Notice of Patient Privacy

This notice describes how medical/health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

What is the purpose of this Notice?

We respect the privacy of your health information and pledge to protect that information. This Notice describes your rights and our duties on the subject of your health information. It tells you about how we may use and give out ("disclose") your personal medical information. This Notice applies to all information and records about your care that we have received or created. It also applies to information received or created by our employees, staff, and volunteers as well as by the Medical Director and other health care staff who practice at Access Rehab Centers.

Our promise to you about our duties and responsibilities:

The law says we must protect the privacy of your information. The law also says that we need to give you this notice about what we do with the information we collect and maintain about you. We must follow the practices described in this notice. The Notice will be posted in public areas in our building. We agree to consider any reasonable privacy requests and to notify you if we are unable to meet those requests. We will not use or give out your information without your permission, except as described in this notice.

Who will follow this Notice?

Access Rehab Centers provides care to our patients and clients together with doctors and other health professionals. This Notice will be followed by:

All employees of the departments and units of Access Rehab Centers;
All therapy staff of Waterbury Hospital

What are your rights as a patient?

You have the following rights regarding your health information at Access Rehab Centers:

You have the right to ask us to limit how your personal medical information is used and given out for your care, for billing, and for our business reasons. If you write to us and ask us to limit this information, we will consider your request. Please understand that under the law, we do not have to accept it. You may also ask us to limit your medical information that we use and give out to a family member, friend or other person who is involved in your care or the payment for your care.
You have the right to see and get a copy of your medical or billing records or other written information that we may use to make decisions about your care, with some limited exceptions. In most cases, we may charge a reasonable fee for our costs in copying and mailing the information you have asked for. There are certain circumstances where we cannot agree to your request. In these cases, you will have the right to review the reasons why we did not agree with your request. A licensed health care professional named by the hospital will perform the review.
You have the right to request that we add to ("amend") your health record if you believe that the information is wrong or if you believe that important information is missing. Your request must be made in writing and must list the reason for your request. If we disagree with your request, you may ask us to include your written statement asking for the change as part of your record. We will also provide you a written statement that lists the reasons why we disagreed with your request.
You have the right to get a listing or "accounting" of those people or organizations that received your medical information from us. This list includes disclosures made by Access Rehab Centers or by others on our behalf. It does not include disclosures for treatment, payment and our business operations or certain other exceptions. To request an accounting of disclosures, you must send us a request in writing. The first list provided within a 12-month period will be free. After that, we may charge you our costs.
You have the right to have a paper copy of this Notice at any time you ask for it from any of our service or treatment areas.
You have the right to ask that we communicate with you about your health matters in a different way or at a different place. For example, you can ask that we contact you only at a certain phone number or address that may be different from your home address. We will agree to reasonable requests.

Who do you contact for more information or to report a problem?

If you believe that your privacy rights have been violated, you may file a complaint in writing with the Access Rehab Centers by contacting the person listed below.

Privacy Officer of Access Rehab Centers
22 Tompkins Street
Waterbury, CT 06708
Telephone: 203-419-0381 Ext. 222

You may also file a complaint with the Office of Civil Rights in the U.S. Department of Health and Human Services. There are no penalties if you file a complaint.

What happens if Access Rehab Centers changes this Notice?

We have the right to change this notice. We will post a copy of the current notice in the clinics. The notice will contain on the first page, in the top right-hand corner, the effective date. Also, each time you register at or are admitted to Access Rehab Centers for treatment or health care services as an outpatient, you may ask for a copy of the current notice in effect. If we change this notice, you will be notified the next time you come to Access Rehab Centers and you may receive a new copy. When and how will Access Rehab Centers use and/or give out your personal medical information? We may use and disclose your health information for purposes of treatment, payment and health care operations (our business operations) without written permission. There are times when we must use your personal medical information. Access Rehab Centers must use and give out your personal medical information to provide information:

To you or someone who has the legal right to act for you (your personal representative),
To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected,
Where required by law, and in certain emergency circumstances.

What are treatment, payment, and health care operations and what are some examples?

Treatment: Treatment is when we provide care to you. It includes many pieces, including when doctors and others consult on your case or when referrals are needed. We will use and disclose your health information when we provide you with treatment and services, and to coordinate your care. Your health information may be used by doctors and nurses, as well as by lab technologists, dieticians, physical therapists, radiologists or other personnel involved in your care. For example, our therapists may need certain information to complete a prescription ordered by your doctor. We also may give health information to individuals or facilities that will be involved in your care after you leave Access Rehab Centers.
Payment: Payment is billing for services we provided. It also involves receiving payment from individuals or insurance companies. We will give out some of your health information so that we can bill and receive payment for the treatment and services you receive. For billing and payment purposes, we may give out your health information to your representative, insurance or managed care company, Medicare, Medicaid or another payer. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed treatment or service. Payment information may include things that identify you, your diagnosis, procedures performed on you, and supplies we used.
Health Care Operations: Health care operations involves many things that Access Rehab Centers must do to operate its' business side. We may give out your health information as necessary for clinic operations or business reasons. These may include management purposes or reviewing our treatment and services for quality of care. We may also use your information to evaluate the performance of our staff in caring for you by using surveys. For example, health information of many patients may be grouped and studied for purposes such as evaluating and improving quality of care and planning for services. Health information is used in evaluating our employees and in reviewing the qualifications and practices of therapists and other licensed health care staff at Access Rehab Centers. We also may use and disclose health information for education and training purposes. We may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when your therapist is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

How else does Access Rehab Centers use and disclose medical information?

We may also use and disclose health information about you for specific purposes. Below is a list of the various ways in which we may use or give out your health information.

Clinic Directory - Unless you say no, or are a Behavioral Health Patient, we will include certain limited information about you in our directory while you are a patient. Our directory does not include specific medical information about you other than your general condition. If people ask for you by name, we will share that you are a patient here and where you are located.
Individuals Involved in Your Care or Payment for Your Care - Unless you say no, we may disclose health information about you to a family member, close personal friend or other person you identify, including clergy, who is involved in your care. We will only share the information needed for that person to help with your care or in arranging payment for your care.
Business Associates - There may be some services provided by our business associates, such as a billing and transcription services, or legal and accounting consultants. We may give out your health information to our business associates so they can perform the jobs we have asked them to do. To protect your health information, we have our business associates sign written contracts that require them to keep your information safe and confidential.
Disaster Relief - We may disclose health information about you to an organization assisting in a disaster relief effort.
Emergencies - We may use or disclose your health information in emergency treatment situations.
Communication Barriers - We may use and disclose your protected health information if your therapist or another therapist in the practice tries to get permission from you but can't because of language barriers. In this case, the therapist will use reasonable judgment that you intend to give permission to use or disclosure information under the circumstances.
As Required By Law - We may disclose your health information when required by law to do so.
Reporting Victims of Abuse, Neglect or Domestic Violence. If we believe that you have been a victim of abuse or neglect, we may use and disclose your health information to notify a government authority. This will happen if we are authorized or required by law or if you agree to the report. For child / elder abuse or neglect, we will disclose your health information to government authorities.
Legal Proceedings- We may disclose your health information in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process.
Appointment Reminders - We may use or disclose health information to remind you about appointments.
Public Health Activities - We may disclose your health information for public health activities. These activities may include, for example:

reporting to a public health or other government authority for the purpose of preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting births and deaths;
reporting to the federal Food and Drug Administration (FDA) issues concerning problems with products and product recalls, etc., or
to notify a person who may have been exposed to or is at risk of spreading a communicable disease, if authorized by law.

Health Oversight Activities - We may disclose your health information to a health oversight agency for activities authorized by law. These may include, for example, Medicare audits, investigations, State Health Department inspections and licensure actions or other legal proceedings.
Law Enforcement - We may disclose your health information for certain law enforcement purposes. These include, for example, following reporting requirements for emergencies or suspicious deaths; to follow a court order, warrant, or similar legal procedure; to identify or locate a suspect or missing person; or to answer certain requests for information about crimes.
Research - Your health information may be used for research purposes without authorization, but only if there has been review and approval by our Review Board.
Coroners, Medical Examiners, Funeral Directors, and for Organ Donation - We may release your health information to a coroner, medical examiner or funeral director. If you are an organ donor, we may disclose your information to an organization involved in the donation of organs and tissue.
To Avoid a Serious Threat to Health or Safety - Should it be necessary to prevent a serious threat to your health or safety or the health or safety of others, we may use or disclose health information. This type of disclosure will be limited to someone able to help decrease or stop the threatened harm.
Military Activity and National Security - Under certain conditions, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities believed necessary by appropriate military command authorities: (2) for the purpose of determining your eligibility for benefits by the Department of Veterans Affairs, or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information to authorized
Federal Officials for Conducting National Security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Workers' Compensation - We may use or disclose your health information to comply with laws relating to workers' compensation or similar programs.
Inmates/Law Enforcement Custody - If you are an inmate of a prison or jail, or under the custody of a law enforcement official, we may disclose your health information to the institution or official for certain purposes including the health and safety of you and others.
Treatment Alternatives and Health-Related Benefits and Services - We may use or disclose your health information to inform you about treatment alternatives and health-related benefits and services that may be of interest to you. For example, your name and address may be used to send you a newsletter about products or services that we believe may be beneficial to you.
Minors - We will follow Connecticut law when using or disclosing protected health information of minors. For example, if you are an unemancipated minor agreeing to health care services related to HIV/AIDS, venereal disease, abortion, reproductive issues, behavioral health or alcohol/drug dependence, and you have not requested that another person be treated as a personal representative, you may have the authority to agree to the use and disclosure of your health information.

Is information about Behavioral Health, substance abuse treatment, and HIV treated differently?

For disclosures concerning health information relating to care for Behavioral Health (psychiatric) conditions, substance abuse or HIV-related testing and treatment, special rules may apply. For example, we usually are not able to disclose this specially protected information in response to a subpoena, warrant or other legal process unless you sign a special authorization or a court orders the disclosure. We will follow state and/or federal law and obtain a special authorization to release this type of information about you in cases other than what is listed here.

Psychiatric (Behavioral Health) information - If needed for your diagnosis or treatment in a mental health program, psychiatric information may be disclosed based on your general agreement, and very limited information may be disclosed for payment purposes.
HIV-related information - HIV-related information may be disclosed based on your general agreement for purposes of treatment or payment.
Substance abuse treatment- If you are treated in a special substance (drug and/or alcohol) abuse program, your authorization will be needed for most disclosures, except for emergencies, certain reporting requirements and other disclosures specifically allowed under federal law.

Your authorization or permission is required for other uses of your medical information.

For other reasons that are not listed in this Notice, we will use or give out your information only with your written permission ("authorization"). When you sign our Patient Agreement, you allow us to use and disclose your health information for treatment, payment and health care operations. A written authorization must list other particular uses or disclosures that you may allow. You may cancel an authorization to use or disclose health information, in writing, at any time. If you cancel an authorization, we will no longer use or disclose your health information for the purposes covered by that authorization, except in cases where we followed your original request.

Effective date: April 14, 2003