ADVANCE HOUSING, INC. • NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE APRIL 14, 2003
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, please contact our Privacy Officer at the address or phone number at the bottom of this notice.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION:
Protected health information is individually identifiable health information 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 do the following:
- Keep your protected health information private.
- Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information.
- Follow the terms of the notice currently in effect.
- Communicate to you any changes we may make in this notice.
CHANGES TO THIS NOTICE:
We may change our policies at any time. Therefore, we reserve the right to also change this notice. Changes will apply to health information we already hold as well as new information we receive after the change occurs. Should any changes occur, we will post the new notice on our website at www.advancehousing.org. You will be offered a copy of the current notice and will also be asked to acknowledge in writing your receipt of this notice.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION:
- We may use or disclose your protected health information for treatment (to a physician or health care provider for continued care or referral), payment (to insurance companies for payment or approval of services), and health care operations (for quality assurance or potential landlords).
- We may use or disclose your protected health information without your prior authorization if law or regulations require such disclosure for: public health purposes, audits or inspections, abuse or neglect, medical examiner, and emergencies. We may also disclose protected health information when required by law (in response to a request by law enforcement officials, in response to a judicial or administrative order, or to prevent harm of any individual,).
- Unless you object to any of the following, we may contact you for appointments by either telephone or mail, or to tell you of health-related benefits or services that may be of interest to you, or to support fundraising efforts.
- We may disclose your protected health information about you to a friend or family member who is involved in your care, or to disaster relief authorities so that your family can be notified of your location and condition.
SPECIAL PROTECTIONS FOR HIV, ALCOHOL, AND SUBSTANCE ABUSE, MENTAL HEALTH, AND GENETIC INFORMATION:
Special privacy protections apply to HIV related information, alcohol and substance abuse treatment information, mental health information, and genetic information. Some parts of this Notice may not apply to these types of information. If any of your services contain this information, you will be provided with a separate authorization before any release of this information occurs.
OTHER USES OF PROTECTED HEALTH INFORMATION
In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing your protected health information. If you chose to authorize use or disclosure, you may later revoke that authorization by notifying us in writing of your decision.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION:
- In most cases, you have the right to look at or get a copy of your protected health information that we use to make decisions about your care for as long as we maintain this information with your written authorization. If you request a copy of your record, we may charge a fee for the cost of copying, mailing, or other related supplies and we will advise you of the exact fee. If we deny your request to review or obtain a copy of your protected health information you may submit a written request for a review of that decision.
- If you believe that the information we have about you is incorrect or incomplete,you have the right to request an amendment to your record, in writing, that provides your reasons for this request. We could deny your request for an amendment if the information was not created by our agency, if it is not part of the information that is maintained by us, or if we determine that the information is correct. You may appeal, in writing, a decision by us not to amend your record.
- You have the right to an accounting of disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice and excludes disclosures made to yourself or where you specifically authorized a disclosure in writing. The accounting will only include disclosures made on or after April 14, 2003, and no more than 6 years prior to the date of your request. The first accounting request in a 12-month period is free of charge; other requests will be charged according to the cost of producing this information. You will be informed of the cost at the time of your request.
- You have the right to obtain a copy of this Notice whether or not you have received this notice electronically.
- You have the right to request that your protected health information be communicated to you by alternative means, such as using an address or phone number other than your own. Requests must be in writing. We will accommodate reasonable requests, when possible, and when payment information has been determined and verified.
- You have the right to request, in writing, that we not disclose any part of your protected health information for treatment, payment, healthcare operations, or to persons involved in your care, except when specifically authorized by you, when required by law, or in an emergency. We will consider your request but we are not obligated to accept it. You will be informed of our decision regarding your request.
- If you believe that your privacy rights have been violated, you may file a written complaint with our Privacy Officer.
- You may also file a written complaint with the U.S. Department of Health and Human Services’ Office of Civil Rights.
- Under no circumstances will you be retaliated against for filing a complaint with our Privacy Officer or with the Office of Civil Rights.
Advance Housing, Inc.
100 First Street, Suite 203
Hackensack, New Jersey 07601
E-Mail: Rachel Kriegel