Notice of Privacy PracticesThis notice describes how medical/health 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 call our Privacy Officer, Linda Mosel at (203) 336-5225 x2109.
The effective date of this privacy notice is April 14, 2003.
At Connecticut Renaissance, Inc. we respect the privacy and confidentiality of your health information. This Notice of Privacy Practices ("Notice") describes how we may use and disclose your medical/health information and how you can get access to this information. This Notice applies to uses and disclosures we may make of all your health information whether created or received by us.
This Notice applies to all programs and services operated by Connecticut Renaissance, Inc. throughout the State of Connecticut.
Information regarding your health care, including payment of health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), 42 U.S.C. & 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. & 290dd-2, 42 C.F.R. Part 2. Under these laws, Connecticut Renaissance, Inc. (Renaissance) may not say to a person outside Renaissance, Inc. that you attend the program, nor may Renaissance disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
Renaissance must obtain your written authorization before it can disclose information about you for payment purposes. For example, Renaissance must obtain your written authorization before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written authorization before Renaissance can share information for treatment purposes or for health care operations. However, federal law permits Renaissance to disclose certain information without your written permission which includes:
For example, Renaissance can disclose information without your consent to obtain legal or financial services, or to another medical facility to provide health care to you, as long as there is a business associate agreement in place. Our business associates are committed to preserving the confidentiality of this information.
Before Renaissance can use or disclose any information about your health in a manner which is not described above, it must first obtain your specific written authorization allowing us to make the disclosure. The authorization describes the particular health information to be used or disclosed and the purpose of the use or disclosure. The written authorization will also specify the name of the person/agency to which we are disclosing the health information. The authorization will also contain an expiration date or event. Any such written consent may be revoked by you in writing. If you revoke your authorization, we will no longer use or disclose your health information for the purposes specified in that authorization except where we have already taken actions in reliance on your authorization.
Listed below are your rights regarding your health information. Each of these rights is subject to certain requirements, limitations and exceptions. Exercise of these rights may require submitting a written request to Renaissance. At your request, Renaissance will supply you with the appropriate form to complete. You have the right to:
Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. Renaissance is not required to agree to any restrictions you request, but if we do agree then we are bound by that agreement and may not use or disclose any information which you have restricted except as described above. Your request for restriction must be made in writing. In your request, you must state what information you want to restrict from use or disclosure and to whom you want the restrictions to apply.
Request Confidential Communications
You have the right to request that we communicate with you concerning your health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. Renaissance will accommodate such requests that are reasonable and will not request an explanation from you. Your request to receive such communications must be made in writing. Your request must clearly state how and where you wish to be contacted.
Access to Personal Health Information
Under HIPAA you also have the right to inspect and copy your own health information maintained by Renaissance, except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal or administrative proceeding or in other limited circumstances. In most cases we may charge a reasonable fee for our costs in copying and mailing your requested information. We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to health information, in some cases you have a right to request review of the denial. This review would be performed by a licensed health care professional designated by Renaissance who did not participate in the decision to deny.
Your request to review and/or obtain a copy of your protected health information records must be made in writing. In your request, you must state what information you want to access and how you would like to access the requested information. You will be notified in writing as to the outcome of your request.
Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in Renaissance's records. Your request must be made in writing and must state what specific information you want amended and the reason for the requested amendment. If accepted, Renaissance will obtain the client's authorization to notify relevant persons/organizations with whom the amendment needs to be shared. We may deny your request for amendment if the information was not created by us, unless you provide reasonable information that the originator of the information is no longer available to act on your request, is not part of the information maintained by us, is information to which you do not have a right of access or is already accurate and complete, as determined by us. The Privacy Officer is responsible for receiving and processing amendment requests.
The outcome of your request will be given to you in writing, stating our acceptance or denial of your request. A denial will include the reasons for the denial and explain to you that you have the right to submit a written statement disagreeing with the denial. Your letter of disagreement and request for amendment will be attached to your medical record if requested by you.
Request an Accounting of Disclosures
You also have the right to request and receive an accounting of disclosures of your health related information made by Renaissance during the six years prior to your request. This is a listing of disclosures made by us or by others on our behalf, but does not include disclosures made to you or with your authorization, facility management, national security/intelligence, prison issues or for records prior to compliance date. You must submit your request in writing and you must state the time period for which you would like the accounting. The accounting will include the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; and a brief statement of the purpose of the disclosure. The Privacy Officer is responsible for receiving and processing patient accounting requests.
Request a Paper Copy of this Notice
You also have the right at any time to receive a paper copy of this notice, even if you have previously received a copy. In addition, you may obtain a copy of this notice at our website, www.ctrenaissance.com.
Renaissance is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. Renaissance will make every reasonable effort to limit the information to "the minimum necessary to accomplish the intended purpose" when using, disclosing or requesting protected health information. Renaissance is required by law to abide by the terms of this notice. Renaissance reserves the right to change our practices and to make the new provisions effective for all health information we maintain, including both health information we already have and health information we create or receive in the future. We will post a copy of the current notice on our web site at www.ctrenaissnace.com. Any time we make a material change to this notice, we will promptly revise and issue the new notice with the new effective date. The most current Privacy Notice will also be available in each reception area in all programs throughout Renaissance.
COMPLAINTS AND REPORTING VIOLATIONS
You may complain to Renaissance and the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated under HIPAA. To file a complaint with us, you should contact our Privacy Officer at the number and/or address listed below. To file a complaint with the Office of Civil Rights in the U.S. Department of Health and Human Services write to: 200 Independence Avenue, SW, Room 509F, HHH Building, Washington D.C. 20201. You will not be retaliated against for filing such a complaint.
Violation of the Confidentiality Law by a program is a crime. Suspected violations of the Confidentiality Law may be reported to the United States Attorney in the district where the violation occurs.
For further information, contact our Privacy Officer, Linda Mosel who is the COO - Outpatient Services for Connecticut Renaissance, Inc.
Phone: (203) 336-5225 x2109
Address: 350 Fairfield Ave Suite 701
Bridgeport, Connecticut 06604