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.
We at Granite Recovery Centers pledge to give you the highest-quality health care and to have a relationship with you that is built on trust. This trust includes our commitment to respect the privacy and confidentiality of your health information.
The word “GRC” in this Notice includes all locations where services are provided by Granite Recovery Centers.
This Notice is being given to you because federal law gives you the right to be told ahead of time about:
- How GRC will handle your medical information;
- GRC’s legal duties related to your medical information;
- Your rights with regard to your medical information.
Please note that treatment at Green Granite Recovery Centers provides you with additional protections, as explained throughout this notice.
- HOW WE MAY USE AND DISCLOSE (SHARE) YOUR PROTECTED HEALTH INFORMATION
When you need health care, you give information about yourself and your health to doctors, nurses, and other health care workers and staff. This information, along with the record of the care you receive, is known as “protected health information” (or “health information”). This information is kept in a paper form such as your medical record and in an electronic form on the computer.
GRC uses your health information within its system and shares your health information outside its system in order to give you excellent medical care. GRC uses and shares your health information for other reasons that can include medical research and training new health care workers. For example, GRC may share your health information with outside health care providers for purposes such as treatment or continuation of services. These providers have a specific relationship with GRC and physicians who have outside private practices but also occasionally work at a GRC hospital. In addition, other outside parties who receive your information in order to perform services on GRC’s behalf (“business associates”) must also take steps to keep your health information private. Some examples of business associates who may receive your information could include ambulance services, laboratories, pharmacies and the like.
This Notice will tell you how GRC uses and shares your health information for these and other purposes. It will also tell you when we need to get your specific permission to do so.
- Treatment, Payment, and Health Care Operations
Except where prohibited by NH state or federal laws (see section 4), GRC may legally use and share your health information for treatment, payment and health care operations. By law we do not need to ask for your specific permission to do these things, as explained below.
GRC health care providers will use and share your health information to provide and manage your health care and related services. For example, your primary care doctor may refer you to a specialist such as a radiologist or surgeon. The specialist may tell you that you need to be admitted to the hospital for treatment or surgery. All of the treatment providers in this example, whether they are in the GRC system or not, will share medical information about you to ensure the best treatment possible for you. This is to coordinate your care before, during and after you go into the hospital or receive other services. GRC will share information with other third parties, such as home health agencies, visiting nurses, rehabilitation hospitals, ambulance companies and others. It will also share information with those who treated you before you went into treatment and those who will treat you in the future. This helps to make sure that everyone caring for you has the information they need.
GRC and/or its providers will not share information with other GRC services and/or outside health care providers without an authorization signed by you to release information except in certain rare circumstances and medical emergencies that will be explained further in this notice.
GRC will use and share your health information to bill and collect payment for the health care services it gives to you. For example, if you have health insurance, your health care provider will share your medical information with the insurance company or government agency. The insurance company uses the information to tell if you are eligible for benefits or if the services you received were medically needed. However if you choose to pay for the full amount of services yourself and to not have your insurance company billed for those services, then you do have the right to restrict us from contacting your insurance company regarding any services received from us.
Health Care Operations
GRC may use and share your health information for activities that are known as health care operations. These are activities that are needed to operate its facilities and carry out its mission. Some of the information is shared with outside parties who perform these health care operations or other services on behalf of GRC (“business associates”), such as lawyers, auditors, consultants, and transcription services. We require these business associates, by contract, to take steps to keep your health information private. Examples of activities that make up health care operations include:
- monitoring the quality of care and making improvements where needed;
- making sure healthcare providers are qualified to do their job;
- reviewing medical records for completeness and accuracy;
- meeting standards set by regulating agencies, such as Joint Commission on Accreditation of Healthcare Organization; and
- teaching health professionals
GRC may use your health information to contact you:
- at the address and telephone numbers you give to us (including leaving messages at the telephone numbers) about scheduled or cancelled appointments, registration/insurance updates, billing or payment matters, pre-procedure assessment or test results;
- with information about patient care issues, treatment choices and follow-up care instructions;
- with other health-related benefits and services that may be of interest to you;
- to raise funds to support the GRC system and its missions of excellence, but we will use only demographic information (such as name, address, phone number, age, or gender) to contact you for such purposes.
- Uses and Disclosures (Sharing) of Your Health Information for Other Purposes
GRC may legally use and/or share your health information with others in the following areas without your specific permission
- as required by state and federal laws and regulations;
- for public health activities, including required reports to the state public health and child protection authorities, and to agencies such as cancer registries and the federal Food and Drug Administration;
- with regard to elder victims of abuse and neglect and, in some instances, to disabled victims of abuse or neglect;
- for health oversight activities;
- for legal and administrative proceedings;
- for law enforcement purposes under specific conditions, such as reporting when someone is the victim of a crime;
- with regard to people who have died, to coroners, medical examiners and funeral directors so they can carry out their lawful duties;
- for organ, eye or tissue donation at death;
- to avert a serious threat to health or safety;
- for specialized government operations;
- as authorized by and as necessary to comply with workers’ compensation laws;
- for research that is approved by a GRC research committee when written permission is not required by federal or state law. This also may include preparing for research or telling you about research studies in which you might be interested.
- Uses and Disclosures (Sharing) You May Ask to Be Limited or Request Not Be Made
If you are admitted to the center your name, room location, general condition and religion may be listed in that center’s directory (information desk). This will be shared with members of your family, friends, clergy members and others who ask for you by name. You may ask to have your name taken off the directory list. You may also ask to restrict the information that is given out about you. If you are in an emergency situation and are not able to make your wishes known, we will put this information in the directory if we think it is in your best interest. We will not put the information in the directory if you have been admitted to the center before and asked that it not be shared. GRC does not have a patient directory and will not give out any information regarding your care.
Disclosures to Family, Friends or Others
GRC may share relevant health information about you with a family member or other person close to you if that person is involved in your care or payment for your care.
GRC may use or share your health information to notify a family member or other person responsible for you about your location, general medical condition or death.
If you are present and are able to make health care decisions, we will try to find out if you want us to share your health information with your family members or others.
If you are in an emergency situation or not able to make your wishes known, we will use our best judgment to decide whether to share information. If it is thought to be in your best interest, we will share only information that others really need to know.
GRC also may use or share your health information with a public or private agency assisting in disaster relief. This is to coordinate efforts to notify someone on your behalf. If we can reasonably do so while trying to respond to the emergency, we will try to find out if you do want us to share this information.
Granite Recovery Centers will not give out any information to family or friends without an authorization signed by you except in rare situations explained in greater detail in this notice.
- Uses and Disclosures (Sharing) of Information That Require Your Written Permission (Authorization)
Except as described in this Notice and as permitted by law, we cannot use or share your health information without your written permission.
State or federal laws require that we obtain your written permission before using or disclosing the information listed below:
- Sharing information about genetic testing (as defined by state law) or genetic test results;
- Sharing information about HIV testing or test results;
- Sharing information from substance abuse rehabilitation treatment programs;
- Sharing information about treatment for sexually transmitted diseases;
- Using and sharing health information for research, research preparation or recruitment, when the appropriate GRC human research committee determines this is required under federal and state laws;
- Information state law recognizes as “privileged” (sensitive) information can be shared only in administrative and judicial proceedings if you give written permission. Privileged (sensitive) information includes information that relates to domestic violence, sexual assault counseling, confidential communications between a patient and a social worker or confidential details of psychotherapy (from a psychiatrist, psychologist or licensed mental health nurse clinical specialist);
- Such proceedings may include civil or criminal trials and their preliminary proceedings or hearings before a state, county or local administrative agency;
- Using and sharing psychotherapist notes (notes maintained outside of the medical record for the therapist’s own use). However, specific permission is not required for use or sharing of these notes for your therapist to treat you, for training programs, for legal defense in an action you bring or for oversight of the therapist;
Using information regarding diagnosis, nature of service and treatment information to raise funds to support the GRC system and its missions of excellence.
Note: If you have given permission for your medical information in the above categories to be used or shared, you may withdraw your permission in writing at any time except to the extent that the providers have already acted on it.
- YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION AND HOW TO EXERCISE THEM
The Right to Ask for Limits on the Use and Sharing of Your Health Information
You have the right to ask for restrictions on the use and sharing of your health information for treatment, payment or health care operations. You can also ask for restrictions on using this information to notify you about appointments and sharing your information with family members and close friends. You have the right to restrict our communication with your insurance company or other payers of bills for your services if you notify us of your desire to restrict these communications and you pay for all your services in full without needing to bill the insurance company or other payor.
GRC is not required to agree to your request. If we do, we must put the restriction in writing and abide by it, except if you need to be treated in an emergency. You may not ask us to restrict uses and sharing of information that we are legally required to make.
The Right to Ask That GRC Communicate Your Health Information to You in a Confidential Manner.
You have the right to ask for your health information to be sent to you in different ways. For example, you may ask that GRC not contact you with appointment reminders by telephone, or only call at your work or cell telephone number rather than home. When we request an address and telephone numbers to contact you, it is your responsibility to give us telephone numbers and an address that will allow us to carry out our needs to reach you and care for you. We may request that the method and location where you wish to be contacted be in writing and that you contact us with any changes to this information. GRC must agree to any reasonable request and cannot ask you to explain the reason for your request. GRC can require you to give information as to how a payment will be handled and to what address a bill should be mailed.
The Right to Look at and Get a Copy of Your Health Information.
You have the right to look at and get a copy of information GRC keeps about your medical treatment and bills. You may request either a paper or electronic copy of your records or portions of your records. You must ask for this in writing. We will respond within 30 days from receipt of your request. If you ask for a copy of your records, you will be charged a fee for them as well as any postage costs that may be incurred in sending these copies to you. Details on any fees for copies of records or instructions on how to request copies of your records may be made by contacting GRC at firstname.lastname@example.org
If your request is denied, we will explain the reasons in writing and tell you which rights you have, if any, to a review of the denial. We may offer to give you a summary or explanation of the information you requested, as long as you agree in advance to this and to any fees that it might cost. If you ask for information that we do not have, but we know where it is, we must tell you where to direct your request.
The Right to Change Your Health Information.
You have the right to ask us to change your health information related to your treatment and bills if you think there has been a mistake or that information is missing. You must make your request in writing and give the reason why you want the change. We have 60 days to respond to your request. If we are not able to act on the request within the 60 days, we will notify you that we are extending the response time by 30 days.
If we extend the response time, we will explain the delay to you in writing and give you a new date of when to expect a response.
We may deny your request.
If we deny your request, we must give you a written statement with the reasons for the denial and what other steps are available to you.
If we grant the request, we will ask you to tell us the persons you want to receive the changes. You need to agree to have us notify them along with any others who received the information before corrections were made and who may have relied on the incorrect information to give you treatment.
The Right to Receive an Accounting of Disclosures (Record of When Your Health Information Was Shared Without Your Written Permission or Authorization).
You have the right to get a record of the times that your health information has been shared without your signed authorization. You must make your request in writing. You may request this information as far back as six years. The listing you get will include the date, name and address (if known) of the person receiving your information. It will also include a brief description of the information given and a brief statement of why the information was shared.
The following exceptions apply:
The listing will not include instances when we shared your health information for the purpose of treatment, payment or healthcare operations.
The listing will also not include those instances when we:
- shared your health information because you gave your permission in writing (signed an authorization form);
- shared the information in a facility directory with people who asked for you by name;
- shared information with persons involved in your care;
- used your information to communicate with you about your health condition;
- shared information for national security or intelligence purposes or with correctional institutions or law enforcement officials who have custody of you;
- shared information based on instances that occurred before the date shown on this Notice
We have 60 days to respond to your request. If we have not been able to act on the request within the 60 days, we will notify you that we are extending the response time by 30 days. If we do extend the response time, we will explain the delay to you in writing and give you a new date of when to expect a response.
Your first request for a record in any 12-month period is free. We will charge a fee for any other requests in that period. We will notify you of the fee before we do the work. This will give you a chance to stop the request if you do not wish to pay the fee.
You may contact GRC and ask for a paper copy of this Notice from the contact listed below. You can ask for a paper copy even if you agreed to receive the Notice by email.
- OUR DUTIES WITH RESPECT TO YOUR HEALTH INFORMATION
GRC is required by law to keep your health information private. We are required to give people notice of our legal duties and privacy practices with respect to your health information.
GRC must abide by the terms of the Notice currently in effect. GRC reserves the right to change its privacy practices and the terms of this Notice at any time. GRC reserves the right to make the new Notice provisions effective for all protected health information that it maintains. If GRC makes a material change to this Notice, the updated Notice will be posted on the GRC website and in all GRC registration areas for public viewing. You may request a copy of the current Notice by emailing email@example.com.
- HOW TO COMPLAIN IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED
If you think that we may have violated your privacy rights or you disagree with any action we have taken with regard to your health information, we want you, your family or your guardian to speak with us. If you present a complaint, your care will not be affected in any way. It is the goal of Granite Recovery Centers to give you the best care while respecting your privacy.
You may file a complaint by sending a written complaint to the Secretary of the Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC 20201, or email to HHS.Mail@hhs.gov. Granite Recovery Centers as well as all other treatment providers are prohibited by law from taking any retaliatory action against you if you file a complaint about our privacy practices.
- PERSON TO CONTACT FOR INFORMATION OR WITH A COMPLAINT
If you have any questions about this Notice or any complaints, please email firstname.lastname@example.org.
EFFECTIVE DATE OF THIS NOTICE
This Notice is effective as of September 1, 2018. (866) 815-0730