Summary of Privacy Practices
This notice briefly describes how medical information about you may be used and shared and how you can get access to this information. This is a summary; a more complete and detailed version of this can be found in our official “Notice of Privacy Practices” that is available at every NSMHA site. It may also be accessed here in English and Spanish.
If you have any questions about the privacy of your information at NSMHA, please contact the Privacy Officer:
265 Beach St.
Revere, MA 02151
“Protected Health Information (PHI)” is the technical term for the health care information about you that we collect and maintain as part of your record as a client of NSMHA. It can include any information that can identify you and relates to your past, present, or future health, diagnoses, treatment, or payment for treatment.
How We Will Use and Disclose Your Health Information
Uses and Disclosures for Which Authorization is Not Required
We may legally use and share your information, without your authorization, in order to provide your services, access payment for your services, run our organization, carry out fundraising, and to inform you about certain health related benefits and services.
Uses and Disclosures Allowed or Required By Law
We may use and share your health information for the following purposes, most of which are public health and safety related:
- Research (some limits)
- As required by law
- To avert a serious threat to health and safety
- To support tissue/organ donation
- Public health systems
- Workman’s Compensation authority
- Health oversight
- As required in legal proceedings
- To support law enforcement activities
- Medical examiners or funeral directors
- Military and veterans authorities
- National security initiatives
- Correctional facilities (if incarcerated)
- We may also share information with your friends or family in the event of a serious medical situation if it seems in your best interest and you have not or cannot tell us your preference.
- In the event of your death, your health information can be disclosed under certain circumstances (see complete notice for details)
Uses and Disclosures of Your Health Information with Your Permission
- If we were to use your health information for marketing …
- If we were to sell your health information …
- If we were to share your psychotherapy notes with anyone …
We would need your signed authorization.
Any other uses and disclosures not described in this Notice of Privacy Practices will only be made with your signed authorization.
Confidentiality of Substance Abuse Records
For individuals who have received treatment, diagnosis, or referral to treatment from our drug or alcohol abuse programs, the confidentiality of their health information is protected by additional federal regulations. We will not share any of your information about such services – except in certain circumstances, such as medical emergency or a court order without your permission.
Genetic information is legally health information, and health plans and insurers are prohibited from using or disclosing PHI that is genetic information for underwriting purposes.
Your Rights Regarding Your Health Information
With regard to your health information, you have the following rights:
- Right to revoke authorizations, or tell us those you do not want to have access
- Right to access and inspect PHI
- Right to receive (for nominal fee) a copy of your PHI in an electronic or paper format within 30 days
- Right to receive a list of those who have received your PHI going back six years
- Right to restrict a provider (NSMHA) from sharing information with your insurance company if you pay out of pocket and in full for the service
- Right to have us respect any guardian or other person acting on your behalf as we would you
- Right to have your PHI sent to a third party within 30 days
- Right to confidential communications in a format that suits your preference (email, fax, phone, etc.)
- Right to change your PHI if you feel there are errors or information missing
- You have the right to be notified in the event there is a “breach,” or your PHI is unsecured.
- Right to receive a paper copy of the complete “Notice of Privacy Practices,” which is available at all NSMHA sites.
If you believe we have violated your privacy rights, you may file a complaint with us. To file a complaint, please contact:
North Suffolk Mental Health Association
265 Beach St.
Revere, MA 02151
We will not retaliate against you for filing a complaint.
You may also file a complaint with the federal government through the Department of Health and Human Services. You can file a complaint (and find forms that you can print and mail) at the following web address: http://www.hhs.gov/ocr/privacy/hipaa/complaints. You can also contact them at the phone number and address below:
Office for Civil Rights, DHHS
JFK Federal Building – Room 1875
Boston, MA 02203
(617) 565-1340; (617) 565-1343 (TDD)
(617) 565-3809 FAX