This notice describes how medical information
about you may be used and disclosed and how you may access
this information.
| 1 |
a. |
Your Protected Health Information (PHI) may be used
and disclosed to carry out treatment, payment and healthcare
operations.
Examples:
We will use your health information for treatment.
Information relevant to your care obtained by staff
members will be recorded in your record and used by
our staff to assist in the planning and evaluation of
your care.
We will use your health information for healthcare
operations. Staff members, such as Quality Improvement,
may use information in your record to assess the care
and outcomes in your case and others like it. This information
will be used in an effort to continually improve the
quality and effectiveness of the healthcare and service
we provide.
We will use your health information for payment.
Claims will be sent to your insurer as well as other
PHI necessary to process the claim.
|
| |
|
|
| |
b. |
You have the right to restrict the use and
disclosure of your protected health information (PHI)
or to revoke your consent. We will comply whenever possible
and except to the extent that we have already taken action
in reliance on your consent. You have the right to request
that we communicate with you via alternative means or
location. |
| |
|
|
| |
c. |
You have the right to request, in writing,
to amend any PHI in your record. If we cannot comply,
we will include your request, statement and our refusal
in your record. |
| |
|
|
| 2. |
Only the minimum
amount of information necessary to accomplish the intended
purpose will be disclosed. |
| |
|
|
| 3. |
Your records will be kept confidential
except under certain circumstances, when authorized
by law, rules or regulations. It is important to understand
that there are specific times when we are required to
report certain information. We have listed the most
common situations. Please note that this is not a complete
list as laws change and new ones are adopted.
|
| |
|
|
| |
a. |
Release to a legally authorized representative:
parent, guardian, durable power of attorney, etc. |
| |
|
|
| |
b. |
Release of information to your insurance
company to comply with billing requirements. |
| |
|
|
| |
c. |
Outside governmental agencies may review
The Mental Health Center's records to be sure we are meeting
their standards. Examples include: NH Division of Behavioral
Health and NH Division of Public Health. |
| |
|
|
| |
d. |
Worker's Compensation (NH Labor Board) when
you have filed a Workers Compensation claim. |
| |
|
|
| |
e. |
Staff are required to report any suspicion
of physical abuse, sexual abuse and/or neglect of children,
the elderly and/or incapacitated adults to the appropriate
agencies. RSA 161-F:43, RSA 169-C:29. |
| |
|
|
| |
f. |
Report of injury caused by criminal act.
RSA 631:6. |
| |
|
|
| |
g. |
By court order. |
| |
|
|
| |
h. |
Statements made to physicians licensed pursuant
to RSA 329 and psychologists or persons certified pursuant
to RSA 330-A or to those who work under their supervision,
may be disclosed for the purpose of commitment hearings. |
| |
|
|
| |
i. |
When a client has made a serious threat
of physical violence against a clearly identified or reasonably
identifiable victim or victims, or a serious threat of
substantial damage to real property, physicians certified
pursuant to RSA 329 and psychologists or persons certified
pursuant to RSA 330-A, or those who work under their supervision,
may disclose the threat to the third party or law enforcement
officials in accordance with RSA 329:31 and RSA 330:A:22. |
| |
|
|
| |
j. |
Information described in RSA 135-C:19-a
may be released to a caretaker or persons who resides
in the home with you, without your consent under certain
circumstances. We will first attempt to obtain your permission. |
| |
|
|
| |
k. |
The Office of the Attorney General and the
Division of Behavioral Health shall have access to all
records and information pertaining to a client when that
client is the subject of an involuntary commitment hearing,
a guardianship proceeding, or when the client has instituted
legal action against the state in regard to care and treatment
provided by the mental health service delivery system. |
| |
|
|
| |
l. |
Information regarding the medical treatment
of a client may be released to law enforcement officials
or health facility personnel if an emergency situation
exists involving danger to the client's health or safety.
Only specific information necessary to the relief of the
emergency may be released without the client's consent. |
| |
|
|
| |
m. |
RSA 330 may require records to be released
to the NH Board of Mental Health Practice in the event
of an investigation into a clinician's practice. |
| |
|
|
| |
n. |
State licensing boards may access your records
in the course of investigating a complaint filed with
them. |
| |
|
|
| |
o. |
The Office of the NH Medical Examiner may
access medical records of a deceased individual. |
| |
|
|
| 4. |
You are able to view your records at
a mutually agreed upon time. In cases where the treatment
team has determined there are specific reasons for having
a staff member present, this may be required. If you
request copies of your record, the first 25 pages are
free and no more than 25 cents per page thereafter will
be charged.
|
| |
|
|
| 5. |
Your records shall be retained for 7
years after discharge for adults and 22 years beyond
the age of 18 for children. In the event of death, records
may only be released upon the consent of the court-appointed
Administrator of the Estate.
|
| |
|
|
| 6. |
You have the right to consent to release
all or any portion of your protected health information
to a third party. You may withdraw this consent at any
time. You have the right to receive an accounting of
disclosures of your PHI.
|
| |
|
|
| 7. |
We sometimes disclose protected health
information to individuals or organizations that provide
services on our behalf. Our contracts with these business
associates provide for privacy protection of that PHI.
|
| |
|
|
| 8. |
Your information may be used for medical
research, but only after approval by the Institutional
Review Board, followed by your consent to participate
in a research study and to have your information used;
or by Institutional Review Board waiver of authorization;
or research on a deceased individual's records.
|
| |
|
|
| 9. |
We may contact you to provide appointment
reminders, other health-related information or for fundraising
activities. If you do not wish to be contacted regarding
fundraising, contact our Development Office.
|
| |
|
|
| 10. |
The Center must comply with the Privacy
Practices currently in place. The Center reserves the
right to revise these practices and, if so, a current
version will be posted in all waiting rooms and may
be obtained upon written request.
|
| |
|
|
| 11. |
If you feel your privacy rights have
been violated, you may contact one of The Center's complaint
investigators at (603) 668-4111 or you may contact the
U.S. Secretary for Health and Human Services. You will
not be retaliated against if you do so.
|
