Notice of Privacy Practices
This notice describes how medical and drug and alcohol related information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 U.S.C. Sec. 1320d et seq., 45 C.F.R. Parts 160 and 164, and the Confidentiality Law, 42 U.S.C. Sec. 290 dd-2, 42 C.F.R. Part 2. Under these laws, Mountainside may not say to a person outside Mountainside that you attend the program, nor may Mountainside disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
Mountainside must obtain your written consent before it can disclose information about you for payment purposes. For example, Mountainside may obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before Mountainside can share information for treatment purposes or for your health care operations. However, federal law permits Mountainside to disclose information without your written consent:
- Pursuant to an agreement with a qualified service organization/business associate;
- To report a crime committed on Mountainside’s premises or against Mountainside’s personnel;
- To medical personnel in a medical emergency;
- To appropriate authorities to report suspected child abuse or neglect;
- As allowed by court order.
Before Mountainside can use or disclose any information about your health in a manner which is not described above, it must first obtain your specific written consent allowing it to make the disclosure. Any such written consent may be revoked by you in writing.
Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. Mountainside is not required to agree to any restrictions you request, but if it does agree then it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency.
Under HIPAA you have the right to inspect and copy your own health information obtained by Mountainside except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal, administrative proceeding or in other limited circumstances.
Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in Mountainside’s records, and to request and receive and accounting of disclosures of your health related information made by Mountainside during the six years prior to your request. You also have the right to receive a paper copy of this notice.
Mountainside is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. Mountainside is required by law to abide by the terms of this notice. Mountainside reserves the right to change the terms of this notice and to make new notice provisions effective for all protected information it maintains. All requests should be made in writing to the contact listed as the bottom of this notice.
Complaints and Reporting Violations
You may complain to Mountainside and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. You may complain to us in writing using the information listed in this form. At your request we will also provide you with the address of the US Department of Health and Human Services. We support your right to the privacy of your health information. You will not be retaliated against for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurred.
For further information, contact:
Mountainside Privacy Officer
187 Route 7, Box 717
Canaan, CT 06018