy your clinical information. For more information, please
see later in this notice. See (1) under the section below titled "Your
Rights".
How To Correct Your Clinical Information. You have the
right to request that we amend your clinical information if you believe
it is inaccurate or incomplete. For more information, please see later
in this notice. See (2) under the section below titled "Your
Rights".
How To Keep Track Of The Ways Your Health Information Has Been
Shared With Others. You have the right to receive a list from
us, called an “accounting list,” which provides information
about when and how we have disclosed clinical information about you to
outside persons or organizations. Many routine disclosures we make will
not be included on this accounting list, but the accounting list will
identify non-routine disclosures of your information. For more information,
please see later in this notice. See (3) under the section below titled
"Your Rights".
How To Request Additional Privacy Protections. You have
the right to request further restrictions on the way we use clinical information
about you or share it with others. We are not required to agree to the
restriction you request, but if we do, we will be bound by our agreement.
For more information, please see later in this notice. See (4) under
the section below titled "Your Rights".
How To Request More Confidential Communications. You
have the right to request that we contact you in a way that is more confidential
for you, such as at home instead of at work. We will try to accommodate
all reasonable requests. For more information, please see later in this
notice. See (5) under the section below titled "Your Rights".
How Someone May Act On Your Behalf. You have the right
to name a personal representative who may act on your behalf to control
the privacy of your clinical information. Parents and guardians will generally
have the right to control the privacy of clinical information about minors
unless the minors are permitted by law to act on their own behalf.
How To Learn About Special Protections For HIV, Alcohol and Substance
Abuse, And Genetic Information. Special privacy protections apply
to HIV-related information, alcohol and substance abuse treatment information,
and genetic information. Some parts of this general Notice of Privacy
Practices may not apply to these types of information. If your clinical
records include this type of information, you will be provided with separate
notices explaining how the information will be protected. To request copies
of these other notices now, please contact Paul
Challita at 718-805-6796,
ext. 138.
How To Obtain A Copy Of This Notice. You have the right
to a paper copy of this notice. You may request a paper copy at any time,
even if you have previously agreed to receive this notice electronically.
To do so, please call us at 718-805-6796,
ext. 0, or by requesting a copy at your next visit.
How To Obtain A Copy Of Revised Notice. We may change
our privacy practices from time to time. If we do, we will revise this
notice so you will have an accurate summary of our practices. The revised
notice will apply to all of your clinical information, and we will be
required by law to abide by its terms. We will post any revised notice
in our agency reception area. You will also be able to obtain your own
copy of the revised notice by accessing our website at www.in-res.org,
calling us
at 718- 805-6796, ext. 0 or asking
for one at the time of your next visit. The effective date of the notice
will always be noted in the top right corner of the first page.
How To File A Complaint. If you believe your privacy
rights have been violated, you may file a complaint with us or with the
Secretary of the Department of Health and Human Services. To file a complaint
with us, please contact Paul Challita at
718-805-6796, ext. 138.
No one will retaliate or take action against you for filing a complaint.
We want you to know that you have the following rights to access and control your clinical information. These rights are important because they will help you make sure that the clinical information we have about you is accurate. They may also help you control the way we use your information and share it with others, or the way we communicate with you about your medical matters.
1. Right To Inspect And
Copy Records
You have the right to inspect and obtain a copy of any of any clinical
information that may be used to make decisions about you and your treatment
for as long as we maintain this information in our records. This includes
medical and billing records. To inspect or obtain a copy of your clinical
information, please submit your request in writing to Paul
Challita at 718-805-6796,
ext. 138 .
If you request a copy of the information,
we may charge a fee for the costs of copying, mailing or other supplies
we use to fulfill your request. The standard fee is $0.75 per page and
must generally be paid before or at the time we give the copies to you.
We will respond to your request for inspection of records within 10 days.
We ordinarily will respond to requests for copies within 30 days if the
information is located in our facility, and within 60 days if it is located
off-site at another facility. If we need additional time to respond to
a request for copies, we will notify you in writing within the time frame
above to explain the reason for the delay and when you can expect to have
a final answer to your request.
Under certain very limited circumstances, we may deny your request to
inspect or obtain a copy of your information. If we do, we will provide
you with a summary of the information instead. We will also provide a
written notice that explains our reasons for providing only a summary,
and a complete description of your rights to have that decision reviewed
and how you can exercise those rights. The notice will also include information
on how to file a complaint about these issues with us or with the Secretary
of the Department of Health and Human Services. If we have reason to deny
only part of your request, we will provide complete access to the remaining
parts after excluding the information we cannot let you inspect or copy.
2. Right To Request Amendment
of Records
If you believe that the clinical information we have about you is incorrect
or incomplete, you may ask us to amend the information. You have the right
to request an amendment for as long as the information is kept in our
records. To request an amendment, please write to Paul
Challita at 718-805-6796,
ext. 138 .
Your request should include the
reasons why you think we should make the amendment. Ordinarily we will
respond to your request within 60 days. If we need additional time to
respond, we will notify you in writing within 60 days to explain the reason
for the delay and when you can expect to have a final answer to your request.
If we deny part or all of your request, we will provide a written notice
that explains our reasons for doing so. You will have the right to have
certain information related to your requested amendment included in your
records. For example, if you disagree with our decision, you will have
an opportunity to submit a statement explaining your disagreement which
we will include in your records. We will also include information on how
to file a complaint with us or with the Secretary of the Department of
Health and Human Services. These procedures will be explained in more
detail in any written denial notice we send you.
3. Right To An Accounting
Of Disclosures
After April 14, 2003, you have a right to request an “accounting
of disclosures” which is a list that contains certain information
about how we have shared your information with others. An accounting list,
however, will not include any information about:
• Disclosures we made to you;
• Disclosures we made pursuant to your authorization;
• Disclosures we made for treatment, payment or health care operations;
• Disclosures made in the facility directory;
• Disclosures made to your friends and family involved in your care
or payment for your care;
• Disclosures made to federal officials for national security and
intelligence activities;
• Disclosures that were incidental to permissible uses and disclosures
of your clinical information;
• Disclosures for purposes of research, public health or our normal
business operations of limited portions of your clinical information that
do not directly identify you;
• Disclosures about inmates to correctional institutions or law
enforcement officers;
• Disclosures made before April 14, 2003.
To request this accounting list, please write to Paul Challita at 718-805-6796,
ext. 138 .
Your request must state a time
period within the past six years (but after April 14, 2003) for the disclosures
you want us to include. For example, you may request a list of the disclosures
that we made between January 1, 2004 and January 1, 2005. You have a right
to receive one accounting list within every 12-month period for free.
However, we may charge you for the cost of providing any additional accounting
list in that same 12-month period. We will always notify you of any cost
involved so that you may choose to withdraw or modify your request before
any costs are incurred.
Ordinarily we will respond to your request for an accounting list within
60 days. If we need additional time to prepare the accounting list you
have requested, we will notify you in writing about the reason for the
delay and the date when you can expect to receive the accounting list.
In rare cases, we may have to delay providing you with the accounting
list without notifying you because a law enforcement official or government
agency has asked us to do so.
4. Right To Request Additional
Privacy Protections
You have the right to request that we further restrict the way we use
and disclose your clinical information to treat your condition, collect
payment for that treatment, or run our agency’s normal business
operations. You may also request that we limit how we disclose information
about you to family or friends involved in your care. For example, you
could request that we not disclose information about a surgery you had.
To request restrictions, please write to Paul
Challita at 718-805-6796,
ext. 138.
Your request should include (1)
what information you want to limit; (2) whether you want to limit how
we use the information, how we share it with others, or both; and (3)
to whom you want the limits to apply.
We are not required to agree to your request for a restriction, and in
some cases the restriction you request may not be permitted under law.
However, if we do agree, we will be bound by our agreement unless
the information is needed to provide you with emergency treatment or comply
with the law. Once we have agreed to a restriction, you have the
right to revoke the restriction at any time. Under some circumstances,
we will also have the right to revoke the restriction as long as we notify
you before doing so; in other cases, we will need your permission before
we can revoke the restriction.
5. Right To Request Confidential
Communications
You have the right to request that we communicate with you about your
medical matters in a more confidential way by requesting that we communicated
with you by alternative means or at alternative locations. For example,
you may ask that we contact you by fax instead of by mail, or at work
instead of at home. To request more confidential communications, please
write to Paul Challita
at 718-805-6796, ext. 138
We will not ask you the reason for your request, and we will try to accommodate all reasonable requests. Please specify in your request how or where you wish to be contacted, and how payment for your health care will be handled if we communicate with you through this alternative method or location.
| HOME | | PROGRAM/SERVICES | | CAREERS | | ABOUT IRI | | CONTACT US | | SITE MAP |