Our Pledge Regarding Your Health Information
We at Northeastern Mental Health Center understand that medical/treatment information about you and your health is personal. Protecting medical/treatment information about you is important. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice describes Northeastern Mental Health Center privacy practices and that of all its divisions, programs, employees, interns, volunteers, and the services of its affiliates. Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for your health care is considered
Protected Health Information (PHI).
This Notice will tell you about the ways in which we may use and disclose PHI about you. We also describe your rights and certain obligations we have regarding the use and disclosure of your PHI.
We are required by law to:
Make sure that PHI that identifies you is kept private; Give you this Notice of our legal duties and privacy practices with respect to PHI about you; and Follow the terms of the Notice that is currently in effect.
We reserve the right to change our privacy practices and the terms of this Notice at any time. You may request a copy of the new notice from any Northeastern Mental Health Center office. The following categories describe different ways that we may use and disclose protected health information (PHI). For each category of uses or disclosures we give some examples. Not every use or disclosure in a category will be listed. Except in specified circumstances, we will use or disclose only the minimum necessary PHI to accomplish the intended purpose of the use or disclosure.
For Treatment: We may use your PHI to provide you services. We may disclose your PHI to doctors, counselors, nurses, case managers and other health care personnel who are involved in providing your health care. For example, a psychiatrist may use clinical tests to evaluate the effectiveness of certain medications.
To Obtain Payment: We may use and disclose your PHI so that the treatment and services you receive from us may be billed and payment may be collected from you, an insurance company or other third party. For example, we may need to give your PHI about our treatment plan so your health plan will reimburse us or you for the treatment. We may also tell your health plan about a service you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations: We may use and disclose PHI about you for Northeastern Mental Health Center health care operations. These uses and disclosures are necessary to operate the company and make sure that all of our clients receive quality care. For example, we may use your PHI to review our treatment and services and to evaluate the performance of our staff providing you service. Release of your PHI to our accountants, attorneys or federal or state officials may be necessary for audit or accreditation purposes.
Appointment Reminders: Unless you provide us with alternative instructions, we may telephone or send appointment reminders and other similar material to your home.
Treatment Alternatives: We may use or disclose PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Research: Under certain circumstances, we may use and disclose PHI about you for research purposes. For example, a research project may involve comparing the health and recovery of clients who received one medication to those who received another, for the same condition. Before we use or disclose PHI for research, the project will have been approved through a research approval process.
When Required by Law: We may disclose PHI when required by law such as in cases of suspected abuse, neglect or domestic violence, or in response to a court order.
To Avert Threat to Health or Safety: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.
For Public Health Activities: We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to the public health authority.
For Specific Government Functions: We may disclose PHI in certain situations: military personnel and veterans, to correctional facilities, government benefit programs, and for national security reasons.
Uses and Disclosures of PHI Requiring Authorization
For uses and disclosures not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us an authorization to use or disclose PHI about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose PHI about you for the reasons covered by the written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided you.
Your Rights Regarding Your Protected Health Information
You have the following rights relating to your protected health information (PHI).
To Request Restrictions on Uses/Disclosures: You have the right to ask that we limit how we use or disclose your PHI. We will consider your request, but are not legally bound to agree to the restriction. To the extent that we do agree to any restrictions on our use/disclosure of your PHI, we will comply with your request unless the information is needed to provide you emergency treatment. We cannot agree to limit uses/disclosures that are required by law. To request restrictions, make your request in writing to the Clinical Director at the address listed at the end of this brochure.
To Request Confidential Communications: You have the right to request that we communicate with you about your treatment/services in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, discuss your request with the staff member involved in your treatment.
To Inspect and Request a Copy of Your PHI: Unless your access to your records is restricted for clear and documented treatment reasons, you have a right to see your protected health information upon written request to the Privacy Officer at the address listed at the end of this brochure. If we deny your request, we will give you written reason for the denial and explain any right to have the denial reviewed. If you request a copy of the information, we may charge a reasonable processing fee, depending upon your circumstances. You have the right to choose what portions of your information you want copied and to have prior information on the cost of processing.
To Request an Amendment of Your PHI: If you believe there is a mistake or missing information in our record, you may request, in writing, to the Privacy Officer at the address listed at the end of this brochure, that we correct or add to the record. We may deny the request if we determine that the record is: (1) correct and complete; (2) not created by us and/or not part of our records, or: (3) not permitted to be disclosed. Any denial will state the reason for the denial and explain your rights to have the request and denial, along with any statement in response that you provide, appended to your record. If we approve the request for amendment, we will change the record and so inform you, and inform others that need to know about the change in the record.
To an Accounting of Disclosures: You have the right to request an accounting of disclosures. This is a list of when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure: for the treatment, payment, and health care operations; to you; or pursuant to your written authorization. This list will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or disclosures made before April 2003. To request a list, discuss your request with the staff member involved in your treatment.
If you believe that we have violated your privacy rights, you may file a complaint with Northeastern Mental Health Center by writing to:
Northeastern Mental Health Center
14 South Main Street, Suite 1E
Aberdeen, SD 57401
Phone: (605) 225-1010
Fax: (605) 225-725-8057
You also may file a complaint with the Secretary of the U.S. Department of Health and Human Services:
200 Independence Avenue SW
Washington D.C. 20201
Effective Date: This notice is effective on April 14, 2003