Effective Date: April 14, 2003
This notice will tell you about the ways in which we use and disclose your protected health information. We also describe your rights and certain obligations we have regarding the use and disclosure of your protected health information.
The law requires us to:
- Make sure that any protected health information that identifies you is kept private;
- Follow the terms of the notice that is currently in effect.
The following categories describe different ways that we use and disclose your protected health information. For each category we will explain what we mean and try to give some examples. We will not list every use or disclosure in the examples. However, all of the ways we are permitted to use and disclose protected health information will fall within one of the categories.
We May Use and Disclose Your Protected Health Information For:
1. Treatment: We may use your protected health information to provide you with services and supports. We may disclose information about you to case management, clinical support services, and residential or day program staff that provides you services.
- The staff may need to know that you are taking a certain medication or have a condition such as seizures that may effect your program.
- We may disclose your protected health information to doctors, nurses or other health providers who are involved in taking care of you. For instance, a doctor taking care of you for an injury may need to know if you have diabetes because diabetes may affect treatment.
- We may disclose your protected health information to people such as family members or others who take part in your support outside the DDS.
- People who live in DDS operated facilities are billed to pay for a portion of their room and board.
- We bill Medicaid for services provided to people enrolled in the Home and Community Based Services Waiver.
- We provide information to the Department of Administrative Services, Fiscal Services Center so they can act as DDS’s billing agent.
- We may use your protected health information to review our programs and services and to evaluate the performance of our staff or the performance of a contracted provider.
- We may combine health information about many individuals to decide what changes in service might be needed.
- We may also use combined information to evaluate how we are managing changes in resources or services.
information to remind you about appointments for services or treatments.
5. Service Alternatives: We may use or disclose your protected health information to inform you about or recommend possible service or program alternatives that may be of interest to you.
6. Individuals Involved in Your Support or Payment for Your Support: We may disclose your protected health information to a family member, friend, or staff member who is involved in your support. We may also give information to someone who helps pay for your support. We may also tell your family or friends your condition and location if you must leave your residence for health or medical reasons.
7. Research: Under certain circumstances, we may use and disclose your protected health information for research purposes.
8. As Required by Law: We will disclose your protected health information when required to do so by federal, state or local law.
9. To Avert a Serious Threat to Health or Safety: We may use and disclose your protected health information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
10. Workers' Compensation: We may disclose your protected health information for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
11. Public Health Risk: We may disclose your protected health information for public health activities. These activities include the following:
- To prevent or control disease, injury or disability;
- To report births and deaths;
- To report abuse or neglect;
- To report reactions to medications or problems with products;
- To notify people of recalls of products they may be using;
- To notify a person who may haven been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- To notify the appropriate government authority if we believe a person has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
13. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process. We will disclose the information only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
14. Law Enforcement: We may disclose health information if asked to do so by law enforcement officials:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under limited circumstances, we are unable to obtain the person's agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct within one of our programs; and
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
16. National Security and Intelligence Activities: We may disclose your protected health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
17. Protective Services for the President and Others: We may disclose your protected health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state; or to conduct special investigations.
18. Inmates: If you are an inmate of a correctional institution or under custody of a law enforcement official, we may disclose health information about you to the correctional institution or law enforcement official.
This disclosure would be necessary:
1. for the institution to provide you with health care
2. to protect your health and safety or the health and safety of others; or
3. for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your services. Usually, this includes health and billing records but does not include psychotherapy notes.
To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to your Regional Director of Quality Improvement. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy information, in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another manager chosen by DDS will review your request and the denial. The person conducting the review will not be the same person who denied your request. We will comply with the outcome of the review.
Right to Amend: If you feel that health information we have about you is incorrect or incomplete; you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for DDS.
To request an amendment, your request must be made in writing and submitted to your Regional Director of Quality Improvement. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the health information kept by or for DDS;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
To request this list or accounting of disclosures, you must submit your request in writing to your Regional Director of Quality Improvement. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations.
You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or for the payment for your care. For example, you could ask that we not use or disclose information about a surgery that you had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to your Regional Director of Quality Improvement. In your request, you must tell us:
1. What information you want to limit;
2. Whether you want to limit our use, disclose or both; and
3. To whom you want limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to your Regional Director of Quality Improvement. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice: You have a right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our web site: www.ct.gov/dds.
To obtain a paper copy of this notice you can contact your Regional Director of Quality Improvement.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facilities. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you receive new services from us, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with DDS or with the Secretary of the Department of Health and Human Services. To file a complaint with DDS, contact the OMBUDSPERSON at (860) 418-6047 or toll free at (866) 737-0331. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us written permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the services that we provided you.
CONTACTS FOR FURTHER INFORMATION
If you have any questions about this notice please contact the Director of Quality Improvement in your region. Your case manager can also assist you.