Privacy Practices Information Statement

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

If you have any questions about this statement, please contact Roxanne Nealon at (781) 598-9467 or by mail at:

Serving People In Need, Inc.
270 Union Street, Suite 204
Lynn, MA 01901.

Serving People In Need’s Privacy Practices Information Statement describes how this agency may use and disclose your protected health information. Protected health information can be used or disclosed for the following reasons; treatment, payment or health care operations. The “Privacy Practices Information Statement” describes your rights regarding health information that our agency maintains about you and a description of how you may exercise these rights. The “Privacy Practices Information Statement” explains the obligations that our agency has to protect your health information.

What is “Protected Health Information”?
Protected Health Information is any information that our agency has collected from you or received from your health care providers, health care agencies or health plans. It may include physical or mental health conditions, the provision of your health care, and payment for you health care services.

Our Obligation As A Health Care Provider Agency
It is our obligation to maintain the privacy of your health information and to provide you with notice of our legal responsibility and practices with respect to your health information. We are required to comply with the terms or our “Privacy Practices Information Statement”.

How will your health care information be used or disclosed?

For Treatment: Once you have signed a “Consent for Treatment” and an “Authorization To Release Or Obtain Information Consent” the agency will use and disclose your health information to provide your health care and any related services. Serving People In Need will use and disclose your health information to coordinate and manage your health care services with identified providers or state agencies (e.g., primary care physician, psychiatrist, therapist, laboratory, DSS or DMH) involved in your treatment.

For Payment: Serving People In Need may use your health care information to coordinate payment for services that you may receive while under our care with your health plan or third party payer.

For Health Care Operations: Serving People In Need may combine our health information with other providers to compare how our agency is doing and see where our agency can make improvements in providing care to our consumers. When sharing information, Serving People In Need will be removing identifying information to maintain a level of privacy.

Health Related Benefits and Services: Serving People In Need may use and disclose health information to inform you of health related benefits that may be of interest to you.

Uses or Disclosures that may be made without your consent or authorization but for which you will have an opportunity to object:

Serving People In Need may provide health information to persons who are involved in payment of your care, a family member, personal representative or guardian or any other person that is responsible for your care, your location, general condition or death. Your health care information may be used or disclosed in the case of assisting in disaster relief efforts.
Serving People In Need may use or disclose your health information if you are in an emergency situation. Health information may be disclosed to a spouse, family member or other identified persons involved in your care. In this case Serving People In Need will determine if the disclosure is in your best interest and only disclose information that is relevant to participation in your care.
If you are not in an emergency situation but are unable to make health care decisions, Serving People In Need may disclose your health information to:

• Your health care provider if we have received a valid health care proxy
• Your guardian or medication monitor if one has been appointed by a court
• A state agency responsible for consenting to your care

Uses or Disclosures that may be made without your consent or authorization or opportunity to object

Emergencies: Serving People In Need may use and disclose your health care information in an emergency treatment situation. Our agency will work to obtain your consent as soon as reasonably possible after you are provided with emergency treatment. If a clinician is required by law to treat you and your treating clinician has attempted to obtain your consent but is unable to do so, the treating clinician may use or disclose your health information to treat you.

Communication Barriers: Serving People In Need may use and disclose your health information if an employee has attempted to obtain consent from you but is unable to do so due to substantial communication barriers. In this case, Serving People In Need will only use or disclose your health information if a professional judgment is determined that you would have consented to use or disclosure of information under the circumstances.

As required by law
Serving People In Need will disclose health information when required to do so by federal, state or local law.

To avert serious threat to health or safety
Serving People In Need may use and disclose health information to prevent a serious and imminent threat to your health or safety or to the health and safety of the public or another person. Under these circumstances, information will be disclosed to someone who is able to assist in preventing or lessen the threat.

Public Health
Serving People In Need may disclose health information as necessary for public health activities including:

• Report to public health authorities
• Conduct public health surveillance or investigations
• Report child abuse or neglect
• Notify a person who may have been exposed to a communicable disease or who is at risk of contracting a disease or condition.
• Notify the appropriate government agency if we there is evidence of abuse, neglect or domestic violence as required by our employees by law

Medical Examiner
Medical examiners are appointed by law to assist in identifying deceased persons and to determine the cause of death in certain circumstances. Serving People In Need may provide health information to a medical examiner when applicable and if determined necessary.

Military and Veterans
Serving People In Need may be required to provide health information to military command authorities. This disclosure may be used to determine your eligibility for benefits provided by the Department of Veteran Affairs. Serving People In Need may be required to provide health information foreign military authorities if you are a member of a foreign military service.

National Security and Protective Services for the President and Others
Serving People In Need may disclose medical information to authorized officials for intelligence, counter intelligence, and other national security activities authorized by law.

Inmates
If you are under the custody of a law enforcement official or an inmate in a correctional institution, Serving People In Need may disclose health information to the law enforcement official or correctional institution.

Workers’ Compensation
Serving People In Need is obligated to follow Massachusetts Worker’ Compensation Law and therefore may be obligated by court order or subpoena to disclose your health information.

Uses and disclosures of your health information with your authorization

Uses and disclosures that have not been previously described will require consumers to complete an Authorization To Obtain Or Release Information form. An individual Authorization must be completed for each contact that information will be shared with. An Authorization is generally in effect for six (6) months, unless otherwise stated on the Authorization.

Consumers have the right to revoke an Authorization at any time. This must be requested in writing. It is Serving People In Needs responsibility to then terminated any use or disclosures under that Authorization once a written request has been submitted by the consumer from that date on.

Your rights regarding your health information

Right to inspect and copy:
As a consumer you have the right to request an opportunity to inspect or copy your health information. All requests must be made in writing. If you are unable to put a request in writing by yourself any employee can assist you.

Right to amend:
As a consumer you have the right to request an amendment to any health information that is maintained by Serving People In Need. To make an amendment you must explain, in writing, why you believe that an amendment should be made to your health information (e.g., inaccurate or incorrect). If you are unable to put an explanation in writing by yourself, any employee can assist you.

An amendment may be denied if you can not provide a reason to support the request. An amendment may be denied if the health information was not created by our agency, if it is not part of the health information that we maintain to make decisions about your care, or if the information is accurate and complete.

Serving People In Need will respond to your request for an amendment if it is denied, by written notice that will state the basis for the denial and offering you the opportunity to provide a written statement disagreeing with the denial.

Right to an accounting of disclosures:
As a consumer, you have the right to request an accounting of disclosures that Serving People In Need have made. You must submit this request in writing. If you are unable to put a request in writing by yourself, any employee can assist you. The request must state the time period for which you are requesting information. This time period should not extend more that six (6) years and not include dates prior to April 14, 2003.

Right to request restrictions:
As a consumer you have the right to request restrictions on the use and disclosure of health information. You may request that any part of your health information not be disclosed to specific persons who may be involved in your health care treatment. To request a restriction you must put the information in writing and specify the restrictions being made. Serving People In Need is not required to agree to the restriction that you may request. If we do agree the agency will honor your request unless the restricted health information is needed to provide you with emergency treatment.

Right to request confidential communications:
As a consumer you have the right to request that Serving People In Need communicate with you about your health care only in certain locations or through a certain method. (e.g., only at home, only at work, only by email) To make this request known you must put it in writing. If you are unable to put a request in writing by yourself any employee can assist you. You do not need to give reason as to why you are requesting this but you must be specific on how or where you wish to be contacted.

Right to paper copy of this “Privacy Practices Information Statement”
As a consumer you have the right to request a copy of this “Privacy Practices Information Statement” at any time. Your request can be taken by any employee and all employee’s have access to this statement.

Complaints

If you believe that your privacy rights have been violated, you may file a complaint with Serving People In Need or with the Secretary of the U.S. Department of Health and Human Services.

To file a complaint with Serving People In Need please contact Heather Hildebrand at (781) 598-9467 or by mail at:

Serving People In Need, Inc.
270 Union Street, Suite 204
Lynn, MA 01901.

Serving People In Need will not retaliate against you for filing a complaint.