through counseling, housing and education.
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.
This Privacy Notice is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA) and the laws of the State of New Jersey as provided for in the Community Mental Health Services Act. This Privacy Notice describes how NewBridge may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes our policies with respect to maintaining the confidentiality of Protected Health Information and how you can access and control your Protected Health Information in some cases.
Your "Protected Health Information" means any written and oral health information about you, or information that can be used to identify you, and/or information that is created or received by your health care provider which may relate to your past, present or future physical or mental health condition. NewBridge Services, Inc. ("NewBridge") may use your protected health information for purposes of providing treatment, obtaining payment for treatment, and certain administrative purposes. Your Protected Health Information may be used only for these limited purposes unless NewBridge obtains your authorization or the use or disclosure is otherwise permitted by the HIPAA privacy regulations or state law.
II. Confidentiality of Records
Restrictions on the disclosure of file records have been prescribed by the New Jersey Community Mental Health Services Act, which represents an area of overlapping Federal and State regulations.
We may use or disclose Protected Health Information only when (1) you give us your written authorization on a form that complies with HIPAA and state law; or (2) there is an exception as described in Section IV of this notice. Further, except to the extent that we have taken action in reliance upon it, you may revoke your authorization by delivering a written revocation statement to the Privacy Officer identified in this Notice.
Information directly or indirectly identifying persons currently or formerly receiving services from NewBridge is treated as confidential and may only be disclosed in the following circumstances to persons presenting appropriate identification:
Records for clients who are adults are released upon the written consent of the adult client, or his or her legal guardian.
1. A client who is 14 years or older may consent to the disclosure of his or her records in the same manner as an adult.
2. A parent or legal guardian may authorize the dis closure of a minor's records, provided that the minor shall be given prior notice and an opportunity to object to the disclosure. Objection by a minor, 14 years or older, shall render the consent of the parent or guardian void.
3. Disclosure of the clinical records of a minor, 14 years or older, to a parent or legal guardian is authorized only upon the written consent of the minor.
III. Uses and Disclosure of Protected Health Information Without Authorization
A. Emergency Uses and Disclosures:
1. Under certain circumstances, information may be disclosed to the proper public health or government authorities to prevent or lessen a serious and imminent threat to the health and safety of yourself, another person or the public. This includes reporting imminent threats made to your safety or the safety of another person. It also includes reporting child or elder abuse and/or neglect.
2. In an emergency, NewBridge may exercise its professional judgment to disclose information to emergency medical personnel and/or a family member, other relative, or a close personal friend. NewBridge would disclose only information that is directly relevant to the present emergency.
B. Disclosures As Authorized by Law:
1. The records of a minor shall be released upon request to the New Jersey Division of Youth and Family Services in connection with investigations of whether the minor has been abused or neglected.
2. Protected Health Information may be released to officials within the offices of the State Medical Examiner or a County Medical Examiner making investigations and conducting autopsies, pursuant to N.J.S.A. 52:17B-78 et seq.
3. Protected Health Information may be disclosed in the course of a Judicial or administrative proceeding in response to a legal order or other lawful process .
4. Protected Health Information may be released to the police or other law enforcement officials as required by law or in compliance with a court order.
5. Protected Health Information may be released to a coroner or medical examiner as authorized by law.
6. Protected Health Information may be released to the guardian of a deceased person who formerly received services from NewBridge, or such person chosen by the executor, administrator or other personnel representative of his or her estate, or if no such person exists, a person otherwise empowered by court order who shall exercise control of the disclosure of such person's records.
C. Other Possible Uses and Disclosures of Health Care Information
1. To clinical records audit teams, and to monitoring and site review staff designated by the New Jersey Division, the Office of Legislative Services;
2. To a person participating in a Professional Standards Review Organization,
3. To a health oversight agency that monitors the health care system and ensures compliance with the rules of government health programs such as Medicare or Medicaid,
4. To another agency under contract with the NJ Division of Mental Health Services in the NJ Department of Human Services such a screening service, short-term care or psychiatric facility for the purpose of coordinating care.
IV. Conditions For Disclosure To Third Parties:
A. Restrictions on Re-Disclosure
When records are released, NewBridge Services, Inc. shall, by written notice, advise the person receiving the records that redisclosure with-out the consent of the person who is the subject of the records, or as otherwise approved by law, is prohibited.
B. Limits on Scope of Disclosure
Information and records disclosed to third parties shall be limited to that information which is relevant and necessary for the purpose of the disclosure, except as authorized by the client or required by law.
C. Records of Disclosure Actions Taken
Request for information, and Authorization to Release Records are maintained your file records. Action taken upon these requests is recorded in your file record.
D. Inspection of Material to be Disclosed
If you authorize disclosure of your records, you shall be informed of your right subject to VI. (A), of this notice and Section 10:37-6.79 (a)4 of the New Jersey Community Mental Health Services Act. to inspect the material to be disclosed.
E. Sources of Information Disclosed
Information disclosed shall be limited to information generated by NewBridge. However, NewBridge shall list the sources of nondisclosed information contained in a file record when a formal request is made by you.
V. Ways in Which NewBridge Services May Use Protected Health Information
NewBridge Services Inc, may use your Protected Health Information for Treatment, Payment and Health Care Operations as permitted by HIPPA
NewBridge will record your name, your diagnosis and other information in order to determine the best course of treatment for you. It may be necessary for other NewBridge Services staff to know this information in order to provide you with appropriate treatment. It may be necessary for members of the treatment team to document their actions and observations in your chart. New Bridge will seek your written authorization prior to disclosing any information to another healthcare provider, except in an emergency as described in section III. (A).
NewBridge may use and disclose your Protected Health Information to obtain payment for services that we provide to you - for example, disclosures to generate a claim and obtain payment from your health insurer, HMO, or other company that arranges or pays for the cost of some or all of your health care ("your payer") or to verify that your payer will pay for health care.
C. Health Care Operations:
NewBridge may use your Protected Health Information for internal administration and planning and activities to improve the quality and cost effectiveness of the care that we deliver to you. For example, we may use your Protected Health Information to evaluate the quality and competence of our staff.
VI. Your Rights Regarding Your Protected Health Information:
A. The Right to Inspect and Copy Your Protected Health Information:
You may inspect and obtain a copy of your Protected Health Information that is contained in your file for so long as NewBridge maintains the Protected Health Information. Under federal law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to protected health information. Depending on the circumstances, you may have the right to have a decision to deny access reviewed.
NewBridge may deny your request to inspect or copy your Protected Health Information if, in its professional judgment, NewBridge determines that the access requested is likely to endanger your life or safety or that of another person, or that it is likely to cause substantial harm to another person referenced within the information. You have the right to request a review of this decision.
To inspect and copy your medical information, you must submit a written request to the Privacy Officer. If you request a copy of your information, NewBridge may charge you a fee for the costs of copying, mailing, or other costs incurred in complying with your request. Please contact our Privacy Officer if you have questions about access to your medical record.
B. The Right to Request a Restriction on Uses and Disclosures of Your Protected Health Information:
You may ask NewBridge not to use or disclose certain parts of your Protected Health Information for the purposes of treatment, payment, or health care operations.
Your request must state the specific restriction requested and to whom you want the restriction to apply. NewBridge is not required to agree to a restriction that you request. NewBridge will notify you if we deny your request to a restriction. If NewBridge does agree to the requested restriction, NewBridge may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. Under certain circumstances, NewBridge may terminate our agreement to a restriction. You may request a restriction by contacting the Privacy Officer.
C. The Right to Request to Receive Confidential Communications:
You have the right to request that we communicate with you in certain ways. NewBridge will accommodate reasonable requests. NewBridge may condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. NewBridge will not require you to provide an explanation for your request. Requests must be made in writing to our Privacy Officer.
D. The Right to Request Amendments to Your Protected Health Information:
You may request an amendment to Protected Health Information in your file about you in a designated record set for as long as NewBridge maintains this information. In certain cases, NewBridge may deny your request for an amendment. If NewBridge denies your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement, and will provide you with a copy of any such rebuttal. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendments.
E. The Right to Receive an Accounting of Disclosures
You have the right to request an accounting of certain disclosures of your Protected Health Information made by NewBridge. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this privacy notice. NewBridge is not required to account for disclosures that you requested or disclosures that you agreed to by signing an authorization form or disclosures NewBridge is permitted to make without your authorization. The request for an accounting must be made in writing to our Privacy Officer. The request should specify the time period sought for the accounting. NewBridge is not required to provide an accounting for disclosures that take place prior to April 14, 2003. Accounting requests may not be made for periods of time in excess of six years. NewBridge will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable fee.
F. The Right to Obtain a Paper Copy of this Notice.
Upon request, NewBridge will provide a paper copy of this notice even if you have already received a copy.
VII. Our Duties:
NewBridge is required by law to maintain the privacy of your health information and to provide you with this Privacy Notice. NewBridge is required to abide by terms of this Notice. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all future protected health information that we maintain. If NewBridge changes its Notice, we will make revised copies available in client areas and post it on the internet at www.newbridge.org
You have the right to express complaints to NewBridge if you believe your privacy right have been violated by following the NewBridge Grievience procedure found in the Clients Bill of Rights Pamphlet. You may also contact the Privacy Officer verbally or in writing (see below) or the Secretary of Health and Human Service. You will not be retaliated against in any way for filing a complaint.
IX. Contact Person:
The NewBridge contact person for issues regarding your privacy and your rights under the federal privacy standards is the Privacy Officer. Information regarding matters covered by this Notice can be requested by contacting the Privacy Officer at the address below.
X. Effective Date:
This Notice is effective April 14th, 2003.