EAST COAST SOLUTIONS

This Notice is effective on April 14, 2003 (Revised 1/23/06)

 

THIS NOTICE DESCRIBES HOW HEALTH CARE INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

 

                        

 

 

                                                                       

           

WE ARE REQUIRED BY LAW
TO PROTECT HEALTH CARE INFORMATION
ABOUT YOU.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    

We are required by law to protect the privacy of health care information about you and that identifies you.  This may be information about health care services that we provide to you or payment for health care provided to you.  It may also be information about your past, present, or future health care condition.

We are also required by law to provide you with this Privacy Notice explaining our legal duties and privacy practices with respect to health care information.  We are legally bound to follow the terms of this Notice.  In other words, we are only allowed to use and disclose health care information in the manner that we have described in this Notice. 

We may change the terms of this Notice in the future.  We reserve the right to make changes and to make the new Notice effective for all health care information that we maintain.  If we make changes to the Notice, we will:

  • Post the new Notice in our waiting area
  • Have copies of the new Notice available upon request
  • Post the new Notice on our website located at www.eastcoastsolutions.org

Understanding Your Health Record and Information

Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnosis, treatment and a plan for future care or treatment.  This information which is often referred to as your health or medical record, serves as a basis for planning your care as well as a legal document describing the care you received.

Authorization

As a general rule, East Coast Solutions (ECS) will not disclose healthcare information about you outside our organization without authorization (signed permission) from you or your legally responsible person/personal representative unless otherwise permitted/required by state and federal confidentiality/privacy laws.  If you sign an authorization allowing us to disclose healthcare information about you, you may later revoke or cancel it (except in very limited circumstances related to insurance coverage).  If you would like to revoke your authorization, you may do so in writing by filling out a revocation form.  You may obtain these forms from the receptionist at ECS or your primary counselor.  When an authorization is revoked, ECS will follow your instructions except to the extent that we have already relied upon your authorization and taken some action.

 

 

USES/DISCLOSURES RELATING TO SUBSTANCE ABUSE:

Federal law, 42 CFR Part 2, restricts the use and disclosure of patient information that is received by an alcohol or drug abuse treatment program.  Generally, substance abuse information that we obtain for the purpose of providing you substance abuse treatment, diagnosis, or referral for treatment must not be disclosed without your written authorization. For example, we would need your written authorization before we could disclose substance abuse information to your insurance provider for the purpose of obtaining reimbursement for the cost of services provided to you.

The federal law protecting substance abuse treatment information applies only to information that would identify a substance abuse patient, directly or indirectly, as an alcohol or drug abuser or a recipient of alcohol or drug services.  In addition to restricting disclosure, the federal law places restrictions on the use of information to initiate or substantiate any criminal charges against a patient or to conduct a criminal investigation of a patient.

As stated above, federal law generally requires that we obtain your written consent before we may disclose information that would identify you as a substance abuser or a patient of substance abuse services. But, there are some important exceptions to this requirement. We can disclose information within our program to members of our workforce as needed to coordinate your care.  For example, information obtained about you by a therapist, psychiatrist, nurse or other member of our healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you.  We may also disclose your information to agencies that help us carry out our responsibilities in serving you with whom we have a Qualified Service Organization or Business Associate Agreement.  We may disclose your information within our program to carry out our healthcare operations.  For example, members of the treatment team and quality improvement staff may use information in your record to assess the care and outcomes in your case.  We may disclose information to medical personnel in a medical emergency.   If we suspect that a child is abused or neglected, state law requires us to report the abuse or neglect to the department of social services, and we may disclose substance abuse treatment information when making the report.  We will disclose information about you if a court orders us to do so.  If you commit a crime, or threaten to commit a crime, on the premises of our program or against our program personnel, we may disclose information about you to talk to law enforcement officers about the crime or threat.  We also may disclose information for research, audit or evaluations.  The NC-TOPPS is a questionnaire which the state requires to show how you are doing in treatment. It is completed for those ages 6 and over with Mental Health and Substance Abuse diagnoses, and falls under the research exception of Federal and North Carolina laws.  This means that your personal identifying information may be disclosed without consent to the State and its evaluation contractors.  The contractors may re-disclose information only to your service provider(s) and ECS.

 

Rights

This section of the notice will briefly mention your privacy rights.  If you would like to know more about these rights, please contact the the Privacy Officer at 251-8930.

Right to a Copy of Notice:  You have a right to receive a paper copy of our Notice at any time.  In addition, a copy of this Notice will always be posted in our waiting area and on the ECS website:  http://www.eastcoastsolutions.org.

Right to inspect and request copy of record:  In most cases, you have the right to look at or get copies of your records.  You must make the request by writing a letter to the Privacy Officer or filling out an Access Request Form.  You may obtain these forms from the receptionist at any ECS site.  We will respond to your request within 30 days.  In some cases we may deny your request.  If we deny you access, we will give you written reasons for the denial & explain any right to have the denial reviewed.  If you want copies of your record, a charge for copying may be imposed, depending on your circumstances.  You have a right to choose what portions of your information you want copied & to have prior information on the cost of copying.

Right to Request Amendment to Record:  If you believe that your health information is wrong or some information is missing in your record, you must request, in writing, that we correct or add to the record by writing a letter to the Privacy Officer or filling out the Amendment Request Form.  You may obtain these forms from the receptionist at any ECS site.  We will respond within 60 days of receiving your request.  We may deny the request if we determine that the information is: (1) correct & complete; (2) not created by us and/or not part of our records, or; (3) not permitted to be disclosed, i.e. information compiled in anticipation of a civil proceeding.  Any denial will state the reasons for denial and explain your rights to have the request & denial, along with any statement in response that your provide, added to your health information.  Any request to appeal denial should be addressed in writing to the Privacy Officer of ECS.  If we approve the request for amendment, we will change the information in your record, inform you, and tell others who need to know about the change. 

Right to Request an Accounting of Certain Disclosures:  You have the right to request an accounting (which means a detailed listing) of disclosures that we have made for the previous 6 years (beginning April 14, 2003).  If you would like to receive an accounting, you may send a letter requesting an accounting to the Privacy Officer or fill out an Accounting Request Form.  You may obtain these forms from the receptionist at any ECS site.  Our agency must act on this request no later than 60 days after receipt of the request.  The accounting will not include several types of disclosures, including disclosures for treatment, payment or health care operations.  It will also not include disclosures made prior to April 14, 2003.  If you request an accounting more than once every 12 months, we may charge you a fee to cover the costs of preparing the accounting.

Request a Restriction of Uses or Disclosures:  You have the right to ask that we limit how we use or disclose your healthcare information.  You may make requests in writing by filling out a Restriction Request Form.  You may obtain these forms from the receptionist at any ECS site.  We will consider your request, but are not legally bound to agree to the restriction.  To the extent that we do agree to any restrictions on our use/disclosure of your information, we will put the agreement in writing and abide by it except in emergency situations.  We cannot agree to limit uses/disclosures that are required by law. In order to cancel the restrictions, you must submit a request in writing.  In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation.

Right to Request an Alternate Method of Contact:  You have the right to ask that we send your healthcare or billing information to or contact you at an address or phone number that is different than your home.  We must agree to your request as long as it is reasonably easy for us to do so. You must make this request in writing by filling out an Alternate Contact Request Form.  You may obtain these forms from the receptionist at any ECS site.  You do not have to explain the reason for your request.  Please be aware that if you are using a cell phone or mobile phone, your conversations may be picked up by other cell/mobile phone users.

How to File a Complaint or Report a Problem:  If you believe your privacy rights have been violated or you are dissatisfied with our privacy policies, procedures or practice, please refer to the Client Grievance Procedure described as follows:

 

CLIENT GRIEVANCE PROCEDURE

In the event of any grievance a client wishes to have addressed, the following steps are suggested; however, you may request and submit a written grievance at any time.  A Grievance Form is available at all ECS sites or you may contact the Privacy Officer for a form at 251-8930.

#1.  Please speak to your Primary Counselor directly with specifics regarding your concern/grievance.

#2.  If satisfactory resolution is not reached after speaking to your Counselor, please direct your concern/grievance to your Counselor’s Supervisor.

#3.  If necessary, contact the Executive Director of East Coast Solutions:  Jane Albers  251-8930.

#4.  Should you still have an unresolved concern or grievance after speaking to the above listed personnel, contact one of the agencies listed below:

Southeastern Center - LME Client Advocate (Wilmington)
1-866-886-6667

NC Division of Health Service Regulation (Raleigh)
1-800-624-3004

NC Consumer Care-Line (Raleigh)
1-800-662-7030

Disability Rights of NC (Raleigh)
1-877-235-4210

 

For More Information:  If you have questions or would like additional information, you may speak to your clinician or contact the  Southeastern Center Client Advocate at 1-866-886-6667 or the ECS Privacy Officer at 251-8930.