CUMBERLAND COUNTY AREA MH/DD/SA AUTHORITY
This Notice is effective on April 14, 2003
Cumberland County Mental Health Center is required by the privacy regulations issued under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 to maintain the privacy of your health information and to provide you with notice of our privacy practices in regard to medical information. The medical information may be health information that is created or received by us that may relate to your past, present, or future medical condition; provision of health care to you; or information that relates to the past, present, or future payment for the provision of health care to you. That includes any treatment and payment records and any information that identifies you as a client.
We are required to protect your health information by both state and federal laws. In the event another applicable law, other than HIPAA, prohibits or limits our uses and disclosures of your health information, as set forth below, we will restrict our uses or disclosure of your health information in accordance with the more stringent standard. In other words, we are only allowed to use and disclose medical information in the manner that we have described in this Notice.
We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all Protected Health Information maintained by us. If we make material changes to our privacy practices, we are required to advise all consumers then active in treatment of our new Privacy Practice by:
- Posting the new Notice in our waiting area.
- Having the new Notice available upon request at each of the reception desks.
Copies of our current Notice may be obtained by contacting our Privacy Officer at 910-323-0601, at the address listed below, or on our Web site atwww.ccmentalhealth.org.
In this Notice we will describe how we may use and disclose the health information about you, explain your privacy rights in regard to your health information, and describe how and where you may file a privacy-related complaint. At any time you need information about the uses or disclosures, our privacy practice, or other related information, contact our Privacy Officer at 910-323-0601.
The following categories describe different ways that we may use and disclose your health information in order to provide health care, obtain payment for that health care, and for operations of our agency. Not every use or disclosure in a category will be listed. We will use and disclose only the minimum information necessary to meet the requirements.
- For Treatment. We may use or disclose your health information to provide treatment, coordinate or manage
the services provided to you. This may include communicating with other health care providers who are involved
in your health care and coordinating and managing your health care with others.
Example: Information obtained about you by your therapist, psychiatrist, case manager, nurse or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Members of your healthcare team will also record goals that you established and the interventions used to help you reach your goals. Your psychiatrist will also record information about medications they have prescribed for you as well as your response to these medications.
- For Payment. You will be asked to sign a consent form allowing Area Authority to seek payment for the
health care services that we provide to you. This may include preparing bills, checking for eligibility,
coverage, pre-approval of services, and management of your account. Even though federal law allows us to use
or disclose information to get payment for the health care services you receive, North Carolina law requires that
you consent to such an action.
Example: A bill for services provided to you will be sent to you and/or a third-party payer. Information on or accompanying the bill may include information that identifies you as well as your diagnosis, your treating clinician and the type of services you have received.
- For Health Care Operations. We may use or disclose information during routine operations or for
organizational improvement. Examples of routine operations include the use of sign-in sheets, calling your
name in the waiting room, review quality of services you receive, conduct utilization management, record
audits, peer review, appointment reminders, resolving complaints, use of volunteers and students. We are also
required to disclose health information to the North Carolina Division of Mental Health, Developmental
Disabilities, and Substance Abuse Services for purpose of tracking, monitoring, planning, and eligibility
Example: Members of the treatment team and Quality Improvement staff may use the health information in your health record to access the care and outcomes of your case. This information will then be used to improve the quality and effectiveness of the services we provide to you and others.
- For Other Persons Involved in Your Care. We may disclose health information about you to a relative,
close personal friend or any other person you identify if that person is involved in your care and the information
is relevant to your care except as mandated by state and federal regulations. We will try to obtain your
authorization, but in the event that is difficult or impossible, we may discuss protected health information if it
is our professional judgment that it is in your best interest. In a situation where you are unable to give
authorization, we may use or discuss protected health information to notify or assist in notifying a family
member, personal representative or any other person that is responsible for your care. We may reveal your
location; general condition; including death or serious injury; or any information that may assist in disaster
If the patient is a minor, we may disclose health information about the minor to a parent, guardian, or other person responsible for the minor except in limited circumstances. For more information on the privacy of minor’s information, contact our Privacy Officer at 910-323-0601.
You may ask us at any time not to disclose medical information about you to persons involved in your care. We will agree to your request and not disclose the information except in certain limited circumstances (such as emergencies) or if the patient is a minor. If the patient is a minor, we may or may not be able to agree to your request.
Example: Jane’s husband regularly comes to the mental health center with Jane for her appointments and he helps her with her medication. When the nurse is discussing a new medication with Jane, Jane invites her husband to come into the private room. The nurse discusses the new medication with Jane and Jane’s husband.
- As Required by Law. We will use and disclose medical information about you whenever we are required by law to do so. There are many state and federal laws that require us to use and disclosure health information.
Example: State law requires us to report gunshot wounds and other injuries to the police and to report known or suspected child abuse or neglect to the Department of Social Services. We will comply with those state laws and with all other applicable laws.
- National Priority Uses and Disclosures. When permitted by law, we may use or disclose medical information about you without your permission for various activities that are recognized as “national priorities.” In other words, the government has determined that under certain circumstances (described below), it is so important to disclose medical information that it is acceptable to disclose health information without your permission. We will only disclose medical information about you in the following circumstances when we are permitted to do so by law. Below are brief descriptions of the “national priority” activities recognized by law.
- Threat to health or safety: We may use or disclose medical information about you if we believe it is necessary to prevent or lessen a serious threat to health or safety.
- Public health activities. We may use or disclose health information as required by law to report certain communicable diseases to health agencies. For example, we are required to report any cases of HIV, certain sexually transmitted diseases, or tuberculosis to the Health Department.
- Health oversight activities. We may use or disclose your health information to a health agency that is responsible for overseeing the health care system or certain government programs. For example, a government agency may request information from us while they are investigating possible insurance fraud.
- Abuse reports and investigations. We will use and disclose information required by law to report any suspicion of abuse, neglect, or exploitation to the Department of Social Services (DSS). We are required by North Carolina law to cooperate with DSS investigations into possible abuse, neglect, or exploitation allegations. We are also required to report to Health Care Personnel Register.
- Court proceedings and for Law Enforcement. We will use and disclose information when required or permitted by federal or state law or by a court order. Health information regarding substance abuse information can only be disclosed with your authorization or by a court order. For example, we would disclose health information about you to a court if a judge orders us to do so.
- Coroners and others. We may disclose health information about you to a coroner, medical examiner, or funeral director or to organizations that help with organ, eye, and tissue transplants.
- Workers’ compensation. We may disclose health information about you in order to comply with worker’s compensation laws.
- Research organizations. We may use or disclose health information about you to research organizations if the organization has satisfied certain conditions about protecting the privacy of health information and approved by an institutional review board.
- Government programs. We may use and disclose information for public benefits under other government programs, including but not limited to military and veterans’ activities, national security and intelligence activities. We may also use or disclose health information about you to a correctional institution in some circumstances.
- Your Authorization. Except as outlined above, we will not use or disclose your health information unless you
or your representative has signed a form authorizing the use or disclosure. You have the right to revoke that
authorization in writing (except in very limited circumstances related to obtaining insurance coverage). The
Area Authority is not responsible for any uses or disclosures already made before you cancel an authorization.
North Carolina law places limits on the amount of time that an authorization to disclose may cover (up to one
year). An Authorization Revocation Form is available from our Privacy Officer.
You have several rights with respect to the health information about you. This section of the Notice will briefly mention each of these rights.
- Access to your Protected Health Information (PHI). You have the right to inspect (see or review) and obtain a copy of your health care information that we maintain in your file. Some records may not be available, such as psychotherapy notes. Requests for access to your health information must be in writing specifically identifying the information you wish to review. Access request forms are available through our Privacy Officer. We must act on your request no later than 30 days after receipt of the request. We may deny your request for access in certain circumstances and will provide written explanation for the denial. If it is determined by a clinical professional that the information you requested would jeopardize your health, safety, security, custody, or rehabilitation or would be detrimental or harmful to someone else, we will deny access, in whole or in part, to that information. We may choose to provide you a summary of the information. We will also inform you in writing of your right to have our decision reviewed by a licensed health care professional designated as a reviewing official. We cannot provide you with copies of any information that was sent to us by another source. You may be charged a fee for the cost of copying your information.
- Amendments to your Protected Health Information (PHI). You have the right to request that
health information maintained by us about you be amended or corrected. Your amendment request must be
made in writing, must be signed by you or your representative, and must state the reasons for the
amendment/correction request. Amendment request forms are available through our Privacy Officer. If we
accept the amendment, you will be informed of the acceptance and notification will be made to those
individuals/agencies identified by you needing the amendment. We may deny the request for amendment
in certain circumstances. We cannot honor requests to change records provided to us by other sources,
nor can we change those that are believed to be accurate and complete. A written statement will be
provided to you giving the basis for the denial and your rights to disagree.
- Accounting for Disclosures of our Protected Health Information (PHI). You have the right to receive an
accounting of certain disclosures made by us of your health information after April 14, 2003. Your request
must be made in writing, signed by you or your representative. Accounting of disclosure forms is available
through our Privacy Officer. The accounting will include to whom the information was disclosed, the date it
was disclosed, and what specific information was disclosed. This list will not include the disclosures made
for treatment, payment or other health care operations. The first accounting within a 12-month period is
free; however, we may charge you a fee for each subsequent accounting you request within the same
12-month time period.
Restrictions on Uses or Disclosures of Protected Health Information (PHI). You have the right to request
restrictions on certain uses or disclosures of your health information.
- The request must be made in writing, signed by you or your representative, stating what information you want to restrict and to whom you want the restrictions to apply. We are not required to agree to the restriction if we do not think it is in your best interest. We cannot honor requests that limit our ability to engage in treatment, payment or other health care operations. You also have the right to terminate, in writing or orally, any agreed-to restriction. However, any oral request will need to be verified at next office visit. Requests for a restriction (or termination of an existing restriction) may be made by contacting our Privacy Officer.
- Request for Confidential Communications. You have the right to request that communications about
your health information be made by alternative means or at alternative locations. If such a request is made
we may ask for more information about billing or alternative contacts. For example, you may request that
messages not be left on voice mail or sent to a particular address. We are required to follow reasonable
requests if you inform us that disclosure of all or part of your information could place you in danger.
Requests for confidential communications must be specific and in writing, signed by you or your
- Complaints. If you believe your privacy rights have been violated, you can file a complaint with our
Consumer Relations Officer at the address below. You may also file a complaint in writing with the
Secretary of the U.S. Department of Health and Human Services, Office of Civil Rights within 180 days of a
violation of your rights. There will be no retaliation for filing a complaint.
- Right to a Copy of the Notice. You have the right to request a paper copy of this Notice by asking the
receptionist for a copy or contacting our Privacy Officer at the telephone number and address below.
FOR FURTHER INFORMATION:
If you have questions about this Notice, you may ask to speak with the Privacy Officer of Cumberland County Mental Health Center. To exercise your Privacy Rights as listed above, you may contact our Privacy Officer for the form(s) you need at the address below.
ATTENTION: Privacy Officer
Cumberland County Area MH/DD/SA Authority
P.O. Box 3069
Fayetteville, North Carolina 28302
HOW TO FILE A COMPLAINT:
You may complain to Cumberland County Mental Health Center or to the Secretary of the U.S. Department of Health and Human Services, Office of Civil Rights if you believe we have violated your privacy rights. Cumberland County Mental Health Center cannot retaliate against you for filing a complaint, cooperating in an investigation, or refusing to agree to something you believe to be unlawful.
To file a complaint with Cumberland County Mental Health Center (all complaints will be investigated), please mail to the following address:
ATTENTION: Consumer Relations Officer
Cumberland County Area MH/DD/SA Authority
P. O. Box 3069
Fayetteville, North Carolina 28302
To file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office of Civil Rights, you may contact:
U.S. Department of Health and Human Services
Office of Civil Rights
Medical Privacy Complaint Division
200 Independence Avenue, SW
Washington, DC 20201
Notice of Privacy Practices
Effective Date 4/14/2003