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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.

Behavioral Health Services North, Inc. has always committed to protecting the privacy of your health information. We now are required by law to confirm this commitment to you in writing by furnishing you with this Notice of Privacy Practices. The Notice describes our legal duties and our practices relating to the privacy of any medical or other personal information about you in our records. We must follow the procedures described in this Notice of Privacy Practices as long as the Notice remains in effect. We reserve the right to change our privacy practices at any time and, if we made changes, we will apply our new privacy practices to all the information we have in our records about you and to any new information that we get after the change.

If we make significant changes to our privacy practices, we will revise our Notice of Privacy Practices to reflect the changes.  We will always have a copy of our current Notice of Privacy Practices in our offices and on our website.  In addition, you may get a paper copy of our current Notice of Privacy Practices at any time by asking our front desk staff or by contacting our Privacy Officer as follows:

Ms. Amy C. Hackett, Privacy Officer
Behavioral Health Services North, Inc.
Center for Well-Being 2155 Rte 22B
Morrisonville, NY   12962
Telephone:  518 563 8000
Email:  ahackett@bhsn.org

Our Privacy Officer can also answer any questions you may have about this Notice.

Effective date of this updated Notice:  September 23, 2013

Behavioral Health Services North, Inc. collects health information from you and stores it in a chart and/or on a computer.  We collect your name, address and telephone number; your social security number; information regarding your medical history; information about your heath insurance and other information.  This is your medical or health care record.  The medical record is the property of Behavioral Health Services North, Inc. but the information in the medical records belongs to you.  Your record usually contains information about your health such as your symptoms, examination findings, diagnosis and treatment.   We may also gather information about you from other healthcare providers, such as your referring physician, other health care providers you have seen, healthcare facilities that have run tests on you, your health insurance plan and, sometimes, even family members or close friends that help take care of you.   Some or all of your medical information may be created and/or stored in an electronic format. When permissible for valid purposes (e.g. providing treatment or billing for services) your health care providers may access your medical information electronically. Other healthcare providers outside BHSN & Affiliates caring for you may also receive access to your electronic health records for purposes outlined above.  Because bills must show what services you received and sometimes have to contain information justifying the need for those services, the bills that we and other healthcare providers send you or your insurers also contain information about your health. 

In order to communicate information needed to treat you, obtain payment for services, or conduct our business operations, our staff may communicate information about you via email. However, you will not be contacted by email unless we have obtained your permission to do so, or we are responding to an inquiry that you initiated via email. 

This Notice of Privacy Practices identifies types of uses and disclosures of protected health information (“PHI”) that Behavioral Health Services North, Inc. is permitted to make without obtaining a written authorization from you.  We have not included every kind of use and disclosure within each category but are providing examples.

I.   How Behavioral Health Services North, Inc.  May Use or Disclose Your Health Information

ehavioral Health Services North, Inc. uses and discloses recipient health information for many purposes.  We regularly attempt to limit all uses and disclosures of your health information to the minimum necessary to accomplish the task required.  When other health providers are treating you, we will release your entire medical record to be sure you receive the best possible care. 

1.   Treatment.   Behavioral Health Services North, Inc. may make requests, uses and disclosures of your Protected Health Information (“PHI”) as necessary to provide, coordinate and manage your treatment.  We may use your health information to send you appointment reminders or notices about the need to schedule a new appointment. 

Behavioral Health Services North, Inc. may also share your health information within its programs as appropriate for your treatment.  By way of example, if you are a recipient of Adult Clinic services and our residential (Breakthrough) program, health information may be shared between these two programs to coordinate your treatment.  To the extent required for your treatment, the sharing of your health information may occur between our outpatient clinics, personalized recovery oriented services program (PROS), case management services, health home care management, residential services and supported employment services.  

2.  PaymentBehavioral Health Services North, Inc. may make requests, use and/or disclose your health information as necessary to bill and obtain payment for our services from you or your insurance company.   We may have to disclose your health information to your insurance company so they can determine your benefit eligibility; provide preauthorization for services; or determine how much they should pay us.  

3.  Regular Health Care Operations.  Behavioral Health Services North, Inc. may use and disclose your health information for the general operation of our business.  Examples of health care operations include conducting quality assessment and improvement activities (including outcomes evaluation and development of clinical guidelines); case management and care coordination; legal services and auditing functions, including fraud and abuse detection and compliance programs; business planning and development.   For example, we may use our patients’ health information to evaluate and improve the quality of the health services we provide.  In order to communicate information needed to treat you, obtain payment for services, or conduct our business operations, our staff may communicate information about you via email. However, you will not be contacted by email unless we have obtained your permission to do so, or we are responding to an inquiry that you initiated via email. 

4.  Information provided to you.            

5.  Notification and communication with individuals involved in your care.    We may disclose information about you to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death.  If you are able and available to agree or disagree, we will give you the opportunity to object before we make this notification.  However, under certain circumstances, such as in an emergency, our health professionals will use their best judgment in communicating with your family and/or other individuals involved in your care.

New York State law is, in certain circumstances, stricter than applicable federal law and therefore will control in such circumstances.  The exceptions set forth below are not all inclusive, but are meant to provide you with a general overview of situations in which New York State law, and not HIPAA, controls.  Confidentiality requirements with regard to alcohol and drug treatment records are, for example, beyond the scope of this summary.

                *  Psychotherapy notes are not exempted from the consent requirement under state law;

                *  If disclosure would cause substantial harm to another person, Behavioral Health Services North, Inc. may deny access to all or part of the information and may grant access to a prepared summary of the information if, after considering all the attendant facts and circumstances, Behavioral Health Services North, Inc. determines that the request to review all or a part of the patient information can reasonably be expected to cause substantial and identifiable harm to the subject or others, which would outweigh the qualified person’s right of access to the information;

                *  If a parent requests information concerning a child over 12 years of age, Behavioral Health Services North, Inc. may notify the child and if the child objects to disclosure, may deny the request;

                *  Behavioral Health Services North, Inc. may deny access to all or part of the information and may grant access to a prepared summary of the information if, after consideration of all the attendant facts and circumstances, Behavioral Health Services North, Inc. determines that disclosure would have a detrimental effect on its professional relationship with a minor (a person under 18 years of age) or on the minor’s relationship with his or her parents;

                *  Confidential HIV information obtained in the course of providing any health or social service may not be disclosed without your consent except to an authorized agency in connection with foster care or adoption of a child or to an employee or agent of the division of probation and correctional alternatives or any local probation department or an employee or agent of the commission of correction; and

                *  A physician may disclose confidential HIV information pertaining to a protected individual to a person (known to the physician) authorized pursuant to law to consent to health care for a protected individual when the physician reasonably believes that: (1) disclosure is medically necessary in order to provide timely care and treatment for the subject of the HIV information; (2) after appropriate counseling as to the need for such disclosure, the subject of the HIV information will not inform a person authorized by law to consent to healthcare, provided; however, that the physician will not make such disclosure if, in the judgment of the physician: (1) the disclosure would not be in the best interest of the subject of the HIV information; of (b) the subject of the HIV information is authorized by law to consent to such treatment.

6.  Other Uses and Disclosures.   Behavioral Health Services North, Inc. may make certain other uses and disclosures of your health information without your authorization for any of the following public policy purposes:

                a.  Requirements of Applicable Federal, State or Local Law.  We may use or disclose information about you whenever we are required by law; such as a court order.

                b.  Public Health Reporting.  We may disclose your health information to proper public health authorities for purposes related to preventing and reporting disease; injury or disability.  Public health authorities include the Centers for Disease Control, the Occupational Safety and Health Administration, the Environmental Protection Agency as well as a number of other state and local authorities.

                c.  Victims of Abuse, Neglect or Domestic Violence.  We may disclose health information about you to public health authority or other appropriate government or protective services agencies if we have reason to think that you are a victim of abuse, neglect or domestic violence and you authorize the disclosure or if the law requires us to report regardless of whether you agree.

                d.  Judicial and Administrative Proceedings that Involve You.  We may disclose your health information in the course of a judicial or administrative proceeding that involves you if we get an order from a court or administrative tribunal.  We may also release health information about you in the absence of such an order in response to a discovery request, but we will do so only if we have made an effort to notify you or to get a protective order covering your information from the court or administrative tribunal.

                e.  Law Enforcement Activities.  We may disclose your health information to a law enforcement officer for purposes such as identifying or locating a suspect, fugitive, material witness or missing person.  We may also be required to disclose information about you if we receive a warrant, subpoena or other order from a court or administrative hearing body to assist law enforcement authorities.

                f.  Disclosures to Coroners, Medical Examiners and Funeral Directors.  We may disclose information to help a coroner or medical examiner identify a deceased person or determine the cause of death.  We may also release health information that funeral directors need to do their jobs.

                g.  Organ Procurement Organizations, Transplant Centers and Eye Tissue Banks.  We may disclose information about organ donors or potential organ recipients to organ procurement organizations, transplant centers and eye tissue banks.

                h.  Research.  We may use or disclose certain health information about your condition and treatment for records based research so long as an Institutional Review Board (IRB) or Privacy Board has determined that obtaining permission from you and the other patients’ whose records need to be reviewed would be impractical and that the privacy interest of all patients involved in the study will be adequately protected. 

                i.  Military and National Security.  We may release health information about you to military command authorities, for national security and intelligence activities and for the provision of protective services for heads of state.

                j.  Prevention of Serious Threats to Health or Safety.  We may disclose your health information to prevent a serious threat to your health and safety or to the health and safety of others.

                k.  Workers’ Compensation.  We may disclose health information about you to workers’ compensation insurers or other similar programs which provide benefits for work related injuries or illnesses without regard to fault in accordance with the requirements of the laws governing the programs. 

                l.  As required by law, we will release health information to the Secretary of the Department of Health and Human Services for enforcement of HIPAA. 

7.    Marketing/Fundraising.   We may contact you to provide appointment reminders or to give you information about other treatments or health related benefits and services that may be of interest to you.  We may use your information for certain limited marketing purposes, such as face-to-face communication.   For other marketing activities we will obtain your authorization. 

8.   Change of Ownership.       In the event that Behavioral Health Services North, Inc. is sold or merged with another organization, your health information/record will become the property of the new owner.  We may only sell your protected health information in very limited circumstances, such as the condition listed above, without your permission.

II.  When Behavioral Health Services North, Inc. May Not Use or Disclose Your Health Information

Except as described in this Notice of Privacy Practices, Behavioral Health Services North, Inc. will not use or disclose your health information without your written authorization.  If you do authorize Behavioral Health Services North, Inc. to use or disclose your health information for another purpose beyond those permitted uses and disclosures described above, you may revoke your authorization in writing at any time.

If you revoke your permission, we will no longer use or release health information about you for the reasons covered by your written authorization except to the extent that we have already relied on your original permission. 

III. Your Health Information Rights

1.  You have the right to request restrictions on certain of our uses and disclosures of your health information for treatment, payment and healthcare operations.  You have the right to restrict certain PHI disclosures to a health plan when you (or any other person on your behalf, other than the health plan, including Medicare) pay for the health care item or service out of pocket in full.  Your request must describe in detail the restriction you are requesting.  Behavioral Health Services North, Inc. is not required to agree to the restriction that you requested under HIPAA but we will accommodate reasonable requests when appropriate.

2.  Request for confidential communication.  You have the right to receive your health information through a reasonable alternative means or at an alternative location.  For example, you may request that messages not be left on voice mail or sent to a particular address.  Requests for confidential communication must be in writing and addressed to the Privacy Officer, 2155 State Route 22B, Morrisonville, NY 12962.   We will honor reasonable requests and let you know if a request cannot be honored.

3.  You have the right to be notified of a breach of your unsecured protected health information, with a few limited exceptions. A breach is defined as unauthorized acquisition, access, use or disclosure of protected health information in a manner not permitted, unless there is a low probability that the privacy or security of your protected health information has been compromised.           

4.  You have the right to inspect and copy your health information that we maintain and/or information compiled for use in a civil, criminal or administrative proceeding.  Behavioral Health Services North, Inc. will charge $.75/page for copying and we will require you to pay us for postage if you ask us to mail copies of your records to you.

5.  You have a right to request Behavioral Health Services North, Inc. to change your health information that you think is incorrect or incomplete.  To be considered, your request must be in writing, must be signed by you or your representative and must state the reasons for the amendment/correction request.    We may deny your request if we think the records are correct and complete or if the information you are questioning was created by another healthcare provider. 

6.  You have a right to receive a listing of certain uses and disclosures of your health information made by Behavioral Health Services North, Inc. except for those uses and disclosures made for purposes of treatment, payment or healthcare operations; disclosures made to you under your right to see and copy your records and disclosures you have given us a written authorization to make or any uses and disclosures of your health information made before April 14, 2003 among others.  If you request this accounting more than once every twelve months, we may charge you a fee of each additional listing.  Our fee is currently set at seventy-five cents ($.75)/page. 

7.  You can access this Notice of Privacy Practices on the Behavioral Health Services North, Inc. website or you may request a paper copy of this Notice at the site where you receive care.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact:

Amy C. Hackett, Privacy Officer
Behavioral Health Services North, Inc.               
2155 State Route 22B
Morrisonville, NY   12962
Telephone:  518 563 8000

IV.  Complaints.
Complaints about this Notice of Privacy Practices or how Behavioral Health Services North, Inc. handles your health information should be directed to:

Amy C. Hackett, Privacy Officer
Behavioral Health Services North, Inc.               
2155 State Route 22B
Morrisonville, NY   12962
Telephone:  518 563 8000

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to either:                                          

Department of Health and Human Services
Office of Civil Rights            
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC   20201
                http://www.hhs.gov/ocr/privacy/hipaa/complaints

-or-

Region II, Office for Civil Rights
U. S. Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza, Suite 3312
New York, NY   10278
                Telephone:  212 264 3313
                Fax:              212 264 3039

 
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BHSN's mission is to strengthen individuals, families and our communities by delivering a behavioral health care and human service system that provides an integrated continuum of essential, responsive and cost-effective services.

 
 
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