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Notice of Privacy Practices
A Restored Mind, PLLC.
THIS NOTICE DESCRIBES HOW MEDICACL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. IF YOU DO NOT UNDERSTAND ANY PORTION OF THE NOTICE, PLEASE ASK FOR CLARIFICATION.
Purpose of Privacy Notice:
The purpose of the “Notice of Privacy Practices” is to inform you about how your health information may be used within A Restored Mind, PLLC as well as reasons why your health information could be sent to other service providers outside of the agency. This Notice describes your rights regarding the protection of your health information and how you may exercise those rights. The Notice also gives you the names of contacts should you have questions or comments about the policies and procedures A Restored Mind, PLLC uses to protect the privacy of your health information.
Understanding Your Medical Record/Health Information:
Each time you visit a healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, assessment, diagnosis, treatment plan, and treatment recommendations. This health information, often referred to as your medical record, serves as a basis for planning your treatment and a means to communicate between service providers involved in your care. It also serves as a legal document that assures you and/or a third-party payer that the services billed were provided. It can also be used as a source of data to assure that we are continuously monitoring the quality of services and measuring outcomes. Understanding what is in your medical record and how, when, and why we use the information helps you make informed decisions when authorizing disclosure to others. A Restored Mind will ensure that an internal mechanism is in place to protect oral, written, and electronic Protected Health Information (PHI) across the organization. PHI will be protected with safeguards to ensure that only staff with a need to know has access. Paper documents shall be protected to limit access based on minimum necessary requirements. This will include securing documents in locked cabinets to ensure they are accessible only to staff whose job responsibilities require them to have access. Documents containing PHI are filed in a secure location. Electronic information shall also be protected by an automated system that allows limited access as required by minimum necessary requirements. A Restored Mind, PLLC protects PHI whenever records are removed from any location or when being transported from one location to another.
Our Responsibilities
We are required to protect the privacy of health information about you and that identifies you, which we call PHI, and provide you with a Notice of our legal duties and privacy practices associated with your health information. We must protect health information that we have created or received about your past, present or future health condition, health care we provide to you, or payment for your healthcare. We are only allowed to use and disclose health information in the manner described in this Notice. We will provide you a paper copy of this Notice prior to or the first time you receive a service from us. We reserve the right to revise or change the terms of this Notice at any time and to make the new revisions effective for all health information we maintain. Whenever there are changes to this Notice, we will inform you by: Posting the revised notice in our offices; making copies of the revised Notice available upon request (either at our offices or through the Privacy Office listed in the Notice)
How We May Use and Disclose Health Information About You
  1. To Provide Health Care Services
    We may use and disclose health information about you to provide, coordinate, and/or manage your health care and related services. This may include communicating with other health care providers internally, or externally, regarding your care. For example, when we consult with another health care provider about your care, or to emergency treatment providers when you need emergency services.
  2. To Perform Business Health Care Operations
    We may use and disclose health information in performing our business activities called “health care operations”. These health care operations allow us to improve the quality of services we provide and reduce health care cost. For example, we may share health information in the following health care operation.
    • Internal Quality Review to assess and evaluate the skills, qualifications, and performance of health care providers taking care of you. This may involve review of your health information by our Supervisor of your provider to assess the overall care provided and progress in treatment. This information will then be used to continually improve the quality and effectiveness of the services provided.
    • External Quality Review by cooperation and participation in evaluation of our health care providers, staff, or facilities by outside organization to assess the quality of care we provide.
    • Other Reviews to assist various external individuals or internal staff who review our activities. For example, health information may be reviewed by accountants and lawyers who make certain that we comply with various laws: to appropriate staff to plan for the future, to determine the best way to limit costs, or to audit your file to make sure that no information about you was given to someone in a way that violates this notice.
    • To communicate with other Service Providers who have Business Contracts with A Restored Mind, PLLC. These include therapeutic foster families, residential group homes, and community-based service providers. When these services are contracted, we may disclose your health information to our business associate’s sot that they can provide you services and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
    • To non-professional staff who need to know your health information to perform their duties.
    • To remind you about an appointment you have for services.
Additional Use and Disclosure of Health Information without your Authorization
State and Federal laws require or allow that we share your health information with others in specific situation in which you do not have to give consent, authorize, or can agree or object to the use and disclosure. Prior to disclosing your health information, we will evaluate each request to ensure that only necessary information will be disclosed. These situations include but are not limited to the following:
  1. When receiving substance abuse services, Federal law allows disclosure in the following situations:
    1. To report abuse, neglect, or domestic violence.
    2. To respond to a court order and subpoena
    3. To qualified personnel for research, audit, and program evaluation.
    4. To a health care provider who is providing emergency medical services.
    5. If we believe that you are likely to commit a crime at the program or against program personnel
    6. For the purpose of internal communication, as outlined above, and
    7. To qualified service organization agencies when appropriate. (These agencies agree to abide by the Federal law.)
  2. When receiving services other than substance abuse, State law requires disclosure in specific situations that include, but are not limited to:
    1. To report certain type of wounds or other physical injuries
    2. To report a communicable disease or risk of contracting or spreading a disease or condition
    3. In response to a court order and subpoena
    4. To report suspected child abuse/neglect or disabled adult abuse/neglect
    5. Upon request of the next of kin or other family member or designee who has a legitimate role in services offered or other person designated by the consumer/legally responsible person, the responsible treatment provider shall release the following information after the consumer is notified that the request has been made:
      1. Notification of the consumer’s admission to this agency
      2. Transfer to another facility
      3. Decision to leave this agency again medical advice
      4. Discharge from this agency, and
      5. Referral and appointment information after discharge
      6. To A Restored Mind, PLLC.’s attorney
      7. For the purpose of filing a petition for involuntary commitment or adjudication of incompetency.
      8. To the extent necessary to fulfill responsibilities when a consumer is examined or committed for outpatient treatment a felony or violent misdemeanor.
Your Rights
  1. Your health information will not be disclosed without your authorization unless required by State and Federal law regulations.
  2. Although your health information is the physical property of A Restored Mind, PLLC., the information belongs to you. You have the right to request, in writing, certain uses and disclosures of your health information.
  3. If you sign a written authorization allowing us to use and disclose health information in a specific situation other than this Notice, you may, at any time, revoke or cancel your authorization in writing, and we will stop any use and disclosure of your health information which would occur after we receive your written cancellation. But we cannot cancel any disclosure that were made before we received your written cancellation.
  4. You may request restrictions on the use and disclosure of your health information outlined in this Notice, however, we are not required to comply with your request. To request a restriction, you must make your request in writing to A Restored Mind, PLLC. In your request, you must tell us what information you want to limit and to whom the limits apply.
  5. You have the right to request, in writing, to review and receive copies of your health information. There may be a charge for making copies of your requested health information. There are certain situations where we will be unable to grant your request to review records.
  6. You have the right to request, in writing, to amend existing information that is part of your health information. To request an amendment, your request must be in writing to A Restored Mind, PLLC. Please provide a reason that supports your request to amend your information. There are certain situations where we will be unable to grant your request to amend the health information. You will be notified in writing if this occurs.
  7. You have the right to request, in writing, a list of disclosures we have made regarding your health information. To request an accounting of disclosures, you must submit your request in writing to A Restored Mind, PLLC. Your request must state a time period for the records requested. Your first request for a list will be provided to you free of charge. However, if you request a list of disclosures more than once in a 12-month period, you may be charged a reasonable fee. We will inform you of the cots incurred and you may choose to withdraw or modify your request at that time before any costs are incurred. There are certain exceptions that apply.
  8. You have a right to request, in writing, to be contacted at a different address or phone number or other appropriate ways about your health information or bills. We will grant your request if reasonable.
  9. You have the right to receive a copy of the “Notice of Privacy Practices”
You may also file a written complaint, by mail or fax, to:
Disability Rights North Carolina
2626 Glenwood Ave, Suite 550
Raleigh, NC 27608
877-235-4210
919-856-2195
www.disabilityrightsnc.org
Attestation of receipt of Notice of Privacy Practices
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