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.
If you have any questions about this Notice of Privacy Practices, please contact the Program Director at the site you are to receive services:
Children's Clinic: Cynthia Monahon, 413-587-3265
Northampton Center for Children and Families: Jay Indik, 413-584-1310
Three Rivers Program: Robert Terreden, 413-733-4032
Or, our agency's Executive Director and Privacy Officer: Andrew Pollock, 413-584-1310
I. Introduction
This Notice of Privacy Practices ("Notice") describes how we may use and disclose health information about you. This Notice also describes your rights regarding health information we maintain about you and a brief description of how you may exercise these rights. This Notice further states the obligations we have to protect your health information.
In this Notice, "health information" means health information (including identifying information) about you or your family members we have collected from you or received from your health care providers, health plans, your employer or a health care clearninghouse. It may include information about your past, present or future physical or mental health or condition, the provision of your health care, and payment for your health care services.
We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information. We are also required to comply with the terms of our current Notice.
II. Who We Are
Cutchins Programs for Children and Families, Inc. ("Agency") consists of three programs:
- Northampton Center for Children and Families
- The Children's Clinic
- Three Rivers Program
All these programs will follow the terms of this Notice. Also, these programs may share health information with each other for treatment, payment or health care operations, as described in this Notice.
III. How We Will Use and Disclose Your Health Information
We will use and disclose your health information as described in each category listed below. For each category, we will explain what we mean in general, but not describe all specific uses or disclosures of health information.
For Treatment. We will use and disclose your health information without your authorization within our Agency to provide your health care and any related services. For example, we may disclose your health information among the members of the treatment team who work at the Agency providing services for you (including clinicians other than your therapist or principal clinician). For example, our staff may discuss your case at a case conference, or in supervision. In our residential programs, information may be shared with staff members who are involved in the services being provided. In our residential programs, consistent with and in the course of your treatment, a limited amount of your health information is shared in order to promote the Milieu Treatment. For example, in the residences there may be postings of Levels, Chores, or Goals. To promote normative relationships, we allow and sometimes provide keepsakes or mementos to clients that have limited amounts of protected health information of other clients. Typically, these are photographs or videos in which the image of your child may appear.
We will also use and disclose your health information to coordinate and manage your health care and related services with other providers, such as the Department of Mental Health ("DMH") or the DMH case manager who is responsible for coordinating your care. We generally will not disclose health information about you without your consent to people outside the Agency for treatment purposes, except in emergency situations or in cases that may present a serious threat to the health or safety of you or others or otherwise as may be required or permitted by law.
For Payment. We may use and disclose your health information without your authorization so that the treatment and services you receive from us are billed to, and payment is collected either from your health plan or other third party payer, so long as the policy or certificate under which a claim is made provides that access to your medical information is permitted, or from a state agency that is paying for your care under a contract with us. By way of example, we may disclose your health information to permit your health plan to take certain actions before your health plan approves or pays for your services. These actions may include:
- making a determination of eligibility or coverage for health insurance;
- reviewing your services to determine if they were medically necessary;
- reviewing your services to determine if they are appropriately authorized or certified in advance of your care; or
- reviewing your services for purposes of utilization review, to ensure the appropriateness of your care, or to justify the charges for your care.
For example, your health plan may ask us to share your health information in order to determine if the plan will approve additional visits to your therapist.
For Health Care Operations. We may use and disclose your health information without your authorization for our health care operations. These uses and disclosures are necessary to run our organization and make sure that our clients receive quality care. These activities may include, by way of example, quality assessment and improvement, reviewing the performance or qualifications of our clinicians, training students in clinical activities, licensing, accreditation, business planning and development, and general administrative activities. We may combine health information of many of our clients to decide what additional services we should offer, what services are no longer needed, and whether certain new treatments are effective. We may also combine our health information with health information from other providers to compare how we are doing and see where we can make improvements in our services. When we combine our health information with information of other providers, we will remove identifying information so others may use it to study health care or health care delivery without identifying specific clients.
For Appointment Reminders. We may also use and disclose your health information to contact you to remind you of your appointment or a meeting to plan your care. We may contact you by telephone and may leave a message on your voicemail or answering machine. We may also contact you by mail to remind you of your appointment. You do have a right to request confidential communications. See Section V below
To Persons Involved in Your Care or Payment for Your Care. Unless you object, we may disclose your health information to a friend or family member who is involved in your care or to someone who helps pay for your medical care. We may use or disclose your 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. We abide by court-ordered or court-approved custody rights and provisions as determined by a probate or other court.
In Emergencies. If you are physically present and have the capacity to make health care decisions, your health information may only be disclosed with your agreement to persons you designate to be involved in your care. But, if you are in an emergency situation, we may disclose your health information to a spouse, a family member, or a friend so that such person may assist in your care. In such cases, we will determine whether the disclosure is in your best interest and, if so, only disclose information that is directly relevant to participation in your care.
We may also use or disclose your health information to an entity assisting in disaster relief efforts so that your family can be notified of your condition, status, and location.
For Research. We may disclose your health information to researchers when their research has been approved by an Institutional Review Board or a similar privacy board that has reviewed the research proposal and established protocols to protect the privacy of your health information. For example, a research project might involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. In many cases, most or all the information that could be used to identify you specifically, such as your name, contact information, and medical record number, will have been removed. We will seek your consent in those cases where the health information requested includes information by which you may be specifically identified, and in those cases where the research involves any participation by you. We may, however, disclose health information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave our premises, and as long as the researchers represent that such information is necessary for research purposes.
As Required or Permitted By Law. We will disclose health information about you when required to do so by federal, state or local law. Also, we may use and disclose health information about you when permitted by law to do so. For example, as required or permitted by law, we may disclose information to the U.S. Food and Drug Administration, health oversight agencies, funeral directors and medical examiners, for worker's compensation purposes, and for national security and intelligence purposes.
To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to help prevent a serious and imminent threat to your health or safety or to the health or safety of the public or another person. Under these circumstances, we will only disclose health information to someone who may be able to help prevent or lessen the threat. If a client runs away from one of our residential programs, we may inform the police of a physical description and information about their emotional state and/or specific risks.
For Public Health Activities. We may disclose health information about you as necessary for public health activities including, by way of example, disclosures to:
- report to public health authorities for the purpose of preventing or controlling disease, injury or disability;
- report vital events such as birth or death;
- conduct public health surveillance or investigations;
- report child abuse or neglect;
- report defective products or problems with medications;
- notify consumers about FDA-initiated product recalls;
- notify a person who may have been exposed to a communicable disease or who is at risk of contracting or spreading a disease or condition;
- notify the appropriate government agency if we believe an adult has been a victim of abuse, neglect or domestic violence; however, we will only notify an agency if we obtain your agreement or if we are required or authorized by law to report such abuse, neglect or domestic violence.
Disclosures in Legal Proceedings. We may disclose health information about you when a judge orders us to do so. We also may disclose health information about you in legal proceedings without your permission or a judge's order when:
- you sue any of our clinicians or staff or agency for malpractice or initiate a complaint with a licensing board against any of our clinicians.
For Law Enforcement Activities. We may disclose health information to a
law enforcement official for law enforcement purposes when necessary and appropriate, including
- when the information is provided in response to an order of a court; or
- we determine that the law enforcement purpose is to respond to a threat of an imminently dangerous activity by you against yourself or another person; or
- to report a crime, the location of the crime or victims, or the identity, description or location of the person who may have committed a crime; or
- we report a death required to be reported to a medical examiner, including where we believe the death may be the result of violence or other suspicious circumstances; or
- we report criminal conduct occurring on our premises; or
- the disclosure is otherwise required or permitted by law.
We may also disclose health information about a client who is a victim of a crime, without a court order or without being required to do so by law. However, we will do so only if the disclosure has been requested by a law enforcement official and the victim agrees to the disclosure or, in the case of the victim's incapacity, the following occurs;
- the law enforcement official represents to us that (i) the victim is not the subject of the investigation and (ii) an immediate law enforcement activity to meet a serious danger to the victim or others depends upon the disclosure; and
- we determine that the disclosure is in the victim's best interest.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose, under certain circumstances, health information about you to the correctional institution or law enforcement official. For example, we may disclose health information to a correctional institution or law enforcement officer if such officer represents that the health information is necessary to provide you with health care.
IV. Uses and Disclosures of Your Health Information with Your Permission.
Uses and disclosures not described in Section III of this Notice will generally only be made with your written permission, called an "authorization." A written authorization request will, among other things, specify the purpose of the requested disclosure, to whom the information may be disclosed, and an expiration date for the authorization. You have the right to revoke an authorization at any time. If you revoke your authorization we will not make any further uses or disclosures of your health information under that authorization, unless we have already taken an action relying upon the uses or disclosures you have previously authorized.
V. Your Rights Regarding Your Health Information.
Right to Inspect and Copy. You have the right to request an opportunity to inspect or to obtain a copy of health information used to make decisions about your care - whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes.
You must submit your request in writing to the Program Director at the site of your service or our Privacy Officer (see Page 1). If you request a copy of the information, we may charge a fee for the costs associated with your request, including copying, mailing and related supplies.
We may deny your request to inspect or obtain a copy of your health information in certain limited circumstances. In most cases, you will have the right to have the denial reviewed by a licensed health care professional at the Agency not directly involved in the original decision to deny access. We will inform you in writing if the denial of your request may be reviewed. Once the review is completed, we will honor the decision made by the licensed health care professional reviewer.
Right to Amend. For as long as we keep records about you, you have the right to request us to amend any health information used to make decisions about your care - whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes.
To request an amendment, you must submit a written document to our Privacy Officer at Cutchins Programs for Children and Families, Inc., 78 Pomeroy Terrace, Northampton, MA 01060 and tell us why you believe the information is incorrect or inaccurate.
We may deny your request for an amendment if, for example, it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend health information that we determine:
- was not created by us;
- is not part of the health information that is maintained by us or for us to make decisions about your care;
- is not part of the health information that you would be permitted to inspect or copy; or
- is accurate and complete.
If we deny your request to amend, you have the right to file a statement stating your disagreement with us, and we may provide a rebuttal to your statement and will provide you with a copy of any such rebuttal.
Right to an Accounting of Disclosures. You have the right to request that we provide you with an accounting of certain disclosures we have made of your health information. An accounting is a list of such disclosures. This list will not include certain disclosures of your health information. For example, the list will not include disclosures we have made with your authorization, or for purposes of treatment, payment, and health care operations.
To request an accounting of disclosures, you must submit your request in writing to the Privacy Office at Cutchins Programs for Children and Families, Inc., 78 Pomeroy Terrace, Northampton, MA 01060. For your convenience, you may submit your request on a form called a "Request For Accounting," which you may obtain form our Privacy Officer. The request should state the time period for which you wish to receive an accounting. This time period should not be longer than six years and not include dates before April 14, 2003.
The first accounting you request within a twelve-month period will be free. For additional requests during the same 12-month period, we will charge you for the costs of providing the accounting. We will notify you of the amount we will charge and you may choose to withdraw or modify your request before we incur any costs.
Right to Request Restrictions. You have the right to request a restriction on the health information we use or disclose about you for treatment, payment or health care operations. You may also ask that any part (or all) of your health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in Section III of this Notice.
You must request the restriction in writing and addressed to the Privacy Officer at Cutchins Programs, 78 Pomeroy Terrace, Northampton, MA 01060. The Privacy Officer will ask you to fill out a Request for Restriction Form, which you should complete and return to the Privacy Officer.
We are not required to agree to a restriction that you may request. If we do agree, we will honor your request unless the restricted health information is needed to provide you with emergency treatment or is required by law.
Right to Request Confidential Communications.
You have the right to request that we communicate with you about your health care only in a certain location or through a certain method. For example, you may request that we contact you only at work or by telephone.
To request such a confidential communication, you must make your request in writing to the Program Director at your service site. We will accommodate all reasonable requests. You do not need to give us a reason for the request; but, your request must specify how and where you wish to be contacted.
Right to a Paper Copy of this Notice. You have the right to obtain a paper copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you may still obtain a paper copy. To obtain a paper copy, contact our Privacy Officer at Cutchins Programs for Children and Families, Inc., 78 Pomeroy Terrace, Northampton, MA 01060.
VI. Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact our Executive Director at Cutchins Programs for Children and Families, Inc., 78 Pomeroy Terrace, Northampton, MA 01060, telephone number 413-584-1310. All complaints must be submitted in writing.
The Program Director at your site of service will assist you with writing your complaint, if you request such assistance.
We will not retaliate against you for filing a complaint.
VII. Changes to and Posting of this Notice
We reserve the right to change the terms of our Notice at any time. We also reserve the right to make the revised or changed Notice effective for all health information we already have about you as well as any health information we receive in the future. We will post a copy of the current Notice at our main office and at each site where we provide care. You may also obtain a copy of the current Notice by calling us at 413-584-1310 and requesting that a copy be sent to you in the mail or by asking for one any time you are at one of our offices.
CONTACT INFORMATION
RETURN TO HOME