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This Notice of Privacy Practices describes how we 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" (PHI) means health information (including identifying information about you)
we have collected from you or received from your health care providers. It may include information
about your past, present or future physical or mental health or condition, the provision of your health care,
and payment for your health care services.
We are required by law to maintain the privacy of your health information and to provide you with this notice
of our legal duties and privacy practices with respect to your health information. We are also
required to comply with the terms of our current Notice of Privacy Practices.
We may change the terms of our notice at any time. Notifications of changes will be posted in our
office and on our website (www.urbanpathways.org). A revised copy may be obtained by calling the
office or by asking for one at one of our sites.
This notice will become effective April 14, 2003
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If you have any questions about this Privacy Notice, please contact our Privacy Officer Stephen
Grimaldi at 212.736.7385 ext.226 or email her at sgrimaldi@urbanpathways.org or mail enquires to above address.
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I. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION FOR THE FOLLOWING PURPOSES
Treatment We may use and disclose your PHI to provide, coordinate, or manage your health care
and related services within the continuum of care within this agency. This also may
include sharing information with other mental health or community providers involved in your
treatment to better assist you in achieving your personal goals.
Payment In order for a third party payer (eg: insurance company) to pay for your
treatment we must submit a bill that identifies you, your diagnosis, and the treatment provided to you.
As a result we will/may pass such health information onto an insurer in order to help receive payment for your medical bills.
Health Care Operations We may use and disclose health information about you for agency operations.
These uses and disclosures are necessary to run the agency and see that all of our clients receive quality care.
Treatment records may be reviewed as part of ongoing process directed toward assuring the quality of agency
operations, training, chart review, licensing or accreditation. We may also provide your PHI to
our accountants or regulatory agencies in order to make sure we are complying with the laws that affect us.
Appointments We may also use and disclose your health information to contact you to remind
you of your appointment.
Treatment Alternatives We may use and disclose PHI to tell you about or recommend
possible treatment options or alternatives that may be of interest to you such as nursing services,
treatment groups and the like.
II. USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION BUT FOR WHICH YOU WILL HAVE THE OPPORTUNITY TO OBJECT
Facility Directory Within our residential facilities we maintain a name
directory for the purpose of allowing visitors and callers to contact you. The fact that
you reside at one of these facilities will only be provided to individuals who ask for you by name.
Family/Friends/Caregivers UP may disclose important health information about
you to individual involved in your care, such as your family member, friend, caregiver, partner, relative,
legal guardian or foster parent. We would make every attempt to gain your permission prior to
disclosing information, but may need to notify any of the above persons responsible for your care in regards
to your location, general condition, or death. In situations where you are not capable of giving
consent (because you are not present or due to your incapacity or medical emergency), we may, using our
professional judgment, determine that a disclosure to your family member or friend is in you best interest.
In that situation, we will disclose only health information relevant to the person's involvement in your care.
You have the right to object to such disclosure at any point in your care/treatment with UP again unless there is an emergency.
III. USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION
Serious Threat to Health or Safety We may use and disclose protected
health information about you when necessary to prevent a serious threat to your health and safety
or the health and safety of the public or another person.
Required by Law We will disclose health information about you when required to do so by federal,
state or local law.
Public Health Matters UP may be required to report your health information to
authorities to help prevent or control disease, injury or disability. This may require UP to report
information about births, deaths, or suspected child/elder abuse or neglect.
Mental Health/Health Oversight Activities UP may disclose health information
to individuals/agencies for the purpose of audits, investigations, inspections, or licensing purposes.
These disclosures may be necessary for certain state and federal agencies to monitor UP and ensure compliance
with government and civil rights laws.
Military, Veterans, National Security/or Incarceration/Law Enforcement Custody If you
are involved with the military, national security or intelligence activities, or are in the custody of law
enforcement officials or an inmate in a correctional institution, we may release your health information to
the proper authorities so they may carry out their duties under the law.
Law Enforcement/Lawsuits/Court Services We may release PHI if asked to do so
by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process
subject to all applicable legal requirements.
Victims of Abuse, Neglect or Domestic Violence UP may notify the appropriate
government authorities if we believe a client has been the victim of abuse, neglect or domestic violence.
We will only make such disclosure if you agree or when required or authorized by law.
Death/Organ Donation We may disclose your health information to coroners,
medical examiners and funeral directors so they can carry out their duties related to your death, such as
identifying the body, determining cause of death. If you are an organ donor, we may also disclose
your health information to people involved with obtaining, storing or transplanting organs or tissue donations.
Emergencies We may disclose your PHI in an emergency treatment situation.
IV. USES AND DISCLOSURES OF YOUR HEALTH INFORMATION WITH YOUR PERMISSION
Uses and disclosures not described above will generally only be made with your written permission, called
an "authorization." You have the right to revoke an authorization at any time.
If you revoke your authorization we will not make any further uses or disclosures of your health information
under that authorization, unless we have already taken an action relying upon the uses or disclosures you have
previously authorized.
V. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Request to Inspect and Copy You have to inspect or copy health
information used to make decisions about your care. Usually, this would include clinical
and billing records. You must submit your request in writing to our Privacy Officer and
we may charge a fee for the cost of supplying the information. We may also deny your request
to inspect and/or copy in certain limited circumstances. If you are denied access to your
health information, you may ask that the denial be reviewed. Please contact UP's Privacy
Officer, Ettie Shapiro, CSW if you have any questions about how to access your records.
Right to Request to Make Changes For as long as we keep records about you,
you have the right to request us to amend any health information used to make decisions about your care.
To request an amendment, you must contact our Privacy Officer and tell us with as much detail as possible
what needs to be changed and why. We may deny your request if you ask us to amend information
that UP did not create, or if UP believes the information is complete and accurate.
If we deny your request to amend, we will send you a written notice of the denial stating the basis for the
denial and offering you the opportunity to provide a written statement disagreeing with the denial.
If you do not wish to prepare a written statement of disagreement, you may ask that the requested amendment and
our denial be attached to all future disclosures of the health information that is the subject of your request.
If you choose to submit a written statement of disagreement, we have the right to prepare a written rebuttal to
your statement of disagreement. In this case, we will attach the written request and the rebuttal
(as well as the original request and denial) to all future disclosures of the health information that is the
subject of your request.
Right to an Accounting of Disclosures You have the right to request an "accounting
of disclosures." This is a list of the disclosures we made of medical information about you for
purposes other than treatment, payment and health care operations. To request this list you must
submit your request in writing to the Privacy Officer. The request should state the time period
for which you wish to receive an accounting. This time period should not be longer than six years
and not include dates before April 14, 2003. We must comply with your request for a list within 30 days,
unless you agree to a 30-day extension, and we may not charge you for the list, unless you request it more than
once per year. In addition, we will not include in the list: disclosures made to you, disclosures
made for purposes of treatment, payment, health care operations, national security, law enforcement/corrections,
and certain health oversight activities.
Right to Request Restrictions You have the right to request a restriction on the
health information we use or disclose about you for treatment, payment or health care operations.
You also have the right to request a limit on the health information we disclose about you to someone who is
involved in your care or the payment for it. To request a restriction, you must request the restriction
in writing to the Privacy Officer. The Privacy Officer will ask you to sign a request for restriction
form, which you should complete and return to the Privacy Officer. We are not required to agree to a
restriction that you may request. If we do agree, we will comply with your request unless the
restricted health information is needed to provide you with emergency treatment.
Right to Request Confidential Communications You have the right to request that
we communicate with you about your health care only in a certain location or through a certain method.
Right to a Paper Copy of this Notice You have the right to obtain a paper copy
of this Notice of Privacy Practices at any time. Even if you have agreed to receive this Notice
of Privacy Practices electronically, you may still obtain a paper copy. To obtain a paper copy,
contact our Privacy Officer.
VI. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary
of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
If you would like to file a complaint with us, contact our Privacy Officer at 575 8th Ave, 9th floor NYC 10018,
212.736.7385 ext. 26 who will assist you with writing your complaint, if you request such assistance.
VII. CHANGES TO THIS NOTICE
We reserve the right to change the terms of our Notice of Privacy Practices. We also reserve the right
to make the revised or changed Notice of Privacy Practices effective for all health information we already have
about you as well as any health information we receive in the future. We will post a copy of the current
Notice of Privacy Practices at our main office and at each site where we provide care. You may also
obtain a copy of the current Notice of Privacy Practices by accessing our website at www.urbanpathways.org or
by calling us at 212.736.7385 and requesting that a copy be sent to you in the mail or by asking for one
any time you are at our offices.
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