This notice describes how identifiable medical/health information about you (your family member or someone else) may be used and disclosed and how you can get access to this information. Please review it carefully.
This notice is effective on April 14, 2003. If you have questions about this notice please call SKIP at (212) 268-5999 and ask for Mary Mulvey, the Compliance Officer.
This is your Health Information Privacy Notice from SKIP. You are receiving this notice because you, a member of your family or someone else you know have requested or are receiving services from SKIP. (For simplicity this notice will refer to you, a member of your family or someone else as “you” throughout this document.) We understand that information about you is personal. We strongly believe in protecting the confidentiality and security of all the information we collect. We will share information only with those who need to know, and are permitted to see the information to assure the provision of quality goods and services.
This notice describes how we safeguard the Protected Health Information we have which relates your involvement with SKIP, and how we may use and disclose this information. Protected Health Information includes individually identifiable information, which relates to your past, present or future health, treatment and/or payment for health care services. This notice also describes your rights with respect to Protected Health Information and how you can exercise those rights.
HIPAA requires that we:
All SKIP employees, business associates and volunteers are bound by the contents of this notice. Protected Health Information consists of all the information we create or keep that relates to your health or care and treatment. It includes, but may not be limited to, your name, address, birth date, social security number, your medical information and other information regarding the care you receive.
We safeguard your Protected Health Information from inappropriate use or disclosure. Our employees, and others who provide you with services, are required to comply with these requirements that protect the confidentiality of your Protected Health Information. They may look at your Protected Health Information only when there is an appropriate reason to do so, such as to furnish goods or services, or to administer these, etc.
We will not disclose your Protected Health Information to any other company for their use in marketing their products to you. However, as described below, we will use and disclose Protected Health Information about you for business purposes relating to services you have requested or receive from SKIP. We will request you to sign a global Authorization for the Request and/or Release of Health-Related Information so that we can use and disclose certain types of information. Although we will not deny you services, we will be unable to provide you with effective services without this non-specific authorization. You must reauthorize this document on an annual basis.
We may use and disclose your Protected Health Information with an Authorization for the Request and/or Release of Health-Related Information without your specific permission for the purposes described below. For each use and disclosure category, we offer a brief explanation and an example. While not every use or disclosure is described, all of the ways we will use or disclose will fall into these categories. Your specific written authorization is required for release of Protected Health Information for other purposes. This is described later in this notice.
OTHER USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR SPECIFIC PERMISSION:
USES AND DISCLOSURES THAT REQUIRE YOUR VERBAL AGREEMENT AND AUTHORIZATION
SKIP may disclose Protected Health Information to the following persons if we tell you we are going to use or disclose it and you agree and do not object:
USES AND DISCLOSURES THAT REQUIRE YOUR SPECIFIC AUTHORIZATION
Other uses and disclosures of Protected Health Information not covered by this notice, and permitted by law, will be made only with your specific written authorization or that of your legal representative. This authorization must indicate what information is to be shared, who is to receive the information, the purpose of the disclosure and an expiration date for the authorization. Specific authorizations are always required for use and disclosure of psychotherapy notes and for marketing purposes. You may revoke this specific authorization in writing at any time. If we have already used or disclosed Protected Health Information based upon your specific authorization, we will not be able to take back any disclosures we have made during the time the specific authorization was in effect.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION THAT SKIP MAINTAINS
The following are your rights under HIPAA concerning your Protected Health Information:
You will not be penalized for filing a complaint.
ADDITIONAL INFORMATION
We reserve the right to change the terms of this notice at anytime. We reserve the right to make the revised notice effective for Protected Health Information we already have about you as well as any Protected Health Information we receive in the future. The effective date of this notice and any revised notice may be found in the bottom right hand corner. You will receive a copy of any revised notice.
For additional information regarding SKIP’s HIPAA Medical Information Privacy Policy or our general privacy policies, please contact Mary Mulvey at (212) 268-5999.