Piedmont Community Services
–Privacy Notice
Effective 4/14/2003 – Revised 9/23/2013
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY
Piedmont
Community Services (PCS) understands your privacy is important. We are required by law to maintain the
privacy of your protected health information and to provide you with notice of
our legal duties and privacy practices with respect to protected health
information. PCS will handle this
information only as allowed by federal and state law and agency policies,
adhering to the most stringent law that protects your health information.
Each time you receive services from Piedmont Community
Services; we make a record of your visit and store it in your medical
record. This record may consist of your
assessment, service plan, progress notes, diagnosis, treatment and discharge
plan for further care or treatment.
If at any time you believe your privacy rights have been
violated you may file a complaint with the agency Privacy Officer, State Human
Rights Advocate or with the Secretary of Health and Human Services. We will not retaliate or penalize you for
filing a complaint. If you would like
more information or to make a complaint verbally or in writing please contact:
·
Piedmont CSB
Privacy Officer:
v 24 Clay
Street, Martinsville, VA 24112
v Telephone: (276) 632-7128
·
State Human
Rights Advocate:
v 382 Taylor
Drive, Danville, VA 24541
v Telephone: (434) 773-4314
·
Secretary of
U.S. Dept. of Health & Human Services:
v Region III
OCR, Health and Human Services
v 150 S.
Independence Mall West, Suite 372
v Philadelphia,
PA 19106-9111 Telephone
(800) 368-1019
Although your medical record is the property of Piedmont
Community Services, there are several rights concerning your protected health
information we want you to be aware of. You have the right to:
·
Inspect or obtain a paper and/or electronic copy of
your medical record. This right is not
absolute. In certain situations, if
accessing your information would cause harm, we may deny access. If access is denied, you will receive a
written notice of the decision and reason.
If you receive paper or electronic copies of your medical records, a
reasonable fee may be applied.
·
Request amendments or corrections to your medical
record if you believe the information in the record is inaccurate or
incomplete. We may deny the request for
certain reasons but you will be provided with a written explanation of the
denial.
·
Receive an accounting of the agency’s disclosures of
your protected health information made after April 14, 2003 that were not for
the purpose of treatment, payment of healthcare operations or that were not
authorized by you.
·
Request that we communicate with you about your health
information or medical information in a certain method or location. For example, a specific telephone number or mailing address.
·
Request a restriction with regard to use and disclosure
of your protected health information.
You will be informed promptly whether we will be able to honor the
request restriction and still offer effective services, receive payment and
maintain healthcare operations. We are
not required to agree to any restrictions that you request. However, once an agreement is made, we are
bound by that agreement except under certain emergency circumstances.
·
Ask for a restriction of your health information to
your health plan if you pay for medical services entirely out-of-pocket unless
required by law for treatment purposes.
·
Receive notification whenever a breach of your
unsecured health information occurs.
·
Revoke any authorization to disclose confidential
information except to the extent that action has already been taken.
·
Receive a paper copy of this Privacy Notice at any time
upon your request.
·
Choose, refuse or request a provider within our service
delivery team. Effort will be made to
honor your request. However, staff
availability and payer requirements will determine if we can honor your
request.
·
Have access to your information in sufficient time to
help facilitate decision making in regards to treatment.
Upon enrolling in services at Piedmont Community Services,
you are allowing us to use and disclose necessary information about you within
the agency and with our business associates in order to provide treatment,
receive payments for provided services and conduct our day-to-day health care
operations. Listed below are examples of
how we use your information for Treatment, Payment and Healthcare Operations:
·
Treatment: In order to provide you treatment, we
disclose your information within the agency to your case manager, counselor,
physician, nurse or other service providers and administrative staff in order
to meet your healthcare needs.
·
Payment: In order to receive payment for services
provided, your health information may be sent to those companies or groups
responsible for payment coverage as well as statements sent to the Responsible
Party. Your health information may be
transmitted electronically with security measures to protect your information.
·
Healthcare
Operations: In day-to-day
business practices, staff may access your paper and/or electronic medical
record for service delivery, filing documentation, providing reminder services,
as well as conducting quality assessment and improvement activities. There are some services provided in our organization
through an agreement with business associates.
When these services are contacted, we may disclose your health
information to our business associates.
Business Associates are required to safeguard your information as
required by law.
·
Marketing: Piedmont Community Services will not sell or
use your Protected Health Information for marketing purposes.
·
Fund Raising: Piedmont Community Services will not sell or
use your Protected Health Information for fund raising purposes.
Use and
Disclosure without Authorizations:
Piedmont Community Services is allowed by federal and state law to
disclose certain information about you in certain circumstances:
·
Comply with federal, state or local laws that require
disclosure.
·
Public Health Authorities for authorized activities.
·
Inform authorities to protect victims of abuse, neglect
or exploitation.
·
Comply with federal and state health oversight
activities.
·
Report to the Department of Behavioral Health and
Developmental Services statistical data elements and allow access to your
record for health oversight reviews.
·
Respond to law enforcement officials or to judicial
orders, subpoenas or other processes that are mandated under the law.
·
Avert a serious threat to health and safety.
·
Respond to Specialized Government Functions (military
services, national security or intelligence activities, state department).
·
Inform a correctional institution if you are an inmate.
·
Health Oversight Activities.
·
Workers Compensation (ex: facilitate processing,
treatment and payment).
·
Coroners and Medical Examiners.
·
Secretary of Health and Human Services.
·
Communicate with other providers in an emergency (ex:
serious health condition for treatment).
·
Discharge follow-up and/or conduct satisfaction
surveys.
Piedmont Community Services reserves the right to change
privacy policies and practices at any time, as allowed by federal and state
law. Revised Privacy Notices will be
posted at all service sites, and are available upon request, in our offices and
on our web site.