Brown Stone Family Services Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Your Privacy is Important
Brown Stone Family Services understands your privacy is important. We are required by law to maintain the privacy of your protected health information. We are required to provide a notice of our legal duties and privacy practices with respect to your protected health information. We are committed to treating and using protected health information about you responsibly. We strive to safeguard your private health information through administrative, physical and technical means allowed by federal and state law, agency policy and adherence to the most stringent laws that protects your health information. This notice will also describe your rights related to your protected health information. We are required to abide by the terms of this notice. This notice is effective April 14, 2003, and applies to all protected health information as defined by the regulations.
Understanding Your Medical /Health Record Information
Each time you receive services from Brown Stone Family Services, we make a record of your visit. Typically this record contains your assessment, service plan, progress notes, diagnosis, treatment, response to medications and plan for future care or treatment. This information is referred to as your health information or medical record. The record serves as a:
How do we use and disclose your health information?
Upon signing Brown Stone Family Services’ consent to treatment, you are allowing us to use and disclose necessary information about you within the agency and with our business associates in order to provide treatment, receive payments for provided services and conduct our day to day health care operations.
Listed below are examples of how we use your health information for Treatment, Payment and Healthcare Operations.
Treatment – In order to provide treatment, we disclose this information, within the agency, to your case manager/counselor, physician, nurses, other service providers and administrative staff in order to meet your needs. For example, your Case Manager/Counselor may consult with the various service providers within the agency. At the time of the consultation, your health information may be shared during treatment planning.
Payment – We document the services you receive at each visit so that you, your insurance company or other third party payors can pay us. For example, we may provide copies of your medical record to your insurance company or tell your health plan about upcoming services or services received that require their approval. We also may send you a bill that may include information that identifies you.
Health Care Operations – Health Information is used to improve services we provide to train staff, and students, for business management, quality improvement and for customer service. For example, we may use your health information to review our treatment and services and to evaluate the performance of our staff in caring for you.
There are some services provided in our organization through an agreement with business associates. When these services are contracted, we may disclose your health information to our business associates so they can perform the job we have asked them to do. We require business associates to safeguard your information.
Brown Stone Family Services is also allowed by federal and state laws to disclose specific health information about you in certain circumstances. We may disclose your health information to:
We may also use or disclose your personal health information for the following operational purposes to enhance your health care. We may contact you to provide:
- Appointment reminders by mail or phone.
- Information about treatment alternatives.
- Information about health-related benefits and services that may be of interest to you.
You may tell your primary care providers that you do not want us to use or disclose your information for the above three activities.
All other uses and disclosures for reason other than for treatment, payment and health care operations not previously described may only be done with your written authorization. You may revoke your authorization; however, this will not affect prior uses and disclosures. Request for revoke of your authorization must be done in writing.
Your Rights Defined by Federal and State Law
Although your medical record is the property of Brown Stone Family Services, the protected health information belongs to you. You have the right to:
Fees may apply to request followed by a asterisk (*). Contact your primary care provider if you wish to exercise your rights.
Changes to Privacy Notice
Brown Stone Family Services reserves the right to change privacy practices, and make the new practices effective for all the information we maintain. Revised notices will be posted in our facilities and we will offer you a copy when you receive services.
If You Have a Complaint
If you believe that your privacy has been violated, you may file a complaint with the agency Privacy Officer or with the Secretary of Health and Human Services in Washington, D.C. We will not retaliate or penalize you for filing a complaint with the facility or the Secretary.
|To file a complaint or receive more information write or contact:
Michelle Lakins-Waller, Compliance Officer
|To file a complaint with the Secretary of Health and Human Services call or write to:
Region III OCR