HIPAA Notice of Privacy Practices

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.

We1 are required by law to protect the privacy of your health information.  We also are required to send you this Notice, which explains how we may use information about you and when we can give it out or “disclose” it to others. You also have rights regarding your health information that are described in this Notice.  We are required by law to follow the terms of this Notice.

The term “information” or “health information” in this Notice includes any information we maintain that reasonably can be used to identify you and that relates to your physical or mental health condition, the provision of health care to you, or the payment for such health care.

HOW DO WE USE OR DISCLOSE YOUR HEALTH INFORMATION?

We may use and disclose your health information without your permission for your treatment, to pay for your health care and to operate our business as follows:

We also may use or disclose your health information, in most cases without your permission2, for the following purposes:

If you are present and do not object or if it is an emergency and we determine that it is in your best interest, we may disclose your health information:

Uses and Disclosures that Require Your Written Permission:

In any situation not described above, we will not use or disclose any of your health information unless you sign a written authorization that gives us permission to do so. If you sign an authorization and later change your mind, you can let us know in writing. This will stop any future uses and disclosures of your information but will not require us to take back any information we already disclosed.

We will not use or disclose your health information for marketing purposes or sell your health information without your authorization.

WHAT ARE YOUR RIGHTS?

You have the following rights regarding your health information:

EXERCISING YOUR RIGHTS

Contacting PMHCC:  If you have any questions about this Notice, please contact:

PMHCC
Compliance Officer 
123 S. Broad Street, 23rd Floor
Philadelphia, PA  19109

Phone: (215) 546-0300

Submitting a written request: If you want to exercise any of your rights listed above, mail your written request to:

PMHCC
Compliance Officer 
123 S. Broad Street, 23rd Floor
Philadelphia, PA  19109


Submitting a complaint: If you believe that your privacy rights have been violated, you may submit a complaint to PMHCC by contacting the PMHCC Compliance Officer at:

PMHCC
Compliance Officer 
123 S. Broad Street, 23rd Floor
Philadelphia, PA  19109


You also may file a complaint with the Secretary of the U.S. Department of Health and Human Services at the following address:

U.S. Department of Health & Human Services 
Region III Office for Civil Rights
150 S. Independence Mall West, Suite 372
Philadelphia, PA 19106-9111

It is safe to file a complaint.  No one may hold it against you.


Effective Date and Duration of This Notice:

This Notice is effective on September 25, 2017.

We have the right to change our privacy practices and the terms of this Notice at any time.  We reserve the right to apply any changes in our Notice to information we already have and to information that we receive in the future. If we make an important change to our Notice, we will post the revised Notice online at www.pmhcc.org. You also may obtain a revised  Notice by contacting the PMHCC Compliance Officer.

1 For purposes of this Notice of Privacy Practices, “we” or “us” refers to PMHCC, Inc (PMHCC).
2 Special Protections for Sensitive Information: Federal and Pennsylvania laws require special privacy protections for certain sensitive information about you. Generally, we are required to get your written permission to release any alcohol or drug abuse treatment information relating to you or information that would show that you have HIV of AIDS. In some situations, Pennsylvania law also requires us to have your written permission before we disclose any mental health or intellectual disability information relating to you.

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