Notice of Privacy Practices Effective Date: September 13, 2021
This Notice provides an overview of the privacy practices of Avatar Residential Detox. (also referred to in this Notice as “we,” “us,” and/or “our”. The privacy practices described in this Notice will be followed by all Avatar Residential Detox healthcare professionals, employees, staff, trainees, students, volunteers, and business associates. If you have any questions about this Notice, please contact our Privacy Officer. This Notice describes how protected health information (defined below) about you may be used and disclosed and how you can get access to this protected health information. This Notice is not a complete listing of how we use and disclose your protected health information. This Notice applies to all protected health information held in any form by the Avatar Residential Detox entities listed at the end of this Notice. Please review this Notice carefully. Protected health information (also referred to in this Notice as “medical record,” “health information; and/ or “information”) is your individually identifiable information, whether in electronic, paper, or oral form, which may include, but is not limited to, your geographic information, your demographic information, information on healthcare services you have received or may receive in the future, your healthcare insurance benefits, full-face photographs and any comparable images of you, and any unique numbers that may identify you. Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 U.S.C. Sec. 1320d et seq., 45 C.F.R. Parts 160 and 164, and the Confidentiality Law, 42 U.S.C. Sec. 290 dd-2, 42 C.F.R. Part 2. Under these laws, Avatar Residential Detox Center may not say to a person outside Avatar Residential Detox Center that you attend the program, nor may Avatar Residential Detox Center disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.
Your Information. Your Rights. Our Responsibilities.
Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health information. Avatar Residential Detox Center is not required to agree to any restrictions you request, but if it does agree then it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency.
Under HIPAA you have the right to inspect and copy your own health information obtained by Avatar Residential Detox Center except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal, administrative proceeding, or in other limited circumstances.
Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in Avatar Residential Detox Center records, and to request and receive and account for disclosures of your health-related information made by Avatar Residential Detox Center during the six years before your request. You also have the right to receive a paper copy of this notice.
You have the right to:
You have some choices in the way we use and share information as we: See page 3 for
Our Uses and Disclosures
We may use and share your information as we:
Your Rights: When it comes to your health information, you have certain rights. This section explains your rights and our responsibilities to help you.
Get an electronic or paper copy of your medical record:
-You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. To request a copy of your medical record, please contact our medical records department.
-We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record:
-You can ask us to correct health information about you that you think is incorrect or incomplete by submitting the request in writing to the privacy officer, along with proper documentation to support the request.
-We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request Confidential Communications:
-You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
-We will say “yes” to all reasonable requests.
Ask us to limit what we use or share:
-You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
-If you pay for service or health care items out of pocket in full, you can ask us not to share that information for payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information:
-You can ask for a list (accounting) of the times we’ve shared your health information for 6 years before the date you ask, who we shared it with, and why.
-We will include the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice:
-You can ask for a paper copy of this Notice at any time, even if you agreed to receive the Notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you:
-If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
-We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated:
-You can complain if you feel we have violated your rights by contacting our Privacy Officer.
-You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W. Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/
-We will not retaliate against you for filing a complaint
Complaints and Reporting Violations
You may complain to Avatar Residential Detox Center 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. You may complain to us in writing using the information listed in this form. At your request, we will also provide you with the address of the US Department of Health and Human Services. We support your right to the privacy of your health information. 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 occurred.
-For certain health information, you can tell us your choices about what we share. If you have a preference for how we share your information in the situations described below, don’t hesitate to get in touch with our Privacy Officer regarding your preference, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
-Share information with your family, close friends, or others involved in your care
-Share information in a disaster relief situation
In these cases, we never share your information unless you give us written permission:
-Sale of your information
In the case of fundraising:
-We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures:
– How do we typically share your health information? We typically use or share your health information in the following ways.
-We can use your health information and share it with other professionals who are treating you without your consent.
Example: The therapist treating you may need to share treatment notes with your physician.
Run Our Organization:
-We can use and share your health information to run our practice, improve your care, and contact you when necessary without your consent.
Example: We use health information about you to manage your treatment and services.
Bill for Your Services:
-We can use and share your health information to bill and get payment from health plans or other entities without your consent.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Help with Public Health and Safety Issues
We can share health information about you for certain situations such as:
-We can use or share your information for health research.
Our Uses and Disclosures:
-How do we typically share your health information? We typically use or share your health information in the following ways.
Comply with the law:
-We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Address worker’s compensation, law enforcement, and other government requests:
-We can use or share health information about you:
- 1. For workers’ compensation claims
- 2. For law enforcement purposes or with a law enforcement official With health oversight agencies for activities authorized by law
- 3. For special government functions such as military, national security, and presidential protective services.
Respond to lawsuits and legal actions:
-We can share health information about you in response to a court or administrative order or response to a subpoena.
Note on Incidental Disclosures
Changes to the Terms of this Notice
We can change the terms of this Notice without first notifying you. and the changes will apply to all information we have about you, The new Notice will be available upon request, in our office., and on our website.
This Notice of Privacy Practices applies to Avatar Residential Detox, Ringwood, New Jersey.
For more information regarding the Notice of Privacy Practices, please see:
2 Morris Road
Ringwood, NJ 07456