The
Physicians, Therapists, Nurses, and Staff at Raj Clinics are committed to
respond to the ever-growing need of behavioral health services in the
communities that we serve. Our
mission, as a community resource, is to bring modern psychiatric and addiction
medicine to those individuals, their families, and loved ones, who suffer from
mental or addiction illnesses.
It is the
philosophy of Raj Clinics to emphasize the patient's strengths and competencies
and to build upon them. Our
fundamental commitment is to support and to encourage improvement in every
person's functioning and status.
We believe
that the patient's emotional well-being, perceptions, involvement, and
commitment, are central to all aspects of improved care.
Privacy Statement
RAJ
CLINICS
NOTICE
OF PRIVACY PRACTICES
(45
Effective
Date: April 11, 2003
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. If you have any questions about
this notice, please contact Raj Clinics Medical Records at 6 Chase Park,
Logansport, Indiana, 46947-2208, phone number 574-732-1166.
WHO
WILL FOLLOW THIS NOTICE.
This
notice describes our practices and that of:
• Any health care professional
authorized to enter information into your chart.
• All departments and units of Raj
Clinics.
• Any member of a volunteer group
we allow to help you at Raj Clinics.
• All employees, staff and other
personnel of Raj Clinics.
All
these entities, sites and locations follow the terms of this notice.
In addition, these entities, sites and locations may share medical
information with each other for treatment, payment or Raj Clinics operations
purposes described in this notice.
OUR
PLEDGE REGARDING MEDICAL INFORMATION.
We
understand that medical information about you and your health is personal. We are committed to protecting medical information about you.
We create a record of the care and services you receive at Raj Clinics.
We need this record to provide you with quality care and to comply with
certain legal requirements. This
notice applies to all of the records of your care generated by Raj Clinics.
Other Health Care Rehabilitation Facilities may have different policies
or notices regarding use and disclosure of your medical information.
This notice will tell you about the ways in which we may use and disclose
medical information about you. We
also describe your rights and certain obligations we have regarding the use and
disclosure of medical information.
We
are required by law to:
• make sure that medical
information that identifies you is kept private;
•
give you this notice of our legal duties and privacy practices with
respect to medical information about you; and
• follow the terms of the notice
that is currently in effect.
HOW
WE ARE REQUIRED BY LAW TO DISCLOSE MEDICAL INFORMATION ABOUT YOU.
•
As Required By Law. We
will disclose medical information about you when required to do so by federal,
state or local law.
•
To Avert a Serious Threat to Health or Safety.
We will use and disclose medical information
about you when we have a “Duty to Report” under state or federal law,
because we believe that it is necessary to prevent a serious threat to your
health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to
help prevent the threat.
•
Public Health Risks. We
will disclose medical information about you for public health reporting required
by federal or state law. These
activities generally include the following:
º to
prevent or control disease, injury or disability;
º
to report births and deaths;
º to
report child abuse or neglect;
º to
report reactions to medications or problems with products;
º to
notify people of recalls of products they may be using;
º to notify a person who may have
been exposed to a disease or may be at risk for contracting or spreading a
disease or condition;
º to notify the appropriate
government authority if we believe a Client has been the victim of abuse,
neglect or domestic violence. We
will only make this disclosure if you agree or when required or authorized by
law.
•
Healthy Oversight Activities.
We will disclose medical information as required by law to a health
oversight agency for activities authorized by law.
These oversight activities include, for example, audits, investigations,
inspections, and licensure. These
activities are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
Lawsuits and Disputes: If you
are involved in a lawsuit or a dispute, we will disclose medical information
about you when properly ordered to do so by a court.
•
Law Enforcement. We
will release medical information if asked to do so by a law enforcement
official, and if permitted by law:
º
In response to a court order;
º If
required by state or federal law;
º To
identify or locate a suspect, fugitive, material witness, or missing person;
º About
the victim of a crime if, under certain limited circumstances, we are unable to
obtain the person’s agreement;
º About
a death we believe may be the result of criminal conduct;
º About
criminal conduct at Raj Clinics; and
º In
emergency circumstances to report a crime; the location of the crime or victims;
or the identity, description or location of the person who committed the crime.
•
Protective Services for President and Others.
We will disclose medical information about you to authorized federal
officials so they may provide protection to the President, other authorized
persons or foreign heads of state or conduct special investigations.
HOW
WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The
following categories describe different ways that we use and disclose medical
information. For each category of
uses or disclosures we will explain what we mean and try to give some examples.
Not every use or disclosure in a category will be listed.
However, all of the ways we are permitted to use and disclose information
will fall within one of the categories.
•
For Treatment. We may
use medical information about you to provide you with medical treatment or
services. We may disclose medical information about you to doctors,
psychologists, nurses, social workers, therapists, technicians, medical
students, or other Raj Clinics personnel who are involved in taking care of you.
Different departments of the Raj Clinics also may share medical
information about you in order to coordinate the different things you need.
We also may disclose medical information about you to people outside Raj
Clinics, such as other health care providers involved in providing medical
treatment for you and to people who may be involved in your medical care, such
as family members, clergy or others we use to provide services that are part of
your care.
•
For Payment. We may
use and disclose medical information about you so that the treatment and
services you receive at Raj Clinics, or other health care providers from whom
you receive treatment, may be billed to, and payment may be collected from, you,
an insurance company or a third party. For
example, we may need to give your health plan information about treatment you
received at Raj Clinics so your health plan will pay us or reimburse you for
your treatment. We may also tell
your health plan about a treatment you are going to receive to obtain prior
approval or to determine whether your plan will cover the treatment.
•
For Health Care Operations. We
may use and disclose medical information about you for Raj Clinics operations or
to another health care provider or health plan, if you have a relationship with
that health care provider or health plan. These
uses and disclosures are necessary to run Raj Clinics and make sure that all of
our Clients receive quality care. For
example, we may use medical information to review our treatment and services and
to evaluate the performance of our staff in caring for you.
We may also combine medical information about many Clients to decide what
additional services Raj Clinics should offer, what services are not needed, and
whether certain new treatments are effective.
We may also disclose information to doctors, social workers, therapists,
nurses, psychologists, technicians, medical students, and other personnel for
review and learning purposes. We
may also combine the medical information we have with medical information from
other Health Care Providers to compare how we are doing and see where we can
make improvements in the care and services we offer.
We may remove information that identifies you from this set of medical
information so others may use it to study health care and health care delivery
without learning who the specific Clients are.
•
Appointment Reminders. We
may use and disclose medical information to contact you as a reminder that you
have an appointment for treatment or medical care at Raj Clinics.
•
Treatment Alternatives. We
may use and disclose medical information to tell you about or recommend possible
treatment options or alternatives that may be of interest to you.
•
Health-Related Benefits and Services.
We may use and disclose medical information to tell you about
health-related benefits or services that may be of interest to you.
•
Research. Under
certain circumstances, we may use and disclose medical information about you for
research purposes. For example, a
research project may involve comparing the health and recovery of all Clients
who received one medication to those who received another, for the same
condition. All research projects, however, are subject to a special
approval process. This process
evaluates a proposed research project and its use of medical information, trying
to balance the research needs with Clients’ need for privacy of their medical
information. Before we use or
disclose medical information for research, the project will have been approved
through this research approval process, but we may, however, disclose medical
information about you to people preparing to conduct a research project, for
example, to help them look for Clients with specific medical needs, so long as
the medical information they review does not leave Raj Clinics.
We may ask for your specific permission if the researcher will have
access to your name, address or other information that reveals who you are, or
will be involved in your care at the hospital.
SPECIAL
SITUATIONS
•
Organ and Tissue Donation. If
you are an organ donor, we may release medical information to organizations that
handle organ procurement or organ, eye or tissue transplantation or to an organ
donation bank, as necessary to facilitate organ or tissue donation and
transplantation.
•
Military and Veterans. If
you are a member of the armed forces, we may release medical information about
you as required by military command authorities.
We may also release medical information about foreign military personnel
to the appropriate foreign military authority.
•
Coroners, Medical Examiners and Funeral Directors.
We may release medical information to a corner or medical examiner. This
may be necessary, for example, to identify a deceased person or determine the
cause of death. We may also release
medical information about Clients of Raj Clinics to funeral directors as
necessary to carry out their duties.
•
National Security and Intelligence Activities.
We may release medical information about you to authorized federal
officials for intelligence, counterintelligence, and other national security
activities authorized by law.
•
Inmates. If you are an inmate of a correctional institution or under
the custody of a law enforcement official, we may release medical information
about you to the correctional institution or law enforcement official.
This release would be necessary (1) for the institution to provide you
with health care; (2) to protect your health and safety or the health and safety
of others; or (3) for the safety and security of the correctional institution.
YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You
have the following rights regarding medical information we maintain about you:
•
Right to Inspect and Copy. You
have the right to inspect and copy medical information that may be used to make
decisions about your care. Usually,
this includes medical and billing records, but does not include psychotherapy
notes. To inspect and copy medical information that may be used to
make decisions about you, you must submit your request in writing to the Raj
Clinics Medical Records. If you
request a copy of the information, we may charge a fee for the costs of copying,
mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied
access to medical information, under some circumstances you may request that the
denial be reviewed. Another
licensed health care professional chosen by Raj Clinics will review your request
and the denial. The person
conducting the review will not be the person who denied your request.
We will comply with the outcome of the review.
•
Right to Amend. If
you feel that medical information we have about you is incorrect or incomplete,
you may ask us to amend the information. You
have the right to request an amendment for as long as the information is kept by
and for Raj Clinics. To request an
amendment, your request must be made in writing and submitted to the Raj Clinics
Medical Records. In addition, you
must provide a reason that supports your request.
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 mend information
that;
º
Was not created by us, unless the person or entity that created the
information is no longer available to make the amendment;
º Is
not part of the medical information kept by or for the hospital;
º Is
not part of the information which you would be permitted to inspect and copy; or
º Is
accurate and complete.
•
Right to an Accounting of Disclosures.
You have the right to request an “Accounting of Disclosures.”
This is a list of the disclosures we made of medical information about
you. To
•
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 health care
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 the payment for your care, like a family member
or friend. For example, you could
ask that we not use or disclose information about a specific treatment session
you had. We are not required to
agree to your request. If we do agree, we will comply with your request unless the
information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to the Raj
Clinics Medical Records. 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.
•
Right to Request Confidential Communications.
You have the right to request that we communicate with you about medical
matters in a certain way or at a certain location.
For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in
writing to the Raj Clinics Medical Records.
We will not ask you the reason for your request.
We will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted.
•
Right to a Paper Copy of This Notice.
You have the right to a paper copy of this notice.
You may ask us to give you a copy of this notice at any time.
Even if you have agreed to receive this notice electronically, you are
still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website, www.rajclinics.com.
To obtain a paper copy of this notice, ask your treatment provider or the
client services staff. You may also contact the Raj Clinics Medical Records to
request a paper copy.
CHANGES
TO THIS NOTICE
We
reserve the right to change this notice. We
reserve the right to make the revised or changed notice effective for medical
information we already have about you as well as any information we receive in
the future. We will post a copy of
the current notice in each of our facilities.
The notice will contain on the first page, in the center, fourth line
from the top, the effective date. In
addition, each time you register at or are admitted to Raj Clinics for treatment
or health care services as outpatient, we will offer you a copy of the current
notice in effect.
COMPLAINTS
If
you believe your privacy rights have been violated, you may file a complaint
with Raj Clinics or with the Secretary of the Department of Health and Human
Services. To file a complaint with
Raj Clinics, contact the Raj Clinics Medical Records at 6 Chase Park,
Logansport, Indiana 46947-2208. All
complaints must be submitted in writing. You
will not be penalized for filing a complaint.
If you have any questions, please contact the Medical Records at
574-732-1166.
OTHER
USES OF MEDICAL INFORMATION
Other
uses and disclosures of medical information not covered in this notice or the
laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical
information about you, you may revoke that permission, in writing, at any time.
If you revoke your permission, we will no longer use or disclose medical
information about you for the reasons covered by your written authorization.
You understand that we are unable to take back any disclosures we have
already made with your permission, and that we are required to retain our
records of the care that we provide to you.