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Notice
of Privacy Practices
Opengate
is required to release to consumers their rights as
they pertain to privacy protection, as part of the Health
Insurance Portability and Accountability Act of 1996.
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 about this Notice please contact:
our Privacy Contact: Randi Rios-Castro.
This
Notice of Privacy Practices describes how Opengate may
use and disclose your protected health information to
carry out treatment, payment or health care operations
and for other purposes that are permitted or required
by law. It also describes your rights to access and
control your protected health information. "Protected
health information" is any information, including
demographic information collected from an individual,
whether oral or recorded in any form or medium that:
- Is
created or received by a health care provider, health
plan, public health authority, employer, life insurer,
school or university, or health care clearinghouse;
andRelates
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 Identifies
the individual; or
- With
respect to which there is reasonable basis to believe
that the information can be used to identify the
individual
We
are required to abide by the terms of this Notice of
Privacy Practices. We may change the terms of our notice,
at any time. The new notice will be effective for all
protected health information that we maintain at that
time. Upon changes to the Notice of Privacy Practice,
a revision will be provided to you by mail. Opengate
will make a reasonable effort to limit use and disclosure
of protected health information to the minimum necessary
to carry out treatment, payment or health care operations.
1.
Uses and Disclosures of Protected Health Information
Uses
and Disclosures of Protected Health Information Based
Upon Your Written Consent
You
will be asked by Opengate to sign a consent form. Once
you have consented to use and disclosure of your protected
health information for treatment, payment and health
care operations by signing the consent form, Opengate
will use or disclose your protected health information
as described in this section 1. Your protected health
information may be used and disclosed by Opengate and
others outside of our Agency that are involved in your
care and treatment for the purpose of providing health
care services to you. Your protected health information
may also be used and disclosed to pay your health care
bills and to support the operation of Opengate.
The
following are examples of the types of uses and disclosures
of your protected health care information that Opengate
is permitted to make once you have signed our consent
form. These examples are not meant to be exhaustive,
but to describe the types of uses and disclosures that
may be made by Opengate once you have provided consent.
Treatment:
Opengate will use and disclose your protected health
information to provide, coordinate, or manage your health
care and any related services. This includes the coordination
or management of your health care with a third party
that has already obtained your permission to have access
to your protected health information. For example, we
would disclose your protected health information, as
necessary, to a physician that provides care to you.
In
addition, we may disclose your protected health information
from time-to-time to another physician or health care
provider (e.g., a specialist or laboratory) who, at
the request of your physician, becomes involved in your
care by providing assistance with your health care diagnosis
or treatment to your physician.
Payment:
Your protected health information will be used, as needed,
to obtain payment for your health care services. This
may include certain activities that your health insurance
plan may undertake before it approves or pays for the
health care services we recommend for you such as; making
a determination of eligibility or coverage for insurance
benefits, reviewing services provided to you for medical
necessity, and undertaking utilization review activities.
Healthcare
Operations: We may use or disclose, as-needed,
your protected health information in order to support
the business activities of Opengate. These activities
include, but are not limited to, quality assessment
activities, employee review activities, training of
staff, certification, fundraising activities, and conducting
or arranging for other business activities.
For
example, we may disclose your protected health information
to staff that provide you with services.
We
will share your protected health information with third
party "business associates" that perform various
activities (e.g., billing or pharmacy review) for Opengate.
Whenever an arrangement between our office and a business
associate involves the use or disclosure of your protected
health information, we will have a written contract
that contains terms that will protect the privacy of
your protected health information.
We
may use or disclose your protected health information,
as necessary, to provide you with information about
treatment alternatives or other health-related benefits
and services that may be of interest to you. We may
also use and disclose your protected health information
for other marketing activities. For example, your name
and address may be used to send you a newsletter about
Opengate and services we offer. We may also send you
information about services that we believe may be beneficial
to you. You may contact our Privacy Contact to request
that these materials not be sent to you.
We
may use or disclose your demographic information and
the dates that you received treatment from Opengate,
as necessary, in order to contact you for fundraising
activities supported by our office. If you do not want
to receive these materials, please contact our Privacy
Contact and request that these fundraising materials
not be sent to you.
Uses
and Disclosures of Protected Health Information Based
upon Your Written Authorization
Other
uses and disclosures of your protected health information
will be made only with your written authorization, unless
otherwise permitted or required by law as described
below. You may revoke this authorization, at any time,
in writing, except to the extent that Opengate has taken
an action in reliance on the use or disclosure indicated
in the authorization.
Other
Permitted and Required Uses and Disclosures That May
Be Made With Your Consent, Authorization or Opportunity
to Object
We
may use and disclose your protected health information
in the following instances. You have the opportunity
to agree or object to the use or disclosure of all or
part of your protected health information. If you are
not present or able to agree or object to the use or
disclosure of the protected health information, then
Opengate may, using professional judgement, determine
whether the disclosure is in your best interest. In
this case, only the protected health information that
is relevant to your health care will be disclosed.
Facility
Directories: Unless you object, we will use
and disclose in our facility directory your name, the
location at which you are receiving care, your condition
(in general terms), and your religious affiliation.
All of this information, except religious affiliation,
will be disclosed to people that ask for you by name.
Members of the clergy will be told your religious affiliation.
Others
Involved in Your Healthcare: Unless you object,
we may disclose to a member of your family, a relative,
a close friend or any other person you identify, your
protected health information that directly relates to
that persons involvement in your health care.
If you are unable to agree or object to such a disclosure,
we may disclose such information as necessary if we
determine that it is in your best interest based on
our professional judgment. We may use or disclose protected
health information to notify or assist in notifying
a family member, personal representative or any other
person that is responsible for your care of your location,
general condition or death. Finally, we may use or disclose
your protected health information to an authorized public
or private entity to assist in disaster relief efforts
and to coordinate uses and disclosures to family or
other individuals involved in your health care.
Emergencies:
We may use or disclose your protected health information
in an emergency treatment situation. If this happens,
Opengate or the physician providing services shall try
to obtain your consent as soon as reasonably practicable
after the delivery of treatment. If Opengate or your
physician is required by law to treat you and has attempted
to obtain your consent but is unable to obtain your
consent, he or she may still use or disclose your protected
health information to treat you.
Communication
Barriers: We may use and disclose your protected
health information if your physician or another physician
in the practice attempts to obtain consent from you
but is unable to do so due to substantial communication
barriers and the physician determines, using professional
judgement, that you intend to consent to use or disclosure
under the circumstances.
Other
Permitted and Required Uses and Disclosures That May
Be Made Without Your Consent, Authorization or Opportunity
to Object
We
may use or disclose your protected health information
in the following situations without your consent or
authorization. These situations include:
Required
By Law: We may use or disclose your protected
health information to the extent that the use or disclosure
is required by law. The use or disclosure will be made
in compliance with the law and will be limited to the
relevant requirements of the law. You will be notified,
as required by law, of any such uses or disclosures.
Public
Health: We may disclose your protected health
information for public health activities and purposes
to a public health authority that is permitted by law
to collect or receive the information. The disclosure
will be made for the purpose of controlling disease,
injury or disability. We may also disclose your protected
health information, if directed by the public health
authority, to a foreign government agency that is collaborating
with the public health authority.
Communicable
Diseases: We may disclose your protected health
information, if authorized by law, to a person who may
have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading the disease or
condition.
Health
Oversight: We may disclose protected health
information to a health oversight agency for activities
authorized by law, such as audits, investigations, and
inspections. Oversight agencies seeking this information
include government agencies that oversee the health
care system, government benefit programs, other government
regulatory programs and civil rights laws.
Abuse
or Neglect: We may disclose your protected health
information to a public health authority that is authorized
by law to receive reports of abuse or neglect. In addition,
we may disclose your protected health information if
we believe that you have been a victim of abuse or neglect
to the governmental entity or agency authorized to receive
such information. In this case, the disclosure will
be made consistent with the requirements of applicable
federal and state laws.
Food
and Drug Administration: We may disclose your
protected health information to a person or company
required by the Food and Drug Administration to report
adverse events, product defects or problems, biologic
product deviations, track products; to enable product
recalls; to make repairs or replacements, or to conduct
post marketing surveillance, as required.
Legal
Proceedings: We may disclose protected health
information in the course of any judicial or administrative
proceeding, in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly
authorized), in certain conditions in response to a
subpoena, discovery request or other lawful process.
Law
Enforcement: We may also disclose protected
health information, so long as applicable legal requirements
are met, for law enforcement purposes. These law enforcement
purposes include (1) legal processes and otherwise required
by law, (2) limited information requests for identification
and location purposes, (3) pertaining to victims of
a crime, (4) suspicion that death has occurred as a
result of criminal conduct, (5) in the event that a
crime occurs on the premises of Opengate, and (6) medical
emergency (not on Opengate premises) and it is likely
that a crime has occurred.
Coroners,
Funeral Directors, and Organ Donation: We may
disclose protected health information to a coroner or
medical examiner for identification purposes, determining
cause of death or for the coroner or medical examiner
to perform other duties authorized by law. We may also
disclose protected health information to a funeral director,
as authorized by law, in order to permit the funeral
director to carry out their duties. We may disclose
such information in reasonable anticipation of death.
Protected health information may be used and disclosed
for cadaveric organ, eye or tissue donation purposes.
Research:
We may disclose your protected health information to
researchers when their research has been approved by
OMRDD that has reviewed the research proposal and established
protocols to ensure the privacy of your protected health
information.
Criminal
Activity: Consistent with applicable federal
and state laws, we may disclose your protected health
information, if we believe that the use or disclosure
is necessary to prevent or lessen a serious and imminent
threat to the health or safety of a person or the public.
We may also disclose protected health information if
it is necessary for law enforcement authorities to identify
or apprehend an individual.
Workers Compensation: we may disclose your protected
health information as authorized to comply with workers compensation laws and other similar legally established
programs.
Required
Uses and Disclosures: Under the law, we must
make disclosures to you and when required by the Secretary
of the Department of Health and Human Services to investigate
or determine our compliance with the requirements of
Section 164.500 et. seq.
2.
Your Rights
Following
is a statement of your rights with respect to your protected
health information and a brief description of how you
may exercise these rights.
You
have the right to inspect and copy your protected health
information. This means you may inspect and
obtain a copy of protected health information about
you that is contained in a designated record set for
as long as we maintain the protected health information.
A "designated record set" contains medical
and billing records and any other records that Opengate
uses for making decisions about you.
Under
federal law, however, you may not inspect or copy the
following records; psychotherapy notes; information
compiled in reasonable anticipation of, or use in, a
civil, criminal, or administrative action or proceeding,
and protected health information that is subject to
law that prohibits access to protected health information.
Depending on the circumstances, a decision to deny access
may be reviewed. In some circumstances, you may have
a right to have this decision reviewed. Please contact
our Privacy Contact if you have questions about access
to your medical record.
You
have the right to request a restriction of your protected
health information. This means you may ask us
not to use or disclose any part of your protected health
information for the purposes of treatment, payment or
healthcare operations. You may also request that any
part of your protected health information not be disclosed
to family members or friends who may be involved in
your care or for notification purposes as described
in this Notice of Privacy Practices. Your request must
state the specific restriction requested and to whom
you want the restriction to apply.
Opengate
is not required to agree to a restriction that you may
request. If Opengate believes it is in your best interest
to permit use and disclosure of your protected health
information, your protected health information will
not be restricted. If Opengate does agree to the requested
restriction, we may not use or disclose your protected
health information in violation of that restriction
unless it is needed to provide emergency treatment.
With this in mind, please discuss any restriction you
wish to request with Opengate. You may request a restriction
by sending a letter to Georgiana Tracy detailing
the restriction as described above and signing and dating
your letter.
You have the right to request to receive confidential
communications from us by alternative means or at an
alternative location. We will accommodate reasonable
requests. We will not request an explanation from you
as to the basis for the request. Please make this request
in writing to our Privacy Contact.
You
may have the right to have Opengate amend your protected
health information. This means you may request
an amendment of protected health information about you
in a designated record set for as long as we maintain
this information. In certain cases, we may deny your
request for an amendment. If we deny your request for
amendment, you have the right to file a statement of
disagreement with us and we may prepare a rebuttal to
your statement and will provide you with a copy of any
such rebuttal. Please contact our Privacy Contact to
determine if you have questions about amending your
medical record.
You
have the right to receive an accounting of certain disclosures
we have made, if any, of your protected health information.
This right applies to disclosures for purposes other
than treatment, payment or healthcare operations as
described in this Notice of Privacy Practices. It excludes
disclosures we may have made to you, for a facility
directory, to family members or friends involved in
your care, or for notification purposes. You have the
right to receive specific information regarding these
disclosures that occurred after April 14, 2003. You
may request a shorter timeframe. The right to receive
this information is subject to certain exceptions, restrictions
and limitations.
3.
Complaints
You
may complain to us or to the Secretary of Health and
Human Services if you believe we have violated your
privacy rights. You may file a complaint with us by
notifying our privacy contact of your complaint. We
will not retaliate against you for filing a complaint.
You
may contact our Privacy Contact, Randi Rios-Castro
at (914) 277-5350 extension 111 or randir@opengate
inc.org for further information
about the complaint process.
This
notice was published and becomes effective on April
14, 2003.
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