Notice to Client or Guardian Regarding Protected Health Information
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.
All information that is provided during the screening, admission, and treatment/habilitation process is considered confidential by the employees, interns, and volunteers of Club Nova. We are required to protect the privacy of health information about you, and the disclosure of protected health information will be governed by North Carolina General Statute 122C, federal law regarding substance abuse records 42 CFR Part 2, and the Health Insurance Portability and Accountability Act of 1996, as well as any other applicable federal or state laws.
NC-Topps outcome data is included in the “audit or evaluation exception” of the laws cited above, which allows collection and sharing of Protected Health Information (PHI) with state and local government agencies for the purpose of oversight and evaluation of the quality and effectiveness of service.
Exchange and use of protected health information between Club Nova staff and/or Club Nova programs for the purpose of treatment, payment, or healthcare operations will be permitted and based on “need to know” guidelines, and positional authority. For example:
- Information obtained about you by a psychiatrist, therapist, case manager, nurse or other member of your treatment team will be recorded in your record and used to determine the course of treatment that should work best for you.
- Treatment team members will also be expected to discuss your progress in treatment on a routine basis.
- Information about the services you receive will be submitted and processed by the Administrative Unit so that we can be paid or you can be reimbursed.
- Your medical record may also be pulled for review by the Quality Improvement Representative in preparation for an audit or for other internal review to improve the quality and effectiveness of the services Club Nova provides.Disclosure of protected health information outside of Club Nova is permitted when you or your legal representative signs a written authorization, or gives verbal authorization in an emergency situation. Any authorization for disclosure may be revoked at any time, except to the extent that action has been taken in reliance on it.You have the right to request restriction of the disclosure of your health information, except when Club Nova is required do so. Under the following specific conditions, disclosure of information outside of Club Nova is permitted and/or required by law and professional ethics without your specific authorization:
- When there is a medical or psychiatric emergency involving your health or safety or the safety of others.
- When Club Nova is required by law to report instances of neglect or abuse of a child or disabled adult.
- When the disclosure is for judicial or administrative proceedings and Club Nova is responding to an order of a court or administrative tribunal.
- When Club Nova is required by North Carolina Administrative Code to disclose physician information due to an incident which would cause health risk to other persons.
- When Club Nova authorizes research for the purpose of program planning and evaluation of services through the use of statistical information that can not be linked to any individual.Club Nova uses computerized records to meet statistical, financial, and medical record requirements. Club Nova will comply with expected norms for security of electronic records and will make every effort to secure any identifying information that is transmitted outside of the organization.You also have other rights related to the use and discloser of health information in your medical record. These rights include:
- Right to request your medical record be designated as a “Secure/Hot File” All medical records are considered to be secure and confidential. However, if special circumstances exist (ex. You are the neighbor of a Club Nova employee) you may request that your record be filed as a “Secured/Hot File”. We will make every effort to accommodate your request, but we are not required to do so.
- Right to inspect and request a copy of your medical record. If you would like to inspect or receive a copy of your health information, please contact your local provider for instructions on how to submit a written request. W e may deny your request in very limited circumstances. I f we deny your request, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial. IF your request is approved, we may charge a reasonable fee for the costs of copying, mailing or other supplies associated with any request for copies.
- Right to request amendment of any section of your medical record. If you feel that we have information that is inaccurate or incomplete, you have the right to request that your record be amended. IF we deny your request we will notify you in writing of our reason and will describe your rights to provide a written statement disagreeing with our denial.
- Right to request an alternative method of contact. Club Nova may call you or mail information to you regarding appointment reminders, billing information, or other information about treatment alternatives or services that might be of interest to you. If you like to request an alternative method of contact please notify your local provider. We will accommodate reasonable requests, but may condition our accommodation on your providing us with information regarding how payment, if any, will be handled.
- Right to a copy of this Notice. You have the right to receive a paper copy of this notice. Club Nova reserves the right to change this notice and to make the new notice effective for all protected health information that is maintained in hard copy or electronic format. Revisions to the NOTICE OF PRIVACY PRACTICES will be made available at Club Nova for distribution to all consumers.Club Nova recognizes the importance of confidentiality, and your right to be fully informed of all regulations regarding protected health information. If you fell that your privacy right have been violated you may contact Club Nova’s Client Rights Coordinator at 919-968-6682 to file a complaint. Our you may contact the Secretary of North Carolina Department of Health and Human Services, 2001 Mail Service Center, Raleigh, North Carolina 27699-2001, or 919-733-4534; or the U.S. Secretary of Health and Human Services, 200 Independence Avenue SW, Washington, DC 220201, or 1-877-696-6775.Provision of services will not be affected by the filling of any complaint