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), 45 CFR Part 164, the federal Confidentiality of Alcohol and Drug Abuse Patient Records regulations at 42 CFR Part 2, (“Part 2”) and the laws of the State of New Jersey as provided for in the Community Mental Health Services Act, N.J.A.C. 10:37-1.1 et seq. This Privacy Notice describes how NewBridge Services, Inc., its employ- ees, agents and health care providers 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”) and its affiliated providers and personnel may use and disclose your Protected Health Information for purposes of providing treatment, obtaining payment for treatment, and certain administrative and other 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 or required by the HIPAA privacy regulations, Part 2, and/or other applicable state law.
II. Confidentiality of Records
NewBridge is governed by HIPAA as well as Part 2 and other State laws which restrict how we may use and disclose your Protected Health Information. Part 2 and State laws further restrict how we may use and disclose certain drug and alcohol, as well as mental health information. Therefore, in general, we may use or disclose Protected Health Information only when (1) you give us your written authorization on a form that complies with HIPAA, Part 2 and state law; or (2) there is an exception as described in this Notice, such as but not limited to a court order or medical emergency.
Information directly or indirectly identifying you or any persons currently or formerly receiving services from New- Bridge is treated as confidential and may only be disclosed as permitted by law and as otherwise described by this Notice.
In addition, we are required to obtain your specific written authorization before using and disclosing any psychotherapy notes which we may maintain except as otherwise permitted by law. We must also obtain your specific written authorization for any uses or disclosures we may make for marketing or where we would receive remuneration (some- thing of value) in exchange for disclosing your Protected Health Information except as otherwise permitted by law.
You have the right not to give your authorization for a use or disclosure of your Protected Health Information. Except to the extent that we may have taken action in reliance upon a previous authorization we receive from you, you may revoke your authorization at any time by delivering a written revocation statement to the Privacy Officer identified in this Notice.
III. Disclosure of Protected Health Information Without Authorization
In certain circumstances, we may disclose your Protected Health Information to another person or entity without obtaining an authorization from you to do so. In general, we will only do so as described by this Notice below. However, in certain circumstances we may ask for your authorization for these types of disclosures where we would be required by law to do so.
A. Emergency Uses and Disclosures:
In certain emergency circumstances, NewBridge may exercise its professional judgment to disclose information to emergency medical personnel in order to treat a condition which poses an immediate threat to the health of yourself and any individual and which requires immediate medical intervention. NewBridge may disclose only information that is directly relevant to the present emergency. We may also be authorized by law to disclose information in emergencies under certain other circumstances.
B. Disclosures As Authorized by Law:
NewBridge is authorized or required by law to disclose Protected Health Information in many circumstances. We will always comply with applicable laws and regulations when disclosing Protected Health Information.
- In most circumstances, we may release Protected Health Information upon request to the New Jersey Division of Child Protection and Permanency in connection with investigations and reports of child abuse or neglect.
- Certain Protected Health Information may be released where directly relevant to crimes or threats of crime committed on NewBridge property or against NewBridge providers and personnel. We may also release Protected Health Information to law enforcement officials under other circumstances to the extent permitted by law.
- Protected Health Information may be released to coroners or 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.
- Protected Health Information may be disclosed in response to a court order.
- Protected Health Information may be released to the guardian or legal representative 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, to next of kin or a person otherwise empowered by court order who shall exercise control of the disclosure of such person’s records.
- Other Possible Uses and Disclosures of Protected Health Information:
NewBridge may also use and disclose your Protected Health Information in certain other circumstances where permitted by law.
- To a family member, other relative, or a close personal friend. We will generally provide you with the opportunity to object to such disclosures and limit such information to your general condition. We will never release any mental health or drug or alcohol related information without your authorization.
- With your expressed permission, we may, from time to time, contact you by phone, email or mail to solicit do- nations to support NewBridge activities and services. You have a right to opt-out of receiving these communications and may do so at any time.
- To clinical records audit teams, and to monitoring and site review staff designated by the New Jersey Department of Health or Department of Human Services, the Office of Legislative Services, the federal Centers for Medicaid and Medicare Services, and for certain other audit activities permitted by law;
- To a person participating in a Professional Standards Review Organization;
- 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,
- In certain circumstances, to your primary care or other physician treating you, or to another agency or provider 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.
- In any other circumstance required or authorized by applicable federal or state law.
IV. Conditions For Disclosure To Third Parties:
When NewBridge discloses your Protected Health Information, 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 you, or permitted or required by law. We maintain all Requests made for your Protected Health Information, and any Authorizations to Release Records in your file records. Any action taken by NewBridge upon these requests is recorded in your file record.
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 (e.g., view the 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, Part 2 and other applicable federal and state law.
Your Protected Health Information generally may be used by NewBridge to provide you with treatment and related services. 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 generally seek your written authorization prior to disclosing any information to an outside healthcare provider, except in an emergency as described in section III. (A) and as oth- erwise may be authorized by law.
NewBridge may use your Protected Health Information to coordinate and obtain payment for services that we provide to you. However, we will generally require your authorization prior to releasing your Protected Health Information to third parties for such payment activities, 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 im- prove 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. NewBridge will generally seek your written authorization prior to disclosing any information to another health care provider or other entity for health care opera- tions activities. We may also use your Protected Health Information to send you educational information or newslet- ters concerning Newbridge operations and services to keep you informed.
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. Where we maintain your Protected Health Information in an electronic designated record set, you may also have a right to receive copies of such Protected Health Information in an electronic form and format. 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 be seriously harmful to your treatment, endanger your life/safety of you or 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.
In case of Family Therapy, if the records for all participants have been integrated, no single family member shall have access to those records unless all adult participants and the guardians of any minor participants agree through a signed authorization form.
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 reasonable cost-based fee for the costs of copying, mailing, or other costs incurred in complying with your request, such as the cost of a CD to provide you with an electronic copy of your Protected Health Information. 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 unless you request a restriction on disclosure to a health plan solely for payment or health care operations purposes for health care items and services that you have paid New- Bridge for in full and out-of-pocket. If you request a restriction on disclosures to your health plan for these purposes, you are responsible for notifying your other doctors, pharmacies and health care providers if you wish for them to also restrict the same information from being disclosed to your health plan.
NewBridge will notify you if we deny your request to a restriction. If NewBridge does agree to the requested restric- tion, 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 reason- able 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 amend- ment. 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 New- Bridge. NewBridge is not required to account for disclosures that you requested or disclosures that you agreed to by signing an authorization form and certain other disclosures. 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 six (6) years from the date on which you request such an accounting. 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 paper or elec- tronic 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 will notify you in the event a Breach occurs of your unsecured Protected Health Information and any steps you may need to protect yourself. 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.
Violations of Part 2, as well as potentially HIPAA, are a federal crime. You have the right to submit complaints to NewBridge if you believe your privacy rights have been violated by following the NewBridge Grievance 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 com- plaint.
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 any of the matters covered by this Notice can be requested by contacting the Privacy Officer at NewBridge Services Inc., Attn: Privacy Officer, P.O. Box 336, Pompton Plains, NJ 07444.
X. Effective Date:
This Notice is effective as of April 14th, 2003, and has been revised as of September 9th, 2013.