HOW WE MAY USE OR DISCLOSE
YOUR MEDICAL INFORMATION
We are permitted or required to use your
medical information for various purposes. While we cannot describe every possible use or
disclosure of your medical information in this notice, uses or disclosures will generally
fall within one of the following categories:
Treatment: We may use and disclose medical
information about you to physicians, psychologists, therapists, and other personnel
involved in your care to ensure you receive proper treatment. For instance, if you are a
student at one of the facilities, information about your progress in counseling may be
shared with your family physician.
Payment: We may use and disclose information
about you to obtain payment for the services we provide to you. For example, we may bill
your insurance company for counseling services.
Healthcare Operations: We may use and disclose
medical information about you for healthcare activities necessary to run the various
Manito, Inc. programs and facilities, and to ensure our clients receive quality care. For
instance, we may use your medical information to review our treatment of you, the services
we provided, and the performance of our staff. We may disclose your medical information to
another entity covered by the privacy regulations for some of their healthcare operations,
if they have or had a relationship with you.
Appointment Reminders: We may use and disclose
your address and telephone number to remind you about an appointment for treatment at one
of our programs or facilities.
Treatment Alternatives: We may use and
disclose medical information to tell you about, or recommend, possible treatment options
or alternatives.
Health-Related Benefits and Services: We may
use and disclose medical information to tell you about the health-related benefits or
services we provide.
Fundraising Activities: We may use your name,
address, phone number, and other demographic information and the dates you received
treatment or services in connection with our fundraising efforts.
Individuals Involved in Your Care or Payment: We
may release medical information about you to a family member or close friend involved in
your medical care or payment. In addition, if you are treated for injuries resulting from
a disaster, we may disclose medical information about you to an entity assisting in a
disaster relief effort, so your family can be notified about your condition, status, and
location. You have the right to request restrictions on or object to any of these uses or
disclosures.
As Required by Law: We will disclose your
medical information when required to do so by federal, state, or local law.
To Avert a Serious Threat to Health or Safety: We
may use and disclose medical information about you when necessary to prevent a serious
threat to your health and safety, the health and safety of the public, or another person.
Any disclosure would be restricted to those who are able to help prevent the threatened
harm.
Workers’ Compensation: We may release
medical information about you for workers’ compensation or similar programs that
provide benefits for work-related injuries or illnesses, as required or permitted by law.
Public Health Risks: We may disclose medical
information about you for public health activities as authorized by law. These disclosures
may be necessary to report such things as communicable diseases, births, deaths, or child
abuse.
Health Oversight Activities: We may disclose
medical information to a health oversight agency for activities authorized by law, such as
audits, investigations, inspections, and licensures. These activities are necessary to
monitor the healthcare system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes: We may disclose medical
information about you in response to a court or administrative order. We may also disclose
medical information about you in response to a subpoena, discovery request, or other
lawful process, but only if efforts have been made to tell you about the request, or to
obtain an order protecting the information requested.
Law Enforcement: We may release information
about you in limited situations, if requested by a law enforcement official to: (a) report
certain types of wounds or injuries; (b) release health information in response to a
court-ordered warrant; (c) assist law enforcement officials in identifying or locating a
suspect, fugitive, material witness, or missing person; or to (d) report the incidence of
a crime.
Coroners, Medical Examiners, and Funeral Directors:
We may release medical information to a coroner or medical examiner to help identify a
deceased person, or determine the cause of death. We may also release medical information
about clients to funeral directors, as deemed necessary.
Government Purposes: We may disclose health
information for specific government purposes. We may release health information about
military personnel to command authorities. We may also release health information to
authorized federal officials for intelligence, counter intelligence, other national
security activities, and federal protection services, as authorized by law. In certain
circumstances, we may release information about inmates to a correctional institution or
law enforcement official.
Incidental Uses and Disclosures: We may use or
disclose your medical information if it is a by-product of any of the uses or disclosures
described above, and cannot be reasonably prevented.
Mental Health Records: The use and release of
mental health records is subject to more stringent protections under state law than those
described above. We may not release your mental health records without your authorization
except in the following situations:
- To those actively engaged in your treatment, or to persons at
facilities you are being referred to, provided a summary or portion of your record is
required to provide continuity of proper care and treatment.
- To third party payers who require information to verify services
were actually provided to you.
- To reviewers and inspectors, including the Joint Commission on the
Accreditation of Healthcare Organizations (JCAHO), and Commonwealth licensure or
certification organizations, when necessary to obtain or maintain certification as an
eligible provider of services.
- To those participating in PSRO or utilization reviews.
- To the administrator of any Manito, Inc. program or facility where
you are being treated, so the administrator can fulfill their duties under applicable
statutes and regulations.
- To a court or mental health review officer, in the course of legal
proceedings authorized by the Pennsylvania Mental Health Procedures Act.
- To appropriate agencies in fulfillment of mandatory requirements
for reporting child abuse.
- To parents, guardians, and others when necessary to obtain consent
for medical treatment.
- To attorneys assigned to represent you in a commitment hearing.
- To employees of the Pennsylvania Department of Public Welfare,
where access to such information is necessary and appropriate for the employee’s
proper performance of their duties.
- To defense counsel to allow Manito, Inc. to defend itself in a
legal action or other proceeding.
- To the subject of a threat to warn that individual of potential
harm.
- In response to a court order for production of the documents.
- In response to an emergency medical situation to prevent serious
risk of bodily harm or death.
Psychotherapy Notes: These are notes recorded
by a mental health professional documenting, or analyzing the contents of a counseling
session, and kept in a place separate from your medical record or file. Psychotherapy
notes are afforded additional protections under federal law. They may only be released in
more limited situations than those described above with respect to mental health records,
or with your authorization.
Drug and Alcohol Abuse and Dependence Information:
Drug and alcohol treatment information may only be released with your authorization in
limited circumstances or pursuant to a court order under state law.
HIV-Related Information: HIV-related
information, such HIV testing or status, may only be released in limited situations under
state law to parents, guardians, and persons legally responsible for you. If you are
under age 14, we may release mental health information to your parents, guardian or other
persons who are legally responsible for you. If you are 14 years of age or older, we must,
in most situations, obtain your authorization for that release. If you are a minor, drug
and alcohol treatment information or HIV-related information about you may be released to
your parents, guardian or other persons who are legally responsible for you if your
treatment provider feels it is in your best interests.
DISCLOSURES WITH YOUR AUTHORIZATION
In addition to the requirements described above, we
are required to obtain your prior authorization for Manito, Inc. to engage in certain
marketing activities. We are also required to obtain your authorization to use or disclose
health information in situations where we are not otherwise permitted to use or disclose,
as described above. If you authorize us to use or disclose your health information for a
purpose not described above, you have the right to revoke that authorization at any time.
YOUR RIGHTS IN CONNECTION WITH YOUR HEALTH
INFORMATION.
You have the following rights in connection with
the medical information we maintain about you:
Your right to inspect and copy your health
information: You have the right to inspect and copy your health information that is in
our possession. You may not, however, have access to psychotherapy notes, peer review
protected information, or information that is put together for use in a civil, criminal,
or administrative proceeding. To inspect or copy your health information, you must submit
your request in writing to the Manito, Inc. Privacy Office at the address listed above. If
you request a copy of your health information, we may charge a fee for the costs of
copying, mailing, or other supplies associated with your request. Occasionally, we may
deny your request to inspect or copy your health information. In most cases, you can
request that the denial be reviewed. If you request a review, the denial of access will be
reviewed by a healthcare professional, not involved in the initial decision.
Your right to amend health information: If you
feel your health information is incorrect or incomplete, you may ask us to amend that
information. You have the right to request an amendment as long as the information is kept
by, or for us. To request an amendment, your request must be made in writing, and
submitted to Manito, Inc.'s Privacy Office at the address listed above. You must explain
why you believe the health information is incorrect or incomplete. We may deny your
request for an amendment if it is not in writing or does not include a reason to support
the request. In addition, we may deny your request if you ask us to amend information that
(a) was not created by us, unless the person or entity creating the information is no
longer available to make the amendment; (b) is not part of the health information we
maintain; (c) is not part of the information you would be permitted to inspect and copy;
or (d) is accurate and complete.
Your right to an accounting of disclosures:
You have the right to request and be provided a list of certain disclosures regarding your
health information. There are certain disclosures we are not required to include on that
list, such as disclosures to carry out your treatment, payment for care, and our
healthcare operations, or disclosures to you. To request this list or accounting of
disclosures, you must submit your request in writing to the Manito, Inc. Privacy Officer
at the address listed at the beginning of this Notice. You must state the time period
covered by your request (which may not be longer than six years or include dates prior to
April 14, 2003). You should indicate in your request the manner in which you want to list;
i.e, paper or electronic. The first list within a 12-month period will be free. You may be
charged for any additional lists, in which case, you will be notified and may choose to
withdraw or modify your request before any costs are incurred.
Your right to request restrictions: You have
the right to request a restriction or limitation on the medical information we use or
disclose about you for treatment, payment, or healthcare operations. You also have the
right to request a limit on the medical information we disclose about you to someone who
is involved in your care, or payment for care, such as a family member or friend. We
are not required to agree to your request for restrictions. If we agree, we
will comply with your request, unless the information is needed to provide you emergency
treatment; however, we may terminate the restriction at any time, by notifying you of our
intention to terminate the restriction. To request restrictions, you must make your
request in writing to the Manito, Inc. Privacy Office at the address listed at the
beginning of this Notice. In your request, you must tell us (1) what information you want
to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you
want the limits to apply, for example, disclosures to your spouse.
Your right to request confidential communications:
You have the right to request that we communicate with you about health matters in a
certain way or to a certain location. You must convey your request in writing to the
healthcare provider responsible for communicating the medical matter in question. We will
not ask the reason for your request; however, you must specify how and where you wish to
be contacted or what alternative payment arrangements have been made. For example: at
home, by phone. We will accommodate all reasonable requests for confidential
communications. We cannot, however, control how your insurer communicates with you. If you
wish to request confidential communication of insurance information, you should contact
your insurance company.
