Notice of Privacy 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.
If you have any questions or need help understanding this Notice, please contact our Privacy Officer. The contact information for the Privacy Officer is listed on the last page of this document.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE
You will be asked to sign a form stating you have received this notice. If you’re a minor under the age of 18 years old, your parent or guardian will sign on your behalf. We want you to understand your privacy rights and how we might use your Protected Health Information (PHI). You do not have to sign the form. If you decide you do not want to sign it, we will still give you the services you need, and will still use your (PHI) when we need to.
In the rest of this Notice, we will use “PHI” to mean “protected health information”, and “release” to mean “disclose”.
“Minor” means an individual under the age of 18 years, this includes child and adolescent.
“Guardian” means a person appointed by the court to exercise specific powers over an individual who is a minor, legally incapacitated, or developmentally disabled.
“You” means an individual receiving services through CNS Healthcare, this includes adults and minors. If you’re a minor under the age of 18 years old, your parent or legal guardian will be acting on your behalf of this notice.
WHO WILL FOLLOW THIS NOTICE
This notice describes CNS Healthcare’s practices regarding your protected health information.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION
“Protected health information” is:
Examples of this may include:
CNS Healthcare is required by law to do the following:
We may change our notice at any time. The new notice will cover all PHI that we keep at the time of the new notice. The new notice will be posted on our website, www.cnshealthcare.org. You can also call our office and ask us to send you a copy in the mail, or you can ask for one at the time of your next appointment.
This Notice of Privacy Practices describes how we may use and release (give to others) your PHI. We may use it to carry out treatment, payment or health care operations. We may also use it for other purposes that are permitted or required by law. This notice also describes your rights to see and control your PHI.
How We May Use or Release Your PHI:
Your PHI may be used and released to help us provide you with health care services. This includes services that you get from your treating professional(s), and our other staff. It can also include others outside of our offices that are involved in your care and treatment. It may also be used and released to pay your health care bills and to help our agency do its work.
Here are examples of the types of uses and releases of your PHI that our office can make. These examples are not a complete list, but they describe the types of uses and releases that we might make.
For example, getting approval for a hospital stay may require that your PHI be released to your insurance company or Oakland Community Health Network (OCHN).
We may also use your PHI for carrying out other business activities. For example, we may release your PHI to volunteers or interns that see consumers at our agency. We may also use a sign-in sheet at the registration desk where you will be asked to sign your name, and/or call you by name in the waiting room. We may use or release your PHI, such as your name and address, to contact you to remind you of your appointment.
We will share your PHI with outside (third-party) “business associates” that perform different kinds of activities for our agency. For example, we might use an outside computer company to help us with our computer records. Whenever an arrangement like this involves the use or release of your PHI, we will have a written contract (Business Associate Agreement) with that organization that will protect your privacy.
We may use or release parts of your PHI to offer you information that may be of interest to you. For example, we may use your name and address to send you newsletters or other information about activities of our agency or Oakland Community Health Network (OCHN). You may contact our Privacy Officer to ask that these materials not be sent to you.
CNS Healthcare may use some of your PHI for certain fundraising activities but we will obtain a written authorization from you when we do this. We may use your photo or other PHI on our Facebook page or in our newsletters.
We may use your PHI to help us determine what other services we or our business partners may be of interest to you. For example, your name and address may be used to send you newsletters, invitations, announcements or general communications about upcoming seminars, or health fairs, We may also send you information based on your own health concerns. We do not receive monies from these third parties for making this communication and if we ever did, we would receive your written authorization first.
You can at any time tell us not to contact you again, or you at any time can “opt out” of being contacted for any fundraising or marketing activities we may be participating in. This in no way will affect your treatment or payment.
We do not sell your information to anyone and do not manage or create a hospital directory.
We do not create psychotherapy notes. We will only release substance abuse treatment records when you sign an authorization for us to do so.
Other Permitted and Required Uses and Releases
We may use or release your PHI in the following situations required by law without your consent or authorization.
Uses and Disclosures of Protected Health Information Based On Your Written Authorization
You must give us special permission by signing a form called an authorization for any use or release of your PHI that is not covered in this Notice of Privacy Practices that we just described.
You may cancel this authorization in writing at any time, unless our agency has already released your PHI based on an authorization you gave us.
You have the right say how we can use or disclose your PHI.
There are two times when your treating professional is allowed to use their professional judgment to decide if a use or release is in your best interest:
“Substantial communication barrier” means that a person does not use any kind of speech, or other type of communication such as a body signal like blinking of the eyes for yes or no. Your treating professional may use their professional judgment to decide if you mean to agree to this use or release. If they do, they must follow these rules:
In these cases, only the PHI that is important for your health care will be released.
The only time we would not need an authorization is if the use or release is permitted or required by state law. We have already described these situations in the section “Other Permitted and Required Uses and Releases”.
Following is a statement of your rights regarding your PHI and a brief description of how you may use these rights.
Under federal law, however, you may not see or copy the following records:
You may have a right to have this decision reviewed. Please contact our Privacy Official if you have questions about seeing or copying your medical record.
We will provide you with a copy or a summary of your PHI, within 30 days of your request if not sooner.
We are not required to agree to your request and may say “no” but we’ll tell you why. We will allow your PHI to be used or released if your treatment professional believes it is in your best interest. If your treatment professional does agree to your request, we will only use or release your PHI if it is needed to provide emergency treatment. Please discuss any restriction you want to ask for with your treating professional.
However if you pay for a service or health care item out of pocket in full, you can ask us not to share that information for the purpose of payment, or our operations with your health insurers. We will say “yes” unless a law requires us to share that information.”
We can only correct information that we created or that was created on our behalf. If you believe that information we have received from another provider or source is wrong, you must ask that provider or agency to change it.
We will make sure the person has this authority and can act for you before we take any action.
For certain PHI you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, let us know. We will be sure to have you sign an authorization allowing for that disclosure on file that will be good for a year.
COMPLAINTS IF YOU FEEL YOUR RIGHTS ARE VIOLATED
You can complain if you feel we have violated your rights by contacting us using the information below. We will not retaliate against you for filing a complaint. You may reach our Privacy Officer at:
279 Summit Drive
Waterford, Michigan 48328
Phone: (248) 745-4900
Or you may contact the U.S. Department of Health and Human Services.
Office for Civil Rights
U.S. Department of Health & Human Services
233 N Michigan Ave., Ste. 240
Chicago, IL 60601
(312) 886-2359 TDD: (312) 353-5693
Fax: (312) 886-1807
This notice was published and becomes effective on April 14, 2003.
Revised 04/18, 09/16, 04/15, 11/14, 12/13, 09/13, 08/08