Notice of Privacy Practices
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.
THIS NOTICE GIVES YOU INFORMATION REQUIRED BY LAW about the duties and privacy practices of Quality Comprehensive Health Services (QCHS) to protect the privacy of your personal health information.
When QCHS provides you with case management, mental or physical health care, or referrals, QCHS receives and maintains personal health information about you. QCHS may also receive and maintain financial and billing information about you. To help QCHS provide these comprehensive core and supportive care services to you, QCHS may contract with companies, social service agencies, or individuals.
These contractors may also receive and maintain your personal information. QCHS will use and share only the minimum necessary health information that our staff and contractors need to do their jobs. QCHS and its contractors are required by law to:
(1) maintain the privacy of protected health information;
(2) to provide you with notice of QCHS's legal duties and privacy practices with respect to your protected health information; and
(3) to notify affected individuals of a breach of unsecured protected health information.
This Notice describes how QCHS may use and disclose your information. It also describes your rights and QCHS's legal obligations with respect to your information. QCHS is required to follow the terms of this Notice until the Notice is replaced. QCHS reserves the right to change the terms of this Notice at any time. If QCHS makes changes to this Notice, the new Notice will be available in QCHS offices, upon request, and on our website:
Any changes to our practices will apply to all of your personal health information maintained by QCHS.
QCHS may share your information without your authorization in the following ways:
Treatment: QCHS can use your health information and share it with other professionals who are treating you in order to enhance coordination of comprehensive care services. For example, QCHS may disclose your personal health information to your provider, at the provider’s request, or for treatment by your provider.
Payment: QCHS can use and share your information for payment purposes. For example, QCHS may use or disclose your personal health information to provide eligibility information to your provider when you receive treatment, to pay for claims for covered health care services, to pay for insurance premiums if eligible, to assist with payment of approved medical/pharmaceutical out-of-pocket costs, or to recover costs from other medical insurance or probate estates.
Health Care Operations: QCHS can use and share your health information for QCHS operations, to improve your care, and to contact you when necessary. For example, QCHS or its contractors may use or disclose your personal health information (1) to conduct quality assessment and improvement activities; (2) to review applications for services; (3) to engage in care coordination or case management; (4) to manage, plan or develop QCHS's services and budget; (5) to coordinate services with another public benefit program; (6) to create or provide individualized service or treatment plans; or (7) to cooperate with State and federal auditors.
Public Health and Safety Issues: QCHS can share health information about you with public health authorities for public health activities such as: preventing or controlling disease, injury, or disability; public health activities (such as surveillance and investigation), interventions and activities related to public health oversight; and to coordinate care and treatment keeping vital records; avoiding a serious threat to the health or safety of a person or the public; and reporting suspected abuse, neglect, or domestic violence to governmental or social services agencies. QCHS also can share your health information with a governmental agency authorized to oversee government health care programs.
Research: QCHS can use or share your information for health research in limited circumstances where the information will be protected by the researchers.
As Required by Law: QCHS will share information about you if State or federal laws require it, including with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) for a compliance review or complaint investigation or with a personal representative appointed by you or designated by law.
Lawsuits and Legal Actions: QCHS can share health information about you in response to a court or administrative order, or in response to a subpoena.
QCHS is required by law to maintain the privacy and security of your protected health information. QCHS will notify you as required by law when there is a breach of your unsecured protected health information. In some circumstances QCHS’s business associate may provide the notification to you.
QCHS must follow the duties and privacy practices described in this Notice and give you a copy of it.
QCHS will not use or share your information for any purposes not described in this Notice without your written permission. If you do authorize QCHS to use or disclose your health information, in most cases, you may revoke your written authorization at any time. Your revocation will be effective from the date QCHS receives the revocation.
QCHS does not market or sell your protected health information.
Communicate Confidentially: You can ask in writing that QCHS communicate with you by a reasonable alternative means or at a reasonable alternative location. For example, you may request that QCHS communicate with you by e-mail rather than by telephone, through a translator, or at home instead of your place of work. QCHS will agree to all reasonable requests.
Request a Copy of this Privacy Notice: You are entitled to a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically.
Inspect and Amend Protected Health Info: You are entitled to inspect and copy your protected health information at any time. At the time of inspection you may request an amendment to your information. QCHS reserves the right to deny your request for amendment.
Choose Someone to Act on Your Behalf: You may give someone a medical power of attorney, or a legal guardian may be appointed for you to exercise your rights and make choices about your health. Before QCHS takes any action, QCHS will confirm the person has this authority and can act on your behalf.
File a Complaint: If you believe your privacy rights have been violated by QCHS, you have the right to complain to QCHS or to the Secretary of the U.S. Department of Health and Human Services. You may file a complaint with the QCHS Chief Privacy Officer, within 180 days of the suspected violation, at the address where you receive services listed below or you may file a complaint with the United States Department of Health and Human Services, Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201; or calling 1-877-696-6775, or visiting QCHS will not retaliate against you for filing a complaint with either QCHS or with the U.S. Department of Health and Human Services.
Your Choices: You have the right to request that QCHS restrict the uses or disclosures of your protected health information to carry out treatment, payment, for health care operations. Your requests must be clearly expressed. QCHS is not required to agree to your requests.
To request additional copies of this notice or to receive more information about QCHS’s privacy practices or your rights, please contact the Chief Privacy Officer at the following address: