Notice of Privacy Practices
Westchester Jewish Community Services
Executive Office: 845 North Broadway, White Plains, NY 10603
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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT CLIENTS OF WJCS MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice please contact our Privacy Officer,
Rachel Scherer, at 914-761-0600, ext. 315 or firstname.lastname@example.org.
This Notice of Privacy Practices describes how we may use and disclose your "protected health information" (PHI) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. PHI is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties and privacy practices. We are required to abide by the terms of this notice. We may change the terms of our notice at any time. Notifications of changes will be posted in the office and our website (www.wjcs.com). A revised copy may be obtained by calling the office and requesting that a copy be sent to you in the mail or by asking for one at the time of your next appointment.
We may use and disclose your health information for the following purposes:
1. Treatment We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. Your treatment includes sharing information among WJCS' mental health care providers who are involved in your treatment. For example, if you are seeing both a psychiatrist and a psychotherapist, they may share information in the process of coordinating your care.
2. Payment Your protected health information will be used, as needed, to obtain payment for your health care services. In order for an insurance company to pay for your treatment, we must submit a bill that identifies you, your diagnosis, and the treatment provided to you. As a result, we will pass such health information onto an insurer in order to receive payment for your medical bills.
3. Health Care Operations We may use and disclose medical information about you for agency operations. These uses and disclosures are necessary to run the agency and to assure that all of our clients receive quality care. Treatment records may be reviewed as part of an on-going process directed toward assuring the quality of agency operations. We may also provide your PHI to our accountants, attorneys, consultants, and others in order to make sure we are complying with the laws that affect us.
4. Appointment Reminders We may use and disclose PHI to contact you as a reminder that you have an appointment.
5. Treatment Alternatives We may use and disclose PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
6. Health Related Benefits and Services We may use and disclose PHI to tell you about health related benefits or services that may be of interest to you.
7. As Required or Permitted by Law We will disclose your PHI when required to do so by federal, state or local law.
8. Public Health Activities We may be required to report your health information to authorities to help prevent or control disease, injury, or disability. This may include using your medical record to report certain diseases, injuries, birth or death information, information of concern to the Food and Drug Administration, or information related to child abuse or neglect. We may also have to report to your employer certain work-related illnesses and injuries so that your workplace can be monitored for safety.
9. Health Oversight Activities We may disclose your health information to authorities so they can monitor, investigate, inspect, discipline or license those who work in the health care system or for government benefit programs.
10. Activities Related to Death We may disclose your health information to coroners, medical examiners and funeral directors so they can carry out their duties related to your death, such as identifying the body, determining cause of death, or in the case of funeral directors to carry out funeral preparations.
11. Organ, Eye or Tissue Donation We may disclose your health information to people involved with obtaining, storing or transplanting organs, eyes or tissue of cadavers for donation purposes.
12. Food and Drug Administration (FDA) We may disclose to the FDA health information relative to adverse events with respect to food, supplements, products and product defects.
13. Research Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research. Such research might try to find out whether a certain treatment is effective in curing an illness.
14. To Avoid a Serious Threat to Health or Safety As required by law and standards of ethical conduct, we may release your health information to the proper authorities if we believe, in good faith, that such release is necessary to prevent or minimize a serious and approaching threat to you or the public's health or safety.
15. Victims of Abuse, Neglect or Domestic Violence We may notify the appropriate government authorities if we believe a client has been the victim of abuse, neglect or domestic violence. We will only make such disclosures if you agree or when required by law.
16. Military, National Security, or Incarceration/Law Enforcement Custody If you are involved with the military, national security or intelligence activities, are in the custody of law enforcement officials or an inmate in a correctional institution, we may release your health information to the proper authorities so they may carry out their duties under the law.
17. Law Enforcement Sometimes we must report some of your health information to legal authorities, such as law enforcement officials, court officials, or government agencies. For example, we may have to respond to a court order or subpoena.
18. Judicial and Administrative Proceedings If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment or the records thereof; such information is privileged under state law, and we will not release information without your written authorization or a court order. The privilege does not apply when the evaluation is court ordered. You will be informed in advance if this is the case.
19. Workers' Compensation We may disclose your health information to the appropriate persons in order to comply with the laws related to workers' compensation or other similar programs. These programs may provide benefits for work-related injuries or illness.
20. Inmates We may use or disclose your protected health information if you are an inmate of a correctional facility and your provider has created or received your protected health information in the course of providing care to you.
21. To Those Involved With Your Care or Payment of Your Care If people such as family members, relatives, or close personal friends are helping care for you, we may release important health information about you to those people. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. You have the right to object to such disclosure, unless you are unable to function or there is an emergency. In addition, we may release your health information to organizations authorized to handle disaster relief efforts so those who care for you can receive information about your location or health status. We may allow you to agree or disagree orally to such release, unless there is an emergency.
22. Emergencies We may use or disclose your protected health information in an emergency treatment situation.
NOTE: Except for the situations listed above, we must obtain your specific written authorization for any other release of your health information including marketing and fundraising. You may revoke an authorization in writing at any time except to the extent that we have already used or disclosed the information on the authorization. To revoke this authorization, you must submit your request in writing to: Rachel Scherer , Privacy Officer, 845 North Broadway, White Plains, NY 10603.
Your Health Information Rights
You have several rights with regard to your health information; specifically, you have the right to:
Inspect and Copy Your Protected Health Information You have the right to inspect and copy medical and billing information maintained in your record except for information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.
You must submit your request in writing to: Rachel Scherer , Privacy Officer, 845 North Broadway, White Plains, NY 10603. We may deny your request to inspect and/or copy your records in certain limited circumstances; however, a decision to deny access may be reviewed. In addition, we may charge you a reasonable fee if you want a copy of your health information.
Request to Correct Your Health Information If you believe your health information is incorrect, you may ask us to correct the information. You will need to make such requests in writing and give a reason as to why your health information should be changed. However, if we did not create the health information that you believe is incorrect, or if we disagree with you and believe your health information is correct, we may deny your request. You must submit your request in writing to: Rachel Scherer , Privacy Officer, 845 North Broadway, White Plains, NY 10603.
Request Restrictions on Certain Uses and Disclosures You have the right ask for restrictions on how your health information is used or to whom your information is disclosed, even if the restriction affects your treatment or our payment or health care operation activities. Or, you may want to limit the health information provided to family or friends involved in your care or payment of medical bills. However, we are not required to agree in all circumstances to your requested restriction. You must submit your request in writing to: Rachel Scherer , Privacy Officer, 845 North Broadway, White Plains, NY 10603.
As Applicable, Receive Confidential Communication of Health Information by Alternative Means and at Alternative Locations You have the right to request that we communicate your health information to you in different ways or places. You may request communications in a certain way or at a certain location, but you must specify how or where you wish to be contacted. For instance, you may ask that we contact you by mail, rather than by telephone, or at home, rather than work. You do not need to give a reason for your request. All reasonable requests will be accommodated.
Receive an Accounting of Disclosures of Your Health Information You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate how you would like us to respond to you (for example, on paper or by e-mail). We must comply with your request for a list within 30 days, unless you agree to a 30-day extension, and we may not charge you for the list, unless you request such list more than once per year. In addition, we will not include in the list: disclosures made to you, disclosures made for purposes of treatment, payment, health care operations, national security, law enforcement/corrections, and certain health oversight activities. You must submit your request in writing to: Rachel Scherer , Privacy Officer, 845 North Broadway, White Plains, NY 10603.
Obtain a Paper Copy of This Notice Upon your request, you may at any time receive a paper copy of this notice, even if you agreed earlier to receive this notice electronically.
Complain If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your protected health information or in response to a request you made to amend or restrict the use or disclosure of your protected health information or to have us communicate with you in confidence by alternative means or at an alternative location, you may contact us or the US Department of Health and Human Services. To file a complaint with us, please contact Rachel Scherer , Privacy Officer, 845 North Broadway, White Plains, NY 10603. All complaints must be made in writing. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We will not retaliate against you for filing such a complaint.
Additional Health Information Rights
The federal health care privacy regulations known as "HIPAA" generally do not take precedence over state or other applicable privacy laws that provide individuals greater privacy protections. As a result, when a state law requires us to impose stricter standards to protect your health information, we will follow the state law rather than the HIPAA Privacy Regulations. For example, where such laws have been enacted, we will follow more stringent state privacy laws that relate to uses and disclosures of the protected health information concerning HIV or AIDS, mental health, and substance abuse/chemical dependency.
If you have any questions or concerns regarding your privacy rights or the information in this notice, please contact our Privacy Officer, Rachel Scherer at 914-761-0600, ext. 315 or email@example.com.
This Notice is effective as of April 14, 2003.