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 review it carefully.
We are required by law to protect the privacy of your health information and will not use or disclose your health information without your written permission, except as described in this Notice.
Throughout this Notice, we use the term “protected health information,” or PHI, to describe information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
You Have a Right to:
- Request that we limit certain uses and disclosures of your PHI, such as in how we provide services to you, get paid for our services or administer our Agency (referred to as “treatment, payment, or health care operations”). You also have the right to request a restriction on the PHI we disclose about you to someone who is involved in your care or payment for your care, such as a family member or friend. However, we are not required to agree to your request. To request limitations, you must send a written request to the director of the program from which you receive services.
- See and get a copy of your PHI that is contained in our medical and billing records. To look at or copy your PHI, please send a written request to the director of the program from which you receive services. We may charge a reasonable, cost-based fee.
- Request additions or corrections to your PHI. If you feel that PHI we have about you is incomplete or incorrect, you may request that we correct or update (amend) the information. To request an amendment, you must send a written request to the director of the program from which you receive services including the reasons for your request. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may prepare a response to your statement, which we will provide to you.
- Receive an accounting of how your PHI was disclosed, excluding disclosures for treatment, payment, health care operations, that we have made directly to you or that you have authorized, or to friends or family members involved in your care, or for notification purposes. To request an accounting, submit your request in writing to the director of the program from which you receive services.
- Request communication by alternative means or at alternative locations. For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of your PHI, you must submit your request in writing to the director of the program from which you receive services. Your request must state how or when you would like to be contacted. We will accommodate all reasonable requests.
- Restrict Disclosures to Your Health Plan. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific service, you have the right to ask that your PHI with respect to that service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
- Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured PHI.
- Obtain a paper copy of the Notice of Privacy Practices upon request, even if you have agreed to receive the Notice electronically.
Using and Disclosing Your Protected Health Information
We will use your information for your treatment. For example, information obtained by ServiceNet staff will be recorded in your record and used to provide services to you. As services are provided, staff will record those services and their observations in your record. However, we may, for clinical reasons, ask you to provide consent before we use your information for your treatment.
We will use your information for payment. For example, a bill may be sent to you, your insurance company or Medicare or Medicaid. The information on or accompanying the bill may include information that identifies you, as well as the treatment provided to you.
We will use your protected health information to operate our Agency. For example, members of our quality improvement team may use information in your record to assess the care and outcomes in your case and others like it.
We may use or disclose your PHI without your consent in the following circumstances:
- When required by federal, state or local law, judicial or administrative proceedings or law enforcement. For example, in response to a court order.
- To communicate with family or friends involved in your care or payment for your care. Our clinical and paraprofessional staff, using their professional judgment, may disclose to a family member, close personal friend or any other person you identify, PHI related to that person’s involvement in your care or payment related to your care, unless you object.
- Worker’s compensation. For example, if you are injured at work.
- Public health and health oversight activities: As required by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability. We may also provide information to coroners, medical examiners, and funeral directors as necessary for these persons to carry out their duties. We may disclose your PHI to an oversight agency for activities authorized by law, including audits and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.
- For specialized government functions, such as national security and intelligence.
- Business associates: There are some services provided by ServiceNet through contracts with business associates such as billing companies. When these services are contracted for, we may disclose your PHI to our business associates so that they can perform the job we have asked them to do. We require our business associates to appropriately safeguard your information.
- Personal communications: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
- Fundraising: We may contact you as part of a fundraising effort for our ServiceNet, though you may opt out of receiving such communications
- Notification: We may use or disclose your PHI to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
- To a correctional institution, if you are or become an inmate.
- To avert a serious threat to health or safety: We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
- To protect victims of abuse, neglect, or domestic violence: For example, we may disclose PHI about you to a social service or protective services agency, if we reasonably believe you or someone else is a victim of abuse, neglect, or domestic violence.
Your Written Authorization is Required for Other Uses and Disclosures
The following uses and disclosures of your PHI will be made only with your written authorization:
- Uses and disclosures of PHI for marketing purposes;
- Disclosures that constitute a sale of your PHI; and
- Most uses and disclosures of psychotherapy notes.
Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation and we will no longer disclose PHI under the authorization. But disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.
Changes to this Notice
We reserve the right to change our Notice of Privacy Practices and to make the new practices effective for all the PHI we maintain. We will post a copy of the current Notice at our main office, at each site where we provide care, and on our website at www.servicenetinc.org. You may also obtain a copy of the current Notice by calling us at 413.584.7329 and requesting that a copy be sent to you in the mail or by asking for one any time you are at our offices.
For More Information or to Report a Problem
If you have questions or would like additional information about ServiceNet’s privacy practices, you may contact the Program Director or the Privacy Officer at ServiceNet, 129 King Street, Northampton, MA 01060 or at 413.584.7329. You may also file a complaint with the Privacy Officer or with the Secretary of Health and Human Services in Washington, D.C. There will be no retaliation for filing a complaint.