NOTICE OF PRIVACY PRACTICES
THE CENTER FOR AUTISM TREATMENT, INC.
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.
In this document, “we” refers to The Center for Autism Treatment, Inc., also referred to as “The Center.” “You” or “yours” refers to individual patients of The Center. We are required by federal law to protect the privacy of your individual health information (referred to in this notice as “Protected Health Information”). We are also required to provide you with this notice regarding our legal duties and privacy practices with respect to your protected health information, and to abide by the terms of this notice, as it may be updated from time to time.
The Center receives and maintains Protected Health Information about you in the course of providing services to you. The Center also hires business associates to help it provide these benefits to you. These business associates may receive and maintain Protected Health Information about you in the course of assisting The Center.
THE EFFECTIVE DATE OF THIS NOTICE IS APRIL 25, 2016. This Notice replaces any previous notice of privacy practices issued by The Center. The Center is required to follow the terms of this notice until it is replaced. The Center reserves the right to change the terms of this notice at any time. If The Center makes changes to this notice, The Center will revise it and make the new notice available to all patients of The Center at that time. The Center reserves the right to make the new changes apply to all Protected Health Information about you maintained by The Center before and after the effective date of the new notice.
Purposes for which The Center May Use or Disclose Medical Information About You Without Your Consent or Authorization
The Center may use and disclose Protected Health Information about you for the following purposes:
· To Provide Treatment. We may use or disclose your Protected Health Information to provide or assist with treatment or services rendered on your behalf. For example, The Center may disclose Protected Health Information about you to your doctor, at the doctor’s request, for your treatment.
· Payment. We may use or disclose your Protected Health Information to other parties involved in paying for your treatment or care For example, The Center may use or disclose Protected Health Information about you to an insurance representative in order to authorize payment for services.
· Health Care Operations. We may use and disclose your Protected Health Information for other operations that may be necessary to maintain or operate The Center. For example, The Center may use or disclose Protected Health Information about you for quality assessment and improvement activities, licensing, audit, and accreditation purposes.
· As Required By Law. We will use and disclose your Protected Health Information when required by federal, state or local law. For example, The Center will disclose your Protected Health Information pursuant to a court order or subpoena.
· To Business Associates. The Center may disclose Protected Health Information about you to third parties (called business associates) that The Center hires for assistance. Each business associate of The Center must agree in writing to ensure the continuing confidentiality and security of Protected Health Information about you in conformance with the Health Insurance and Portability Accountability Act of 1996 and its implementing regulations (“HIPAA”).
The Center may also use and disclose Protected Health Information as follows:
· To avert a serious threat to your health or safety or the health or safety of others.
· To comply with legal proceedings, such as a court or administrative order, subpoena, warrant, summons or request under certain circumstances.
· To law enforcement officials for certain law enforcement purposes:
o to identify or locate a suspect, fugitive, material witness or missing person, provided that the Protected Health Information is limited in nature;
o in response to a request about an individual who is or is suspected to be a victim of a crime if we are unable to obtain the individual’s agreement under certain circumstances; and
o in the event we believe that a crime occurred on our premises.
· To public health authorities or other appropriate government authorities authorized by law to collect or receive such information for public health purposes or activities.
· To a government authority if The Center reasonably believes an individual is a victim of abuse, neglect or domestic violence.
· To a governmental agency authorized to oversee the health care system or government programs.
· To a coroner, medical examiner, or funeral director about a deceased person.
· To your personal representatives appointed by you or designated by applicable law.
· For research purposes, as long as certain privacy-related standards are satisfied in conformance with HIPAA.
· To an organ procurement organization in limited circumstances.
· For specialized government functions (e.g., military and veterans activities, national security and intelligence, federal protective services, medical suitability determinations, correctional institutions and other law enforcement custodial situations).
· We may disclose to one of your family members, to a relative, to a close personal friend, or to any other person identified by you, Protected Health Information that is directly relevant to the person’s involvement with your care or payment related to your care. In addition, we may use or disclose the Protected Health Information to notify a member of your family, your personal representative, another person responsible for your care, or certain disaster relief agencies of your location, general condition, or death. If you are incapacitated, there is an emergency, or you otherwise do not have the opportunity to agree to or object to this use or disclosure, we will do what in our judgment is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your health care.
Authorizations: Uses and Disclosures with Your Permission
The Center will not use or disclose Protected Health Information about you for any other purposes other than stated above or as otherwise required by law unless you give The Center your written authorization to do so. If you give The Center written authorization to use or disclose Protected Health Information about you for a purpose that is not described in this notice, then, you may revoke it in writing at any time.
Your revocation will be effective for all Protected Health Information about you The Center maintains, except for information The Center has already released based on your authorization.
You may make a written request to The Center to do one or more of the following concerning Protected Health Information about you that The Center maintains:
· To request additional restrictions on The Center’s use and disclosure of your Protected Health Information. While we will respectfully consider your request, there may be times when we are not required to agree to your request. However, we will comply with any restriction request if the disclosure is to a health plan for purposes of payment or health care operations, is not otherwise required by law, and the Protected Health Information pertains solely to an item or service for which The Center has been paid in full. If you wish to request such a restriction, please fill out our Restriction on Disclosures Form.
· To receive confidential communications of your Protected Health Information. You also have the right to access certain health information from your Electronic Health Record, to the extent that The Center maintains such a record. You have a right to receive a copy of that information in an electronic format and to tell us to send a copy of that information directly to a person or organization that you designate. However, this information will not include psychotherapy notes, information related to a legal proceeding and information related to the Clinical Laboratory Improvements Amendments of 1988. If you wish to access and receive a copy of your health information from your Electronic Health Record, you must provide us with clear and specific directions on our Electronic Health Record Request Form. We may impose a fee to cover our labor costs in responding to your request for electronic copies of your health information.
· To request confidential communications of your Protected Health Information from The Center by alternative means or at a different location than The Center is currently doing. Your request must specify the alternative means or location.
· To inspect and obtain a copy of Protected Health Information about you that is maintained in a designated record set. In limited cases, The Center does not have to agree to your request. There may be a reasonable fee to cover expenses associated with your request
· To amend Protected Health Information about you that is retained in a designated record set if you believe that your Protected Health Information is incorrect or incomplete. The Center may deny your request for amendment if the Protected Health Information or record was not created by The Center or is not part of the designated record set..
· To receive a list of disclosures of Protected Health Information about you that The Center and its business associates made for certain purposes for the last 6 years. Please note, however, that certain disclosures may not be included in such an accounting, such as disclosures made for treatment, payment or health care operation purposes or disclosures that are incidental.
· To receive an electronic copy of this notice. You also have the right to receive a paper copy of this notice at any time even if you agreed to receive the notice electronically.
· You have the right to be notified in the event that we or one of our contractors discover a breach in the privacy of your health information that has not been secured. We will notify you of any such breach in accordance with federal requirements.
If you want to exercise any of these rights described in this notice, please contact the Privacy Office at the location indicated below. The Center will give you the necessary information and forms for you to complete and return to us.
You have the right to opt-out of receiving any communications from The Center or its affiliates regarding fundraising for The Center. If you choose to opt-out of receiving such communications, we ask that you fill out our Fundraising Opt-Out Form and give or send the form to:
The Center for Autism Treatment, Inc
1496 W. Mequon Road
Mequon, WI 53092
We will keep your request on file. You may choose to change your decision at any time.
If you believe your privacy rights have been violated, you may complain to us in writing by contacting the Privacy Officer at the location indicated below under “Contacting Us” or to the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.
To request additional copies of this notice or to receive more information about our privacy practices or your rights, please contact our Privacy Officer at:
The Center for Autism Treatment, Inc
Attn: Privacy Officer
1496 W. Mequon Road
Mequon, WI 53092
Use and disclosure of Protected Health Information by The Center is regulated, in part, by a federal law known as HIPAA. You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. This Notice attempts to summarize the Privacy Standards. The Privacy Standards will supersede any discrepancy between the information in this Notice and the Privacy Standards.