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 of Privacy Practices describes the privacy practices of Turnbridge Clinical Services (the “Facility”). The Facility must comply with certain privacy and security requirements and must follow this notice when providing services to you. If you have questions about this notice please contact us at (203) 937-2309.
OUR PLEDGE REGARDING MEDICAL INFORMATION.
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to:
- Make sure that medical information that identifies you is kept private in accordance with the law;
- Notify you of a breach of your unsecured protected health information;
- Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the notice that is currently in effect.
We must also obtain your written authorization before using your health information or sharing it with others for:
- Marketing. We may not disclose any of your health information for marketing purposes if we will receive direct or indirect financial remuneration not reasonably related to our cost of making the communication, without your written authorization.
- Sale of Health Information. We will not sell your health information to third parties without your written authorization. The sale of health information, however, does not include a disclosure for public health purposes, for research purposes where we will only receive remuneration for our costs to prepare and transmit the health information, for treatment and payment purposes, for the sale, transfer, merger or consolidation of all or part of the Facility, for a business associate or its subcontractor to perform health care functions on our behalf, or for other purposes as required and permitted by law.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
- For Treatment. We may use medical information about you to provide you with medical treatment or services and to coordinate your continuing care. We may disclose medical information about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you. For example, we may share medical information about you in order to coordinate the different things you need, such as prescriptions.
- For Payment. We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about treatment you received so your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
- For Health Care Operations. We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run our facility and to make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.
- Authorizations. We may disclose your medical information pursuant to an authorization signed by you or your authorized representative. If you would like to revoke the authorization, please contact us at (203) 937-2309. or send a written notice of revocation to the address listed below.
- Business Associates. We may disclose medical information to a contractor (called “business associates”) that needs the information to perform services for us. All business associates are required to sign a written agreement to keep this information confidential.
- Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment.
- Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
- Future Communications. We may communicate to you via newsletters, mail outs, or other means regarding treatment options, health related information, disease management programs, wellness programs, or other community based initiatives or activities we are participating in.
- Individuals Involved in Your Care or Payment for Your Care. Unless you object or request a restriction, we may release medical information about you to a friend or family member who is involved in your medical care or payment for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
- As Required By Law. We will disclose medical information about you when required to do so by federal, state, or local law.
- To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
- Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. All research projects, however, are subject to a special approval process. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave our facility.
- Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
- Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
- Workers’ Compensation. We may release medical information about you to comply with workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Law Enforcement. We may release medical information if asked to do so by a law enforcement official in certain situations, including but not limited to: (i) in response to a court order, authorized subpoena, warrant, summons or similar process; (ii) to identify or locate a suspect, fugitive, material witness, or missing person; and (iii) about criminal conduct at the Facility.
- Public Health Risks. We may disclose medical information about you for public health activities. These activities include, but are not limited to: (i) preventing or controlling disease, injury or disability; (ii) reporting child abuse or neglect; and (iii) notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, 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.
- National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
- Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors as necessary to carry out their duties.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (i) for the institution to provide you with health care, (ii) to protect your health and safety or the health and safety of others, or (iii) for the safety and security of the correctional institution.
For disclosures concerning health information relating to care for psychiatric conditions, certain substance abuse treatment, or HIV-related testing or treatment, special restrictions may apply. For example, we generally may not disclose this specially protected information in response to a subpoena, warrant or other legal process unless you sign a special authorization or a court orders the disclosure.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we maintain about you:
- Right to Access, Inspect and Copy. You have the right to access, inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. You also have the right to obtain an electronic copy of any such information that we maintain in electronic format. To access, inspect, and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Facility. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to access, inspect and copy in certain very limited circumstances.
- Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, your request must be made in writing and submitted to the Facility. In addition, you must provide a reason that supports your request. We may deny your request for an amendment for certain reasons. If a request is denied, we will provide a written statement of the reasons for the denial, and you have a right to submit a statement disagreeing with that decision.
- Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you. Disclosures for treatment, payment, healthcare operations and according to authorizations you gave us to release your information are not included in this listing. To request this list or accounting of disclosures, you must submit your request in writing to the Facility. Your request must state a time period that may not be longer than six years from today. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. You may require a restriction on disclosure of your medical information to a health plan (other than Medicare or other federal health care program that requires us to submit information) for purposes of payment or other health care operations (but not treatment) if you paid out of pocket, in full, for the item or service to which the medical information pertains. Otherwise, we are not required to agree to your request.
- Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request in writing to the Facility. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to Request Transmission of Your Medical Information in Electronic Format. You may direct us to transmit an electronic copy of your medical information that we maintain in electronic format (if any) to an individual or entity you designate. To request the transmission of your electronic medical information, you must submit the request in writing to the Facility.
- Right to a Paper Copy of This Notice. To obtain a paper copy of this notice, please contact us. You may ask us to give you a copy of this notice at any time. You may also obtain a copy of this notice at the Facility’s website, www.turnbridge.com.
CHANGES TO THIS NOTICE.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the Facility. The notice will contain on each page, in the top right-hand corner, the effective date. Should our notice be revised, we will also post the revised notice on our website.
If you believe your privacy rights have been violated, you may file a complaint by contacting us at the number listed below. You may also file a complaint with the Office for Civil Rights of the U.S. Department of Health and Human Services. We can provide you with the correct address. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION.
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
Turnbridge Clinical Services
189 Orange Street
New Haven, CT 06510