NSIGHT PSYCHOLOGY & ADDICTION
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 READ IT CAREFULLY AND ASK ABOUT ANYTHING YOU DO NOT UNDERSTAND.
OUR COMMITMENT TO YOU
We at NSIGHT understand that information we collect about you and your health is personal. Keeping your health information confidential and secure is one of our most important responsibilities. We are committed to protecting your health information and abiding by all state and federal laws regarding the protection of your health information. This notice tells you how we may use or release your health information. It also tells you about your rights and the federal and state requirements concerning the use and disclosure of your health information.
YOUR HEALTH INFORMATION RIGHTS
You have the following rights regarding the health information that NSIGHT has about you:
Right to Inspect and Copy: You have the right to inspect and obtain a copy of your health information. This request may include your medical, billing, or health care payment information. It does not include information that is needed for civil, criminal or administrative actions or proceedings, or psychotherapy notes. We may charge a fee for the costs of copying, mailing or other supplies associated with your request. If you want to request a copy of your records, you may ask a member of our staff or our Privacy Coordinator for a Client Access to Records Request form. The form will include instructions about the processes, fees, and timeframes for requesting copies. In certain situations we may deny your request and will tell you why we are denying it. In some cases you may have the right to ask for a review of our denial.
Right to Amend: If you feel that the health information NSIGHT has created about you is incorrect or incomplete, you may ask us to amend that information. NSIGHT may deny your request if you ask to amend information that: 1) was not created by NSIGHT; 2) is not part of the health information NSIGHT maintains; 3) is not part of the information which you would be permitted to inspect or copy; or 4) the information is determined to be accurate and complete. If you wish to request an amendment of the information created by NSIGHT, you can obtain a Request for Amendment of Medical Records form from your therapist, case coordinator or our Privacy Coordinator. This form will contain instructions for completing the form and an explanation of the process NSIGHT will follow to approve or deny your request for amendment.
Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your medical record we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.
Right to Accounting of Health Information Releases: You have the right to request a list of information releases that NSIGHT has made of your health information. The list will include an accounting of releases of your health information we have made without your express authorization, if any, and may include disclosures such as:
- Reporting disease or injury to a public health official (other than staff employed for public health functions).
- Responding to mandatory child or elder abuse reporting laws to an entity authorized by law to receive the abuse report (other than protective services staff who respond to such reports).
- Information from your record in response to an audit or review of a provider or contractor (whether financial, quality of care, or other audit or review).
- Information from your records in relation to licensing or regulation or certification of a provider or licensee or entity involved in the care or services of the individual.
- Information about an individual that is ordered to be disclosed pursuant to a court order in a court case or other legal proceedings.
- Information about an individual provided to law enforcement officials pursuant to a court order.
- Information about an individual provided by an entity’s staff to avert a serious threat to health or safety of a person.
The list will not include: 1) health information releases made for purposed of providing treatment to you, obtaining payment for services or releases made for administrative or operational purposes; 2) health information releases made for national security; 3) health information releases made to correctional institutions and other law enforcement custodial situations; 4) health information releases NSIGHT has made based on your written authorization; 5) health information releases to persons who are involved in your care; or 6) health information releases made prior to April 14th, 2003.
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. 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.
Right to Request Restrictions: You have the right to request that we communicate with you about health care matters in a certain way, or at a certain location. For example, you can request that we only contact you at work, or at home, or by mail. NSIGHT will accommodate all reasonable requests, but we are not required to agree to all requests for restrictions. To request restrictions to communications, you must specify how or where you wish to be contacted. You can get a copy of the Request for Restricted Communications form from your therapist or case coordinator, by contacting our Privacy Coordinator, or from the NSIGHT website.
You have the right to request a restriction or limitation on the health 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 health 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. Please note that we are not required to agree to your request. If we do agree, we will honor your limits unless it is an emergency situation. To request restrictions, you must make your request in writing to the NSIGHT Executive Director or Compliance Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to a Paper Copy of this Notice: You have the right to request a paper copy of this notice from NSIGHT at any time.
All requests of inspecting, copying, amending, making restrictions, or obtaining an accounting of your health information must be made in writing to:
Executive Director- NSIGHT
4000 Birch Street, Suite 112
Newport Beach, California 92660
Please call (888) 256-2201 to request the appropriate forms, or you may request one of the appropriate forms from your therapist or case coordinator. Once the Privacy Coordinator receives your request, he or she must respond within ten (10) business days acknowledging that the Privacy Coordinator has received your request, and is acting on it. The Privacy Coordinator is not required to have completed all actions on your request at that time.
HOW NSIGHT USES AND RELEASES HEALTH CARE INFORMATION
NSIGHT may use and release your health information, without your permission, for the purposes of providing treatment, obtaining payment for services, for administrative and operational purposes, and to evaluate the quality of services that you receive. In addition, your health information may be shared among various entities that are legally separate but are owned or controlled by NSIGHT for purposes of treatment, payment or health care operations. NSIGHT provides a wide range and variety of health care and social services to the people of Orange, Los Angeles, and San Diego counties. For this reason, not all types of uses and releases can be described in this document. We have listed some common examples of permitted uses and releases below.
For Treatment: Caregivers, such as nurses, doctors, therapists, social workers, and case managers, may use your health information to determine your plan of care. Individuals and programs within NSIGHT and the county programs with which they operate may share health information about you in order to coordinate the services you may need, such as clinical examinations, therapy, nutritional services, medications, hospitalization, or follow-up care. We may also use your health information to determine if your treatment is medically necessary or to ensure that proper treatment is being given.
For Payment: NSIGHT may release information about you to your health plan or health insurance carrier to obtain payment for services. For example, we may need to give your health plan information about a mental health assessment, treatment services, prescribed psychotropic medications, and case management services that you or your child received so your health plan will pay us or reimburse us for treatment or services provided NSIGHT provided. We may also share your information, when appropriate, with other government programs in order to coordinate your benefits and payments. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval, or to determine whether your plan will cover the treatment.
For Operations: NSIGHT may use and release information about you to ensure that the services and benefits provided to you are appropriate and are of high quality. For example, we may use your information to evaluate our treatment and service programs, or to evaluate the services of other providers that use government funds to provide health care services to you. We may combine health information about many individuals to research health trends, to determine which services and programs should be offered, or whether new treatment or services are useful. Our program may share your prescription information with your pharmacist so that he or she can ensure that you are receiving the proper type and dosage and that you medicines will not interact with each other. We may share your health information with business associates who perform functions on behalf of NSIGHT. For example, our business associates may use your information to perform case management, coordination of care, or other assessment activities. NSIGHT requires that our business partners abide by the same level of confidentiality and security as we do when handling your health information.
To Other Government Agencies Providing Benefits or Services: NSIGHT may release your health information to other government agencies that are providing you with benefits of services when the information is necessary for you to receive those benefits and services.
To Keep You Informed: NSIGHT may contact you about reminders for treatment, medical care or health check-ups. We may also contact you to tell you about health related benefits, programs or services that may be of interest to you, or to give you information about your treatment choices.
For Public Health: NSIGHT may release your health information to public health agencies, subject to the provisions of applicable state and federal law, for the following kinds of activities:
- To prevent or control disease, injury or disability, or to keep vital statistics records such as births or deaths;
- To notify social service agencies that are authorized by law to receive reports of child or elder abuse, fiduciary abuse, physical abuse or neglect, or domestic violence;
- To report reactions to medications or problems with products to the Food and Drug Administration (FDA).
For Health Oversight Activities: NSIGHT may share your health information with other divisions within the agency and with other agencies for oversight activities as required by law. Examples of these oversight activities include audits, inspections, investigations and licensure.
For Law Enforcement: NSIGHT may release health information to a law enforcement official, subject to applicable federal and state laws and regulations, for purposes that are required by law or in response to a court order or subpoena.
For Research: NSIGHT may release your non-identifiable health information for research projects that have been reviewed and approved by an institutional review board or privacy board to ensure the continued privacy and protection of the health information.
For Lawsuits and Disputes: NSIGHT may release health information about you in response to a court or administrative order, if you are involved in a lawsuit or a dispute. We may also release health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only in accordance with state law.
To Coroners, Medical Examiners and Funeral Directors: NSIGHT may release health information under subpoena and under the review of a judge, to a coroner, medical examiner or funeral director, as necessary to carry out duties required by law.
For Organ Donations: HIPAA allows providers to release protected health information to organizations for organ donation activities. However, state law and NSIGHT policy do not allow for such release without your permission.
To Avert a Serious Threat to Health or Safety: NSIGHT may release your health information if it is necessary to prevent a serious threat to your health or safety, or to the health and safety of the public or another person.
For National Security and Protection of the President: NSIGHT may release your health information to an authorized federal official or other authorized persons for the purposes of national security, for providing protection to the President, or to conduct special investigations, as authorized by law.
To a Correctional Institution: NSIGHT may release your health information, if you are an inmate or a correctional institution, including juvenile halls, or under the custody of a law enforcement officer, to the correctional institution or law enforcement officer. The information released must be necessary for the institution to provide you with health care, protect your health and safety of the health and safety of others, or for the safety and security of the correctional institution.
To the Military: NSIGHT may release your personal health information, if you are a veteran or a current member of the armed forces, as required by military command or veteran administration authorities.
NSIGHT is required by state and federal law to maintain the privacy of your health information. We are required to give you this notice of our legal duties and privacy practices with respect to the health information that NSIGHT collects and maintains about you. We are required to follow the terms of this notice.
This notice describes and gives some examples of the permitted ways that your health information may be used or released. Release of your information outside of the boundaries of NSIGHT-related treatment, payment or operations, or as otherwise permitted by state or federal law, will be made only with your specific written authorization. You may revoke specific authorizations to release your information, in writing, at any time. To revoke an authorization you previously gave NSIGHT, contact your therapist or case coordinator to obtain and complete the “Revocation of Authorization for Release of Consumer Identification” form. If you revoke an authorization, we will no longer release your health information to the authorized recipient(s), except to the extent that NSIGHT has already used or released that information in reliance of the original authorization.
NSIGHT reserves the right to revise this notice. We reserve the right to make the revised notice effective for the health information we already have about you, as well as any information we create or receive in the future. If you are enrolled in a health plan, such as Medicaid, MediCal, EPSDT, or Healthy Families, we will provide you with a copy of the revised notice within sixty (60) days from the date it becomes effective. We will post a copy of the current notice at NSIGHT treatment sites, and on our website at www.aspencommunityservices.org. In addition, you may ask for a copy of our current notice of privacy practices anytime you visit an NSIGHT facility for treatment or other services.
You may request an oral translation of this notice into your preferred language. When possible, a written translation will be provided. If the request cannot be accommodated immediately, please contact the Privacy Coordinator at the address below to arrange for a translation or other materials.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
To obtain more information about NSIGHT’s privacy practices, to receive additional copies of this notice, or to receive request forms to access or amend your health information, please contact: Executive Director, NSIGHT, 4000 Birch Street, Suite 112, Newport Beach, California 92660.
If you believe your privacy rights have been violated, you may file a complaint with any or all of the agencies listed below. There will be no penalty or retaliation against you for filing a complaint. You may obtain a complaint form by calling the number listed below, or by asking our staff for a Privacy Complaint Form.
Executive Director- NSIGHT
4000 Birch Street, Suite 112
Newport Beach, California 92660