This Notice of Privacy Practices (this “Notice”) describes our policies and certain laws regarding the collection and use of medical information about you, as well as how you can access this information. You should review this Notice carefully.
This Notice was last revised on April 3, 2015.
This Notice explains the duties that apply to Endeavor House North and its affiliates (collectively, “Endeavor House”) under Federal Law (including the Health Insurance Portability and Accountability Act, or “HIPAA”), as well outlining your rights.
This Notice applies to protected health information (“PHI”). PHI is information about you that may identify you (including demographic information), that relates to:
- your past, present, or future physical or mental health or condition;
- provision of healthcare services to you; or,
- past, present, or future payment for provision of healthcare services to you.
Federal law requires Endeavor House to:
- maintain the privacy of your PHI;
- provide you with notice of our legal duties and privacy practices with respect to your PHI; and,
- notify you following a breach of unsecured PHI related to you.
We are required to abide by the terms of this Notice. This Notice is effective as of the date listed on the first page of this Notice. This Notice remains effective until it is revised. Federal law requires us to modify this Notice whenever there are material changes to our duties, your rights, or the matters discussed in this Notice.
We reserve the right to change our privacy policies and practices (including the terms of this Notice), as permitted by applicable law, and in our sole an absolute discretion. Any new version of this Notice will be effective for all PHI maintained at (or after) the date of such revision.
Notifications regarding any revision of this Notice will be provided as follows:
- upon request;
- electronically (through our website or other electronic means); and,
- as posted in our places of business.
In addition, Federal Law requires that we respond to your requests regarding your rights appropriately, and in a timely manner.
CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE RECORDS
Federal law provides for confidential treatment of records maintained by us regarding alcohol and drug abuse. In general, we may not say to a person outside of the treatment center that you are a patient of that treatment center, or disclose any information identifying you as an alcohol or drug abuser unless such disclosure is:
- consented to in writing;
- authorized by a court order; or,
- made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.
You can find out more information under, “Authorization to Use or Disclose PHI,” and “Uses and Disclosures,” below.
A treatment center’s violation of applicable Federal laws regarding PHI may be a crime. If you suspect a violation you may report it to the appropriate authorities.
Federal law does not protect any information about a crime committed at one of our treatment facilities (or against any person who works for Endeavor House), or about any threat to commit such a crime. Federal law does not protect any information about suspected child abuse or neglect from being reported under applicable State law to any designated State or local authorities. You can read more below under “Uses and Disclosures”.
USES AND DISCLOSURES
The use and disclosures of PHI may be permitted, required, or authorized under certain circumstances. The following describes ways that we use and disclose PHI:
Among Treatment Facilities and our Personnel. We may use or disclose PHI among Endeavor House personnel having a need for the information in connection with duties arising out of the diagnosis, treatment, or referral for treatment of alcohol or drug abuse; provided, that, such communication is (i) within the treatment facility; or, (ii) between the treatment facility and Endeavor House. Our staff (including clinical staff and other treatment staff) may use your PHI to provide your treatment. We may also use your PHI in connection with billing that is sent to you, and in tracking your billing account. Your PHI may be used to check insurance coverage and to prepare claims for your insurance company. We may also use and disclose PHI in order to conduct our treatment/healthcare business and to perform functions associated with our business activities, including accreditation and licensing functions.
Secretary of Health and Human Services. We may be required to disclose PHI to the Secretary of the U.S. Department of Health and Human Services (“HHS”) when the Secretary is investigating or determining our compliance with the privacy rules under the Health Insurance Portability and Accountability Act.
Business Associates. We may disclose your PHI to a “Business Associate” that is contracted by us to perform services on our behalf. Prior to any such disclosure, each Business Associate must agree to:
- protect the privacy PHI;
- use and disclose PHI only for the purposes for which the Business Associate was engaged;
- be bound by 42 CFR Part 2; and,
- if necessary, participate in judicial proceedings to resist any efforts to obtain access to patient records, except as otherwise permitted by law.
Crimes on premises. We may disclose to law enforcement officers PHI that is directly related to the commission of a crime on our premises, or against our personnel (or the threat to commit such a crime).
Reports of suspected child abuse and neglect. We may be required to disclose PHI under state laws regarding suspected child abuse and neglect. We may not disclose original patient records without consent, including in any civil or criminal proceedings that may arise out any report of suspected child abuse or neglect we are required to report.
Court order. We may disclose PHI in response to a court order, provided the order meets certain requirements.
Emergencies. We may disclose PHI to medical personnel for the purpose of treating you in an emergency.
Research. We may use and disclose PHI for research if certain requirements are met (e.g., approval by an Institutional Review Board).
Audit and Evaluation Activities. We may disclose PHI to persons conducting certain audit and evaluation activities, provided that the receiving person agrees to restrictions on disclosure of information.
Reporting of Death. We may disclose PHI related to cause of death to a public health authority that is authorized to receive such information.
AUTHORIZATION TO USE OR DISCLOSE PHI
Other than as stated above, we may only use or disclose PHI with written authorization. Subject to limited exceptions, we will not use or disclose PHI (including psychotherapy notes) for marketing purposes or sell your PHI, unless you have signed an authorization. If you or your representative previously authorized us to use or disclose PHI, you may revoke that authorization, in writing, at any time to stop future uses or disclosures. We may honor oral revocations once we can authenticate your identity, and until a written revocation is received. Any revocation by you will not affect any PHI use or disclosures that were permitted while your authorization was in effect.
The following are your rights regarding any PHI we maintain about you. Information regarding how to exercise those rights is included.
RIGHT TO NOTICE
You have the right to adequate notice of the use and disclosure of PHI, and our duties and responsibilities regarding PHI. You may request both a paper and electronic copy of this Notice. You may ask us to provide a copy of this notice at any time. You may obtain this notice on our website at www.endeavorhousenorth.com or from facility staff or our Privacy Officer.
RIGHT OF ACCESS TO INSPECT AND COPY
For as long as we maintain your PHI, and as required by law, you have the right to access, inspect and obtain a copy. This right may be restricted only in certain limited circumstances. All requests for access to your PHI must be made in writing. Under certain circumstances, we may deny your request. Any denial of a request to access PHI will be communicated in writing. If you are denied access to your PHI, you may request that the denial be reviewed. Another licensed health care professional chosen by Endeavor House will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the decision made by the designated professional. If you are further denied, you have a right to have a denial reviewed by a licensed third-party healthcare professional (i.e. one not affiliated with us). We will comply with the decision made by the designated professional.
We may charge a reasonable, cost-based fee for the copying and/or mailing process of your request. For PHI maintained in an electronic format, you may request that the copy to which you are otherwise entitled be produced in that electronic format if it is readily producible. If not, electronically stored PHI may be produced in any readable format as we may agree (e.g. PDF). Your request may also include transmittal directions to another individual or entity.
RIGHT TO AMEND
For so long as we maintain your PHI, if you believe the PHI is incorrect or incomplete, you have the right to request that we amend your PHI. The request must be made in writing and you must provide a reason to support the requested amendment. Under certain circumstances we may deny your request, including but not limited to, when the PHI:
- was not created by us;
- is excluded from access and inspection under applicable law; or,
- is accurate and complete.
If we deny your request, we will provide the reasons in writing. You may write a statement of disagreement if your request is denied. This statement will be maintained as part of your PHI, and will be included with any disclosure of your PHI. If we grant your request, we will work with you to identify any other healthcare stakeholders that require notification and provide it.
RIGHT TO REQUEST AN ACCOUNTING OF DISCLOSURES
We are required to create and maintain a list (an “accounting”) of certain PHI disclosures. You have the right to request a copy of such an accounting for a specified time period (e.g., an accounting for the period of two years prior to the date on which the accounting is requested). No such request may exceed six years. Any request for an accounting must be submitted in writing.
The law does not require us to record certain types of disclosures (such as disclosures made pursuant to your authorization). If you request this accounting more than once in a 12 month period, we may charge you a reasonable, cost-based fee for responding to the additional requests. We will notify you of the fee to be charged (if any) at the time of the request.
RIGHT TO REQUEST RESTRICTIONS
You have the right to request restrictions or limitations on how we use and disclose your PHI for treatment, payment, and operations. We are not generally required to agree to such restrictions. Any such request must be in writing. If we agree to a proposed restriction, we will comply with restriction going forward. However, we may cease compliance if you take affirmative steps to revoke the restriction. We may also cease compliance if we believe, in our professional judgment, that an emergency warrants voiding the restriction in order to provide the appropriate care, or unless the use or disclosure is otherwise permitted by law. In certain circumstances, we reserve the right to terminate a restriction that we have previously agreed to, but only after providing you notice of termination.
If you have paid out-of-pocket in full for a specific item or service (i.e., you or someone other than your health plan has paid for your care), you have the right to request that your PHI with respect to that item or service not be disclosed to a health plan for purposes of payment or healthcare operations, and we are required by law to honor that request unless affirmatively terminated by you in writing; provided, that the disclosures are not required by law. Any such request must be made in writing.
RIGHT TO CONFIDENTIAL COMMUNICATIONS
You have the right to request that we communicate with you about your PHI and health matters by alternative means or alternative locations. Your request must be made in writing, and must specify the alternative means or location. We will accommodate reasonable requests that do not conflict with our duty to ensure that your PHI is appropriately protected.
RIGHT TO NOTIFICATION OF A BREACH
You have the right to be notified in the event that we (or one of our Business Associates) discover a breach involving unsecured PHI.
RIGHT TO VOICE CONCERNS
You have the right to file a complaint in writing with us or with the U.S. Department of Health and Human Services if you believe we have violated your privacy rights. Any complaints to us should be made in writing to our Privacy Official at the address listed below.
We may not retaliate against you for filing a complaint.
Complaints may be filed with:
U.S. Dept. of Health and Human Services
Office for Civil Rights
200 Independence Ave., S.W.
Washington, DC 20201
Endeavor House North
206 Bergen Ave.
Kearny, NJ 07032