Notice of Privacy Practices
This Notice describes how medical and mental health information about you and your family may be used and disclosed and how you can get access to this information. We encourage you to review it carefully.
USE OF YOUR CONFIDENTIAL INFORMATION
- Spurwink may use your information for treatment, payment, and health care operations. For example:
- For treatment: we will use your information to discuss your care and treatment at Spurwink or, with your consent, to coordinate referrals to another program or provider.
- For payment: we may submit portions of your information to your insurance carrier or other third party payer to secure payment on your behalf.
- For health care operations: we may use your information in the course of quality assurance, evaluation, training or audit activities.
- Client records are available to agency staff on a need to know basis. For example:
- Records of clients that receive more than one service from Spurwink are accessible to staff from both programs;
- Continuous Quality Improvement staff conducts client record reviews to ensure compliance with agency record keeping requirements and quality improvement standards.
- We may use your information to contact you for appointment reminders, to provide information about treatment alternatives or other health services; to share important information; or to discuss care or treatment issues.
- Business associates of Spurwink who perform services related to treatment, payment or health care operations may also have access to your information solely for the purpose of providing such services. Business associates of Spurwink must agree, in writing, to maintain the confidentiality of such information. Business associates must also comply with applicable security practices required by law.
- We may disclose information without your authorization as required or permitted by law including any of the following reasons:
- To comply with state and federal laws and regulations;
- To make a required report of abuse or neglect and cooperate with abuse or neglect investigations;
- To comply with health oversight activities by government agencies;
- To comply with a court order, subpoena, or other lawful process;
- To avert a serious threat to health or safety;
- For workers’ compensation purposes;
- In an emergency or for disaster relief purposes, such as to notify family about your whereabouts and condition;
- For research where your information has been di-identified;
- For active members or veterans of the military information may be disclosed as required by the military; or
- To cooperate with the conduct of national security intelligence activities authorized by law.
Except as described above, Spurwink Services will not use or disclose your private health information without your written authorization to do so.
- Spurwink’s Responsibilities:
- To protect and maintain the privacy and security of your protected health information.
- Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
- Follow the duties and privacy practices described in this notice.
- Provide a copy of this notice to you.
Spurwink reserves the right to change our privacy practices, if necessary. If our privacy practices change, the revised notice will be accessible on the agency website (spurwink.org), posted at agency offices, and available upon request from agency staff.
Spurwink participates in HealthInfoNet, the statewide health information exchange designated by the State of Maine. This secure computer based system is being used statewide and helps doctors and other health and behavioral health care providers share important patient health information to improve your care. For example, if you have received services from another health care facility our staff will be able to view this important health information in the HealthInfoNet computer system. This can improve the safety and quality of your health care.
Your record in the HealthInfoNet may include prescriptions, lab and test results, imaging reports, conditions, diagnoses or health problems. To ensure your health information is entered into the correct record, your full name and birth date are also included. All information contained in HealthInfoNet is kept private and used in accordance with applicable state and federal laws and regulations. The information is accessible to participating providers to support treatment and healthcare operations.
You do not have to participate in HealthInfoNet to receive care. For more information about HealthInfoNet and your choices regarding participation, visit www.hinfonet.org or call toll-free 1-866-592-4352.
You have the right to:
- Request restrictions on the use and disclosure of your information. Spurwink will honor all reasonable requests. If you pay for a service in full, you can ask us not to share information for the purpose of payment with your health insurer, unless a law requires us to do so.
- Receive communications from us in a confidential manner. You may elect to allow communication via email, texting, or message left on a voicemail system. You may elect to receive mail in a plain envelope rather than one with Spurwink identified as the return address. Spurwink will honor all reasonable requests.
- Receive a list (accounting) of unauthorized disclosures of your information for six years prior to the date of your request. To receive such an accounting, please contact Spurwink at the address given below. One accounting is provided free of charge every 12 months, but there may be a reasonable charge if you ask for another one within 12 months.
- Authorize and request that we send your information to other health care providers, agencies, or other persons. You may revoke this authorization at any time through verbal or written request, except to the extent that information has been disclosed based upon the previous authorization.
- Review and/or receive a copy of your information, with some exceptions noted in our “Disclosure of Records” policy. If you wish to do so, we will provide you or others you select an opportunity to review your record within three (3) working days of such a request. You may be charged reasonable costs of copying your information or of preparing any summaries that you request.
- Request to amend your information. If you wish to do so, please submit the proposed amendment in writing to your worker or clinician. If approved, he/she will ensure your amended information is added to the record. If we make any written response to your amended information, you will be given a copy. If Spurwink declines your request, a written explanation of the reasons will be provided within 60 days.
- Receive a paper copy of this Notice of Privacy Practices upon request. This notice may be revised and the revised notice will be accessible on the agency website (Spurwink.org), posted at agency offices, and available upon request from agency staff.
- Choose someone to act for you in exercising your rights. For example, if you have a medical power of attorney or legal guardian, that person can make choices about sharing your protected health information. Spurwink will make sure the person has this authority before we take any action in this regard.
- File a complaint to Spurwink Services, the Maine Dept. of Health & Human Services, or the U.S. Department of Health and Human Services if you believe your privacy rights have been violated (see contact information, below).
Be free from any form of retaliation by a Spurwink Services staff for filing a complaint or grievance. If you believe retaliation is occurring, please report this to Spurwink’s Chief Privacy Officer. For More Information or to Make a Complaint Contact
For More Information or to Make a Complaint Contact
Spurwink’s Chief Privacy Officer: Al Durgin, LCSW, Vice President of Continuous Quality Improvement & Outcomes
Mailing Address: 901 Washington Ave., Suite 100 Portland, Maine 04103 Email: firstname.lastname@example.org Telephone: (207) 871-1200, Ext 2184
OR YOU MAY CONTACT ONE OF THESE STATE OR FEDERAL AGENCIES FOR ASSISTANCE
Maine Dept of Health & Human Services
221 State Street Augusta, ME 04333
TTY: Maine relay 711
Disability Rights Maine
24 Stone St., Suite 204 Augusta, ME 04330
Toll Free: 1-800-452-1948
Federal Office for Civil Rights
Office for Civil Rights, US Dept. of Health & Human Services
email: email@example.com Region I Regional Manager,
Government Center. John F. Kennedy Federal Building-Room 1875 Boston, MA 02203
Fax: (202) 619-3818