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Client Privacy Policy/HIPAA
HIPAA NOTICE OF PRIVACY PRACTICES (click here to read in Spanish.)
HIPAA: Health Insurance Portability and Accountability Act
This notice describes how medical and mental health care information about you and/or your child may be used and disclosed and how you can get access to this information.
Please review it carefully.
OUR RESPONSIBILITIES
New York Foundling (NYF) is required to maintain the privacy of your health and mental health information and the health and mental health information of your child(ren). In addition, we must provide you with this notice about our privacy practices as they relate to disclosure of your confidential health and mental health information. NYF must abide by the terms of this notice, notify you if we are unable to agree to a requested restriction, and accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We reserve the right to change our practices and to make the new provisions effective for the Protected Health Information (PHI) we maintain. Should our information practices change, we will provide you with a revised notice. We will also post our new notice on our web site (www.nyfoundling.org), which provides information about our services.
NYF has the right to disclose your health information or the health information of your child for purposes of treatment, payment, or healthcare operations as described in this notice without your express authorization. Disclosure for any other reason will not be made without your authorization.
YOUR MEDICAL/MENTAL HEALTH INFORMATION:
Each time you or your child receives medical or mental health services from NYF an entry is made in the medical/mental health record. Depending on the program, this medical/mental health record will contain the reasons for admission to the program, your symptoms, assessments and test results, medication information, diagnoses, treatment or service plan, notes with progress in addressing your goals, periodic treatment or service plan reviews, and a plan for future care or treatment.
Each time NYF receives medical or mental health information, including drug treatment information, on you or your child from a non-NYF provider this information is placed in your case record and/or your medical/mental health record.
Both the information from NYF medical and mental health programs and the information from outside providers is your PHI.
At NYF, this information serves as a basis for planning your family’s care and treatment and serves as a means of communication among the professionals who contribute to your family’s care. Understanding what is in the record and how this information is used will help you to ensure its accuracy and will help you understand why your information may be disclosed allowing you to make more informed decisions when authorizing disclosure to others.
YOUR HEALTH INFORMATION RIGHTS:
Unless otherwise required by law, your medical/mental health record and the record of your child, including reports and information from outside providers, is the physical property of the NYF program that compiled it. Your record is kept by the agency and its contents are protected and confidential. You have the right to access to your medical/mental health record. You have the right to:
1. Request a restriction on certain uses and disclosures of your information, and to request changes or additions to your medical/mental health record;
2. Obtain a paper copy of this Privacy Notice;
3. Inspect, and obtain a copy of your medical/mental health record; (Your request has to be made in writing and reviewed by our Quality Assurance Department and even then there is certain confidential medical and mental health information that may be edited when reviewed by our general counsel and/or medical or mental health director). If there is a denial then this must be sent or given to you in writing;
4. Obtain a written explanation of whom your health information has been disclosed to;
5. Request copies of your health information by alternative means (e.g. by fax, E-mail or another form) or at other locations;
6. Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH OPERATIONS
Below are examples of situations where disclosure of your health information or the health information of your child does not require your express, written authorization to disclose.
We will use your health information for treatment.
Example: Information obtained by NYF program staff who provide clinical services will be recorded in your case record and used to determine the course of treatment that should work best for you or your child. We will also provide other staff involved in your care with copies of various reports that should assist them in treating you. This information may be shared with other programs within NYF where you receive care and treatment.
We will use your health information for payment.
Example: A bill may be given to you or a third-party payer, such as Medicaid. The information on or accompanying the bill may include information that identifies you or your child, as well as your diagnosis, procedures, and supplies used.
We will use your health information for regular health operations.
Example: Members of the clinical and social work staff or the quality improvement staff may use information in your case record to assess the care and outcomes in your case. The information may be used in program evaluation studies to assess the care provided and to measure effectiveness of different program models. Also, emergency medical information may be provided as needed. We are required to disclose information to the NYS Central Registry.
Business associates: There are some services provided in our organization through contracts with business associates. Examples include our insurance company, which we use when making reports of accidents/injuries on our property, certification and compliance activities (e.g. auditors need to review a sample of our case records to confirm the quality of care provided and to assess our compliance with their standards). When these services are contracted, we may disclose some or all of your health information to our business associate so that they can perform the job we have asked them to do. To protect your health information, however, we require the Business Associate to appropriately safeguard your information, and we only provide them with the "minimum necessary" information to carry out their responsibilities and complete their work.
Family: In accordance with policies and procedures governing consents to release information, clinical professionals may disclose to a family member, other relatives, close personal friends or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care. Unless it is an emergency, your consent will be secured prior to these disclosures. (Disclosure to family members may differ in the foster care program; contact our Privacy Officer for this information.)
Food and Drug Administration (FDA): As required by law, we may disclose to the FDA health information relative to adverse events with respect to medication and/or product defects.
Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. We may also release information to the NYS Central Registry and may disclose information for emergency medical care.
Correctional institution: Should you or your child become an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals. An inmate does not have the right to the Notice of Privacy Practices.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney provided that an employer or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
Notice of Privacy Practices availability: This notice will be prominently posted in the office where screening and/or intake occur. Clients will be provided a hard copy and the notice will be maintained on our web site (www.nyfoundling.org) for downloading.
FOR MORE INFORMATION OR TO REPORT A PROBLEM:
If you have questions and would like additional information, you may contact the NYF Privacy Officer at (212) 886-4071. If you believe your privacy rights have been violated, you can also file a complaint with the Privacy Officer. There will be no retaliation for filing a complaint.
ACKNOWLEDGEMENT AND CONSENT OF
NOTIFICATION OF PRIVACY PRACTICES
Client/Consumer Name: ___________________________________________________
Guardian/Personal Representative: ____________________________________________________
Program Name: ____________________________________________________
Case/Identification Number: ____________________________________________________
Please initial on each item below
_____I acknowledge that I have been provided a copy of the NYF Notice of Privacy Practices and have therefore been advised of how health information about me and/or my child may be used and disclosed by NYF and the program where I and/or my child receive services. I have also been advised about how I may obtain access to and control this information. I also acknowledge and understand that I can request copies of separate notices explaining special privacy practices that apply to HIV-related information or alcohol and substance abuse treatment information.
_____I consent to the use and disclosure of my heath information to treat me and/or my child and arrange for my/my child’s medical care, to seek and receive payment for services given to me/my child, and for the business operations of NYF, its staff, and the program where I am/my child is receiving services.
____________________________________________________ ___________
Signature of Client or Guardian/Personal Representative Date
____________________________________________________ ____________
Print name of Client or Guardian/Personal Representative Date
_____________________________________________ ___________
Name of minor child Date
_____________________________________________ ___________
Name of minor child Date
_____________________________________________ ___________
Name of minor child Date
_____________________________________________ ___________
Name of minor child Date
_____________________________________________ ___________
Name of minor child Date
___________________________________ __________________________________
Print Name of Witness Signature of Witness
This form will be placed in your case record and you will be given a copy.
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