NOTICE OF PRIVACY PRACTICES
Isaiah House, Inc.
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION
PLEASE REVIEW IT CAREFULLY
Responsibilities of Isaiah House, Inc.: Isaiah House, Inc. is required by state and federal law to protect the privacy of your health information that may identify you. This health information includes mental health, developmental disability and/or substance abuse services that are provided to you, payment for those health care services, and/or health care operations provided on your behalf. This agency is required by law to inform you of our legal duties and privacy practices with respect to your health information through this Notice of Privacy Practices. This Notice describes the ways we may share your past, present and future health information, ensuring that we use and/or disclose this information only as we have described in this Notice. We do, however, reserve the right to change our privacy practices and the terms of this Notice, and to make the new Notice provisions effective for all health information we maintain. Any changes to this Notice will be posted in our agency offices. Copies to any revised Notices will be available to you upon request. If at any time you have questions or concerns about the information in this Notice or about our agency’s privacy policies, procedures, and/or practices, you may contact our agency Privacy Officer at 859-375-9200. Use and Disclosure of Health Information without Your Authorization Treatment Isaiah House, Inc. may use your health information, as needed, in order to provide, coordinate or manage your health care and related services. This includes sharing your health information with other health care providers within this agency. Example: Your treatment/habilitation team, composed of staff such as doctors, nurses, and social workers will need to review your treatment and discuss plans for your discharge. We will disclose your health information outside of this agency only with your consent or when otherwise allowed under state or federal law. If you request treatment and rehabilitation for drug dependence, your request will be treated as confidential. We will not refer you to another person for treatment and rehabilitation without your authorization. Example: We may share your health information with a health care provider for emergency services. Payment for Services The treatment provided to you will be shared with our agency’s billing department so a bill can be prepared for services rendered. We may also share your health information with agency staff who review services provided to you to make certain you have received appropriate care and treatment. We will not disclose your health information outside of this agency for billing purposes (i.e., bill your insurance company) without your consent. Example: Our billing department will collect insurance and other financial information for you at the time of admission. Health Care Options Isaiah House, Inc. may use or disclose your health information in performing a variety of business activities that we call “health care operations”. Some examples of how we may use or disclose your health information for health care operations are: Other Circumstances Isaiah House, Inc. may disclose your health information for those circumstances that have been determined to be so important that your authorization may not be required. Prior to disclosing your health information, we will evaluate each request to ensure that only necessary information will be disclosed. Those circumstances include disclosures that are: Disclosure of Your Health Information That Allows You An Opportunity to Object There are certain circumstances where we may disclose your health information and you have an opportunity to object. Such circumstances include: Example: We may share your health information with the American Red Cross following a major disaster such as a flood or tornado. If you would like to object to our disclosure about your health information in an emergency situation such as those examples listed above, please contact our agency Privacy Officer, or designee, listed in this Notice for consideration of your objection. Disclosure of Your Health Information That Requires Your Authorization Isaiah House, Inc., will not disclose your health information without your authorization except as allowed or required by state or federal law. For all other disclosures, we will ask you to sign a written authorization that allows us to share or request your health information. Before you sign an authorization, you will be fully informed of the exact information you are authorizing to be disclosed/requested and to/from whom the information will be disclosed/requested. You may request that your authorization be revoked by informing our agency Privacy Officer, or designee, that you do not want any additional health information about you exchanged with a particular person/agency. You will be asked to sign and date the Authorization Revocation section of your original authorization. Your authorization will then be considered invalid at that point in time; however, any actions that were taken on the authorization prior to the time you revoked your authorization are legal and binding. Your Rights Regarding Your Health Information You have the following rights regarding your health information as created and maintained by this agency. Right to receive a copy of this Notice You have the right to receive a copy of Isaiah House, Inc. Notice of Privacy Practices. At your first treatment encounter with this agency, you will be given a copy of this Notice and asked to sign an acknowledgment that you have received it. In the event of emergency services, you will be provided the Notice as soon as possible after emergency services have been provided. In addition, copies of this Notice have been posted in several public areas throughout this agency. You have the right to request a paper copy of this Notice at any time from our agency Admissions Officer or our agency Privacy Officer, or designee. Right to request different ways to communicate with you You have the right to request to be contacted at a different location or by a different method. For example, you may request all written information from this agency be sent to your work address rather than your home address. We will agree with your request as long as it is reasonable to do so; however, your request must be made in writing and forwarded to our agency Privacy Officer, or designee. Right to request to see and copy your health information Whether you are an incompetent adult or competent adult contained in the designated record set, you have the right to request to see and receive a copy of your health information that is used to make decisions about you. Your request must be in writing and forward to our agency Privacy Officer, or designee. You can expect a response to your request within thirty (30) days. If your request is approved, you may be charged a fee to cover the copy of the information. Instead of providing you with a full copy of your health information record, we may give you a summary or explanation of your health information, if you agree in advance to that format and to the cost of preparing such information. Your request may be denied by your physician or a professional designated by our agency director under certain circumstances. If we do deny your request, we will explain our reason for doing so in writing and describe the rights you may have to request a review of our denial. In addition, you have the right to contact our Privacy Officer, or designee, to request a copy of your health information be sent to a physician or psychiatrist of your choice. Whenever you have a personal representative who consented to your treatment, the personal representative has the same rights to request to see and copy your health information. Right to request amendment of your health information You have the right to request changes in your health information contained in the designated record set used to make decisions about you. If you believe that we have information that is either inaccurate or incomplete, you may submit a request in writing to our agency Privacy Officer, or designee, and explain your reasons for the amendment. We must respond to your request within thirty (30) days of receiving your request. If we accept your request to change your health information, we will add your amendment but will not destroy the original record. In addition, we will make reasonable efforts to inform others of the changes, including persons you name who have received your health information and who need the changes. We may deny your request if: If we deny your request to change your health information, we will explain to you in writing the reasons for denial and describe your rights to give us a written statement disagreeing with the denial. If you provide a written statement, the statement will become a permanent part of your record. Whenever disclosures are made of the information in question, your written statement will be disclosed as well. Right to request a listing of disclosures we have made You have a right to a written list of disclosures of your health information. The list will be maintained for at least six years for any disclosures made after August 1, 2013. This listing will include the date of the disclosures, the name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed and the purpose of the disclosure. This agency is not required to include the following on the Disclosure Log: Your first request for a listing of the disclosures will be provided to you free of charge. However, if you request a listing of disclosures more than once in a twelve (12) month period, you shall be charged a customary fee. We will inform you of the cost involved and you may choose to withdraw or modify your request at that time, before any costs are incurred. Right to request restrictions on uses and disclosures of your health information You have the right to request that we limit our use and disclosure of your health information for treatment, payment and health care operations. You also have the right to request a limit on the health information we disclose about you to your next of kin or someone who is involved in your care. (Example: you may ask that we not disclose information about your family history of heart disease.) We will provide you with a form to document your request. We will make every attempt to honor your request but are not required to agree to such a request. However, if we do agree, we must follow the agreed upon restriction (unless the information is necessary for emergency treatment or unless it is disclosure to the U.S. Secretary of the Department of Health and Human Services.) You may cancel the restrictions at any time and we will ask that your request be in writing. In addition, this agency may cancel a restriction at any time, as long as we notify you of the cancellation. Violations/Complaints Violation of the Federal law and regulations relative to a substance abuse program is a crime. Suspected violations may be reported to our agency Privacy Officer, or designee, who will report the violation to appropriate authorities in accordance with Federal regulations. If you believe we have violated your privacy rights, or if you want to file a complaint regarding our privacy practices, you may contact our agency Privacy Officer, or designee. Contact information is as follows: Isaiah House, Inc. Privacy Officer Willisburg, KY 40078 Agency Phone Number: 859-375-9200 Agency Fax Number: 859-375-9202 Kentucky Department of Health and Human Services 1500 Leestown Rd You may also send a written complaint to the United States Secretary of the Department of Health and Human Services. Contact information is as follows: 200 Independence Ave SW Washington, DC 20201 If you file a complaint, we will not take any action against you or change the quality of health care services we provide to you in any way. Legal References Primary Federal and State laws and regulations that protect the privacy of your health information are listed below. Confidentiality of Alcohol and Drug Abuse Patient Records – 42 U. S. C 20dd-3 and 42 U. S. C. 20cc-3 for Federal laws and 42 CFR Part 2 for Federal Regulations. Health Insurance Portability and Accountability Act (HIPAA), Administrative Simplification, Privacy of Individually Identifiable Health Information – 42 U.S.C. 1320d-1329d-8 and 42 U.S.C. 1320d-2 (note) for Federal laws and 445 CFR Parts 160 and 164 for Federal regulations. Receipt for Notice of Privacy Practices Substance Abuse Rehabilitation Programs The Isaiah House, Inc. Notice of Privacy Practices 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. Isaiah House, Inc. is federally mandated to maintain the privacy of your medical information and wants you to know about our practices for protecting your Protected Health Information (PHI). Isaiah House, Inc. is required to abide by the terms of the Notice of Privacy Practices. Authorized Uses and Disclosures: In general, it is our policy to obtain written authorization for release of information prior to making a disclosure. You may revoke an authorization at any time. Non-Authorized Uses and Disclosures: Under certain conditions we may make disclosure of your medial information without your authorization. These conditions are listed on the Notice of Privacy Practices. What are your rights? You have the right to: How You Can Ask A Question, Learn More or Report a Problem? Isaiah House, Inc., urges you to read the complete Isaiah House, Inc. Notice of Privacy Practices. The Isaiah House, Inc. Privacy Officer at 859-375-9200, The Kentucky Department of Health and Human Services at 859-233-2543, or the U. S. Department of Health and Human Services at 202-601-7000 are ready to assist you. There will be no retaliation for filing a complaint.
Privacy Practices
Lexington, KY
(859) 233-2543
(202) 690-7000