TUERK HOUSE, INC.
NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE: _February 6, 2004_
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.
UNDERSTANDING YOUR HEALTH RECORD/INFORMATION
Each time you visit a hospital, physician, dentist, or other healthcare
provider, which includes substance and alcohol abuse a record of your
visit is made. Typically, this record contains your symptoms, examination
and test results, diagnoses, treatment, and a plan for future care or
treatment. This information often referred to as your health, or substance
and alcohol abuse record serves as a basis for planning your care and
treatment and serves as a means of communication among the many health
professionals who contribute to your care. Understanding what is in your
record and how your health information is used helps you to ensure its
accuracy, better understand who, what, when, where, and why others may
be allowed access to your health information. This effort is being made
to assist you in making informed decisions before authorizing the disclosure
of your medical information to others.
YOUR HEALTH INFORMATION RIGHTS
Unless otherwise required by law, your health record is the physical
property of the healthcare practitioner or facility that compiled it.
However, you have certain rights with respect to the information. You
have the right to:
1. Receive a copy of this Notice of Privacy Practices from us upon enrollment
or upon request.
2. Request restrictions on certain uses and disclosures of your protected
health information for treatment, payment and health care operation. With
this in mind, please discuss any restriction you wish to request with
your substance/alcohol abuse provider. However, we reserve the right not
to agree to the requested restriction if the provider believes this would
not be in your best interest. Other than activity that has already occurred,
you may revoke any further authorizations to use or disclosure of your
health information. You may request a restriction by sending a letter
to: Attn: Privacy Officer, John E. Hickey, Tuerk House, Inc. P.O. Box
31419, Baltimore, Maryland 21216
3. Request to receive communications of protected health information in
confidence. You may also request communications of your health information
by alternative means or to alternative locations. We will advise you if
any such request is not feasible for our office to accommodate.
4. Inspect and obtain a copy of the protected health information contained
in your medical and billing records and in any other Practice records
used by us to make decisions about you. This can be done by appointment
only. A copying charge may apply to obtain a copy of any portion of your
medical record. Additionally, a fee will apply to inspect your records,
if such inspection is requested. (Under federal law. However, you may
not inspect or copy the following records: psychotherapy notes; information
compiled in reasonable anticipation of, or use in, a civil, criminal,
or administrative action or proceeding, and health circumstances) a decision
to deny access may be reviewable. Please contact our Privacy Officer if
you have any questions about access to your medical record.
5. Request an amendment to your protected health information. However,
we may deny your request for an amendment, if we determine that the protected
health information or record that is the subject of the request:
· Was not created by us, unless you provide a reasonable basis
to believe that the originator of the protected health information is
no longer available to act on the requested amendment;
· Is not a part of your medical or billing records;
· Is not available for inspection as set forth above; or
· Is accurate and complete.
In any event, any agreed upon amendment will be included as an addition
to, and not a replacement of, already existing records. If your request
for amendment is denied, you have the right to file a statement of disagreement
with us and we may prepare a rebuttal to your statement and will provide
you with a copy of any such rebuttal.
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
This organization may use and/or disclose your medical information for
the following purposes:
Treatment: We may use and disclose protected health information in the
provision, coordination, or management of your health care, including
consultations between health care from one health care provider to another.
Payment: We may use and disclose protected health information to obtain
reimbursement for the health care provided to you, including determinations
of eligibility and coverage and other utilization review activities.
Regular Healthcare Operations: We may use and disclose protected health
information to support functions of our practice related to treatment
and payment, such as quality assurance activities, case management, receiving
and responding to patient complaints, physician reviews, compliance programs,
audits, business planning, development, management and administrative
activities.
Appointment Reminders: We may use and disclose protected health information
to contact you to provide appointment reminders.
Treatment Alternative: We may and disclose protected health information
to contact you to
provide appointment reminders.
Health-Related Benefits and Services: We may use and disclose protected
health information
to tell you about health-related benefits, services, or medical education
classes that may be of
interest to you.
Individuals involved in Your Care or Payment for Your Care: Unless you
object, we may
disclose your protected health information to your family or friends or
any other
individual identified by you when they are involved in your care or the
payment for your care.
We will only disclose the protected health information directly relevant
to their involvement in your
care or payment. We may also disclose your protected health information
to notify a person
responsible for your care (or to identify such person) of your location,
general condition or
death.
Business Associates: There may be some services provided in our organization
through
contracts with Business Associates. Examples include physician services
in the emergency
department and radiology, certain laboratory tests, and a copy service
we use when making
copies of your health record. When these services are contracted, we may
disclose some or all of
our 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.
Organ and Tissue Donation: If you are an organ donor, we may release
medical information to
organizations that handle organ procurement or organ, eye or tissue transplantation
or to an
organ donation bank, as necessary to facilitate organ or tissue donation
and transplantation.
Worker’s Compensation: We may release protected health information
about you for programs
that provide benefits for work related injuries or illness.
Communicable Diseases: We may disclose protected health information to
notify a person who
may have been exposed to a disease or may be at risk for contracting or
spreading a disease or
condition.
Health Oversight Activities: We may disclose protected health information
to federal or state
agencies that oversee our activities.
Law Enforcement: We may disclose protected health information as required
by law or in
response to a valid judge ordered subpoena. For example in cases of victims
of abuse or
domestic violence: to identify or locate a suspect, fugitive, material
witness, or missing person;
related to other law enforcement purposes.
Military and Veterans: If you are a member of the armed forces, we may
release protected
health information about you as required by military command authorities.
Lawsuits and Disputes: We may disclose protected health information about
you in response to
a court or administrative order. We may also disclose medical information
about you in response
to a subpoena, discovery request, or other lawful process.
Inmates: If you are an inmate of a correctional institution or under
the custody of a law
enforcement official, we may release protected health information about
you to the correctional
institution or law enforcement official. An inmate does not have the right
to the Notice of Privacy
Practices.
Abuse or Neglect: We may disclose protected health information to notify
the appropriate
government authority if we believe a patient has been the victim of abuse,
neglect or domestic
violence. We will only make this disclosure if you agree or when required
or authorized by law.
Corners, Medical Examiner, and Funeral Directors: We may release protected
health
information to a coroner or medical examiner. This may be necessary to
identify a deceased
person or determine the cause of death. We may also release protected
health information about
patients to funeral directors as necessary to carry out their duties.
Public Health Risks: We may disclose your protected health information
for public health
activities and purposes to a public health authority that is permitted
by law to collect or receive the
information. The disclosure will be made for the purpose such as controlling
disease, injury or
disability.
Serious Threats: As permitted by applicable law and standards of ethical
conduct, we may use
and disclose protected health information if we, in good faith, believe
that the use or disclosure is
necessary to prevent or lessen a serious and imminent threat to the health
or safety of a person
or the public.
Food and Drug Administration (FDA): As required by law, we may disclose
to the FDA health
information relative to adverse events with respect to food, supplements,
product and product
defects, or post marketing surveillance information to enable product
recalls, repairs, or
replacement.
OUR RESPONSIBILITIES
We are required to maintain the privacy of your health information. In
addition, we are required to
provide you with a notice of our legal duties and privacy practices with
respect to information we
collect and maintain about you. We must abide by the terms of this notice.
We reserve the right to
change our practices and to make the new provisions effective for all
the protected health
information we maintain. If our information practices change, a revised
notice will be mailed to
the address you have supplied upon request. If we maintain a Web site
that provides information
about our patient services or benefits, the new notice will be posted
on that Web site. Your health
information will not be used or disclosed without your written authorization,
except as described in
this notice. Except as noted above, you may revoke your authorization
in writing at any time.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions about this notice or would like additional information,
you may contact our
Privacy Officer, at the telephone or address below. If you believe that
your privacy rights have
been violated, you have the right to file a complaint with the Privacy
Officer at Tuerk House, Inc.
or with the Secretary of the Department of Health and Human Services.
We will take no
retaliatory action against you if you make such complaints.
· The contact information for both is included below
U.S Department of Health and Human Services
Office of the Secretary
200 Independence Avenue, S.W.
Washington, D.C.20201
Tel: (202) 619-0257
Toll Free: 1-877-696-6775
http;//www.hhs.gov/contacts
Privacy Officer
John E. Hickey
Tuerk House, Inc.
P.O. Box 31419
Baltimore, MD. 21216
Tel: (410) 233-0684 Ext. 116
www.tuerkhouse.com
NOTICE OF PRIVACY PRACTICES AVAILABILITY
This notice will be prominently posted in the office where registration
occurs. You will be provided a hard copy, at the time we first deliver
services to you. Thereafter, you may obtain a copy upon request, and the
notice will be maintained on the organization’s Web site (if applicable
Web site exists) for downloading.
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