At the Heart of Recovery
Notice of Privacy Practices

Chemical Abuse Services Agency, Inc.

 

Notice of Privacy Practices

Protection of your privacy is important to us. Please read about your health information privacy rights as a patient/person served within this notice.

CASA, Inc. continually strives to provide the highest possible standard of care. To help us in our efforts to continually improve our services, we invite you to report to CASA Inc. administration concerns about the quality of care you have received or the safety and cleanliness of our facilities.

To contact us by phone: 203-331-4728

 

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 THIS NOTICE CAREFULLY.

For more information, please contact:

Asher Delerme

Director of Health Information Management and Privacy Officer

Chemical Abuse Services Agency, Inc.

1124 Iranistan Ave. Bridgeport, CT 06605

203-331-4728

Who we are: This notice describes the privacy practices of CASA, which include the privacy practice of.

  • All of our doctors, nurses and other health care professionals authorized to enter information about you in your medical chart.

  • All of our departments, including our medical records and billing  departments

  • All of our behavioral health sites, MAT Site, outreach programs, supportive housing facilities or programs operated by CASA, Inc.

  • All of our employees, staff volunteers and other personnel who work for us on our behalf.

Our Pledge: We understand that health information about you and the health care you receive is personal. We are committed to protecting your personal health information. When you receive treatment and other health care services from us, we create a record of the services that you received. We need this record to provide you with quality care and to comply with legal requirements. This notice applies to all of our records and about your care, whether made by our health care professionals or others working in this office, and tells you about the ways in which we may use and disclose your personal health information. This notice also describes your rights with respect to the health information that we keep about you and the obligations that we have when we use and disclose your health information.

We are required by law to:

  • Make sure that health information that identifies you is kept private

  • Give you this notice of our legal duties and privacy practices with respect to your personal health information

  • Follow personal health information.

How we may use and disclose your health information

We may use and disclose your personal health information for these purposes:

Treatment: to provide you with the health care treatment or services. We may disclose health information about you to the doctors, nurses, technicians, medical students and other who are involved in your care. They may work at CASA, a the  hospital If you are hospitalized under our supervision, or at another doctor’s office, lab, pharmacy or to other health care provider to whom we may refer you for treatment, consultation, x-rays, lab tests, prescriptions or other health care professionals who work at the Chemical Abuse Services Agency or elsewhere who consult your care for example, we may disclose to an emergency room doctor who is treating you for a broken leg that you have diabetes, because diabetes may affect your body’s healing process.

Payment: to bill and collect payment for you, your insurance company, including Medicare Medicaid, or other third party that may be available to reimburse us for some or all of your health care, we may also disclose health information about you to other health care providers or to your health plan so that they can arrange for payment relating to your care. For example, if you have health insurance, we may need to share information about your office visit with your health plan to pay us or reimburse you for the visit. We may also tell your health plan about treatment that you need to obtain your health plan’s prior approval to determine whether your plan will cover the treatment.

Operation: for our day-to-day operations we may disclose information about you to other health care providers involved in your care or to your health plan for use in their day-to-day operations. These uses and disclosures are necessary to run CASA and to make sure that all of our patients receive quality care and to assist other providers and health plans in doing so as well. For example, we may use health information to review the services that we provide and to evaluate the performance of our staff in caring for you. We may also combine health information about our patients with health information from other health care providers to decide what additional services CASA should offer, what services are not needed, whether new treatments are effective, or to compare how we are doing compare to others and to see where to make improvements. We may remove information that identifies you from this set of health information so others may use it to study health care delivery without learning who our patients are.

Appointment reminders: To contact you as a reminder that you have an appointment.

Health-related services and treatment alternatives: To tell you about health-related services or recommended treatment options or alternatives that may be of interest to you. Please let us know if you do not wish us to contact you with this information, of if you wish to have us use a different address when sending this information to you.

Individuals involved in your care or payments for your care: We may release health information about you to a friend or family member who is involved in your health care or the person who helps pay for your care with written authorization, emergency situations or otherwise authorized by law.

Research: Under certain circumstances, we may use and disclose health information for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another medication for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research project and patient’s need for privacy. Before we use or disclose health information for research, the project will be approved through this special approval process, although we disclose health information about you to people preparing to conduct a research project. For example, we may help potential researches look for patients with specific health needs, as long as the health information they review does not leave our facility. We will always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are or will be involved in your care.

As required by law: When required to do so by federal, state, or local law.

To Avert a Serious Threat to Health or Safety: When necessary to prevent a serious threat to your safety or the health and safety of the public or another person. Any disclosure, however, would be to someone able to help in the event of imminent threat.

Military and Veterans: if you are a member of the armed forces or separated/discharged from military services, we may release health information as required by military command authorities or the Department of Veterans Affairs as applicable. We may also release information about foreign military personnel to the appropriate foreign military authorities.

Public Health Activities: These activities generally include:

  • to prevent or control disease, injury or disability

  • to report births and deaths

  • to report child abuse or neglect

  • to report reactions to medications or problems with products

  • to notify a person who may have been exposed to a disease or may be at risk or contracting or spreading a disease or condition.

  • To notify the appropriate government authority if we believe a patient has been the victim of abuse or neglect. We will only make this disclosure if you agree or when required or authorized by law.

     

Health Oversight Activities: for activities authorized by law, which include audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

Lawsuits and Disputes: In response to a court or administrative order, in response to a subpoena, discovery request or other lawful process that is not a accompanied by a court or administrative order, but only if efforts have been made to obtain an order to protect the information requested, or you have given written authorization to the person requesting the information.

Law Enforcement: If asked to do so by law enforcement officials:

  • In response to a court order, subpoena, valid search warrant, or similar process

  • About criminal conduct at CASA

  • In emergency circumstances to report a crime, the location of the crime or victim, or the identity, description or location of the person who committed the crime

Coroners, Health Examiners and Funeral Directors: This may be necessary, for example, to identify a deceased person or determine the cause of death. Also, funeral directors may need information to carry out their duties.

Protective Services for the President and Others: To authorized federal officials so they may provide protection to the President, other authorized person or foreign heads of state or conduct special investigation.

Psychiatric Records and Communications: In the event that information released constitutes privileged psychiatric-patient communications, the confidentiality of these records is required under chapter 899 of the Connecticut General Statutes. This material shall not be transmitted to anyone without written authorization as provided in the aforementioned statues.

Drug and Alcohol Abuse Records: In the event that information is protected by the Confidentiality of Alcohol and Drug Abuse Patient Records regulations. This information has been disclosed to you from records protected by general confidentiality rules (42 CFR Part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.

HIV Related Information: In the event that the information releases constitutes confidential HIV- related information protected under Connecticut law. This information has been disclosed to you from records whose confidentiality is protected by state law. State law prohibits you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by state law. A general authorization for the release of medical or other information is NOT sufficient for this purpose.

Your rights: You have certain rights with respect to your personal health information. This section of our notice describes your rights and how to exercise them.

Right to inspect and copy: you have the right to inspect and copy the personal health information in your medical and billing records, or in any group of records that we maintain and use to make health care decisions about you.

To inspect and copy your personal health information you must submit your request in writing to our privacy contact person identified on the first page of this notice. If your request a copy of the information, we may charge a fee for the copying and mailing cost, and for any other cost associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If your request is denied, you may request that the denial be reviewed. We will designate a licensed health care professional to review our decision to deny your request. The person conducting the review will not be the same person who denied your request. We will comply with the outcome of the review.

Right to amend: If you feel that the health information we maintain about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment, your request must be made in writing, submitted to our privacy contact person identified on the first page of this notice, and must be contained on one piece of paper legible handwritten or typed. In addition, you must provide a reason that supports your request for an amendment.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask to amend information that:

  • Was not created by us, unless the person or organization that created the information is no longer available to make the amendment.

  • Is not part of the health information kept by or for CASA Inc.

  • Is not part of the information which you would be permitted to inspect or copy, or

  • We believe is accurate and complete.

Any amendment we make to your health information will be disclosed to the health care professionals involved in your care and to others to carry out payment and healthcare operations, as we previously described in this notice.

Right to receive an Accounting of Disclosure: You have the right to receive an accounting of certain disclosures of your health information that we made. Any accounting will not include all disclosure that we make. For example, an accounting will not include disclosures:

  • Pursuant to your written authorization

  • To a family member, other relative, or personal friend involved in your care or payment for your care when you have given us permission to do so

  • To law enforcement officials

To request an accounting of disclosures, you must submit your request in writing to our privacy contact person identified on the first page of this notice. Your request must state time period, which may not be more than six years and may not include dates before April 15, 2003. The first list you request within a 12-month period will be free. For additional lists, we may change you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list, this date will not exceed 60 days from the date you made the request.

Right to request restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment o9r healthcare operations. You also have the right to request a limit or restriction on the health information we have been previously authorized to disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you may request that we do not disclose information about you to a certain doctor or other health care professional, or that we not disclose information to your spouse about certain care that you received.

We are not required to agree to your request restrictions if it is not feasible for us to comply with your request or if we believe that it will negatively impact our ability to care for you. if we agree, however, we will comply with your request unless the information is needed to provide emergency treatment. To request a restriction, you must make your request in writing to our privacy contact person identified on the first page of this page of this notice. In your request, you must tell us what information you want to limit and to whom you want the limits to apply.

Right to receive confidential communication: You have the right to request that we communicate with you about health matters in a certain way. For example, you can ask that we only contact you at work or by mail to specified address.

To request we communicate with you in a certain way, you must make your request in writing to our privacy contact person identified on the first page of this notice. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.

Right to notification: you have the right to notify this center if your personal health information has been breach.

Right to be notified of a breach of unsecured PHI (Protected Health Information)

Right to restrict for Out-of-pocket care: you have the right to restrict information from being sent to our accessed by Medicare or your private insurance health plan if you pay your bill out of pocket and in full for services rendered. This rule does not apply to Medicaid patients.

Right to paper copy of this notice: you have the right to receive a paper copy of this notice at any time. To receive a copy, please request it from our privacy contact person identified on the first page of this notice. You may also obtain a copy of this notice at our website: www.casaincct.org

Changes to this notice: we reserve the right to change this notice and to make the changed notice effective for all of the health information that we maintain about you, whether it is information that we previously received about you or information we may receive about you in the future. Our notice will indicate the effective date on the last page. We will also give you a copy of our current notice upon request.

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. You may file a complaint by mailing us a written description of your complaint or by telling us about your complaint in person or over the telephone.

Director of Health Information/Privacy officer: 203-331-4728

Chemical Abuse Services Agency, Inc. 1124 Iranistan Ave. Bridgeport CT 06605

Please describe what happened and give us the dates and names of anyone involved. Please also let us know how to contact you so that we can response to your complaint. You will not be penalized for filing a complaint.

Other uses and disclosures of your protected health information

Other uses and disclosures of personal health information not covered by this notice or applicable law will be made only with your written authorization if you give us your written authorization to use or disclose your personal health information, you may revoke your authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your personal health information for the reasons covered by your written authorization. You understand that we are unable to take back any uses and disclosures that we have already made with your authorization, and that we are required to retain our records of the care we provide to you.

 

Effective Date 10/18/2016 Rev. _____