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CARS Notice of Privacy Practices
This notice describes how protected health information (PHI) about you may be
used and disclosed and how you can gain access to this information. Please
review it carefully.
We are required by applicable federal and state law to maintain the privacy
of your protected health information. “Protected Health Information” (PHI)
is information about you, including demographic information, that may identify
you and that relates to your past, present, or future physical or mental
health or condition and related health care services. We are also required
to give you this notice about our privacy practices, our legal duties, and
your rights concerning your PHI. We must follow the privacy practices that
are described in this notice while it is in effect. This notice is effective
April 14, 2003, and will remain in effect until we replace it.
We reserve the right to change our privacy practice and the terms of this notice
at any time, provided such changes are permitted by applicable law. We reserve
the right to make the changes in our privacy practices and the new terms of
our notice effective for all PHI that we maintain, including PHI we created
or received before we made the changes. Before we make a significant change
in our privacy practices, we will change this notice and make the new notice
available upon request.
For more information about the privacy practices, questions,
or concerns, please contact:
CARS Privacy Officer
1800 Mesa Vista Road NE
MSC 02 1770
1 University of New Mexico
Albuquerque, NM 87131-0001
Treatment: We may use and disclose your PHI
to provide, manage, and coordinate care among the CARS staff.
For example, the person taking screening information from you
by telephone will relay that information to the CARS clinical
staff prior to your initial appointment. With your written
consent we may use or disclose your PHI to a physician or mental
health provider providing treatment to you or to your health
care insurer to obtain necessary authorizations for your treatment.
Payment: CARS does not charge a fee. If CARS refers
you to a mental health provider identified through your health insurance
plan, with your written consent, we may use and disclose PHI information
necessary to your insurance plan, or other parties who help pay for
your care. For example, should you be referred by CARS to a mental
health provider identified through your health insurance plan, we will
ask you for your consent to provide them the minimum information necessary
to determine your eligibility for services.
Healthcare Operations: We may use and disclose your
PHI in order to support the business operations of CARS. These activities
may include accreditation and quality assessment activities, training
of interns, and other related business activities. For example, we
may contact you to reschedule an appointment. We may also provide you
with information about treatment alternatives or other health-related
benefits/services that may be of interest to you.
Permitted Disclosure with Authorization: You may give
us a written authorization to use your PHI or to disclose to another
person for the purpose you designate. If you give us an authorization,
you may withdraw it in writing at any time. Your withdrawal will not
affect any use or disclosures permitted by your authorization while
it was in effect. Unless you give us a written authorization we can
not use or disclose your PHI for any reason other than those described
in this notice unless disclosure is required by law.
Personal Representatives: We will disclose your PHI
to your personal representative when the personal representative has
been properly designated by you and the existence of your personal
representative is documented to us through a written authorization.
Emergencies: We may use or disclose your PHI in an
emergency treatment situation or to avert a serious threat to your
health or the safety of another. For example, we are required to take
the necessary actions in regard to suicidal or homicidal threats.
Public Benefit: We may use or disclose your
PHI as authorized by law for the following purposes deemed to
be in the public interest or benefit:
- As required by law.
- For public health activities to a public health authority
that is permitted by law to collect or receive this information.
The disclosure will be made for the purpose of controlling
disease, injury or disability.
- To report child abuse or neglect to an agency authorized
by law to receive such reports. We may disclose your PHI if
we believe that you have been a victim of abuse, neglect, or
domestic violence to the government agencies authorized to
receive such a report on a case by case basis. The disclosure
will be made consistent with the requirements of applicable
state and federal laws.
- To health oversight agencies for activities authorized by
law, such as audits, investigations and inspections. Oversight
agencies include government agencies that oversee the health
care system, government benefit programs and civil rights laws.
- In response to court and administrative orders.
- To law enforcement officials pursuant to subpoenas and other
lawful purposes, concerning crime victims, suspicious deaths,
crimes on our premises, reporting crimes in emergencies.
- To avert serious threat to health and safety.
- To the military and to federal officials for lawful intelligence,
counterintelligence, and national security issues.
- To correctional institutions regarding inmates.
- As authorized by and to the extent necessary to comply with
state worker’s compensation laws.
We will make disclosures for the following public interest purposes,
only if you provide us with a written authorization or when disclosure
is required by law:
- To coroners, medical examiners, and funeral directors.
Access: You have the right, with limited exceptions
if we believe the PHI is incorrect or incomplete, to look at
or get copies of your PHI contained in a designated records
set. A “designated records set” contains medical,
mental health and billing records as well as any other records
that your treatment provider and CARS may have compiled in
the course of your treatment. Under federal law, however, you
may not inspect or copy the following records: psychotherapy
notes (unless your treatment provider agrees this is acceptable);
information compiled in reasonable anticipation of, or use
in, a civil, criminal, or administrative action or proceeding;
and PHI that is subject to law that prohibits access to PHI.
To obtain access to your PHI, you must make a request in writing. If we deny
your request, we will provide you a written explanation of the denial and inform
you if the denial can be reviewed.
Disclosure Accounting: You have a right to receive
an accounting of certain disclosures we have made of your PHI since
April 14, 2003. This right applies to disclosures for purpose other
than treatment, payment, or health care operations as described in
the Notice of Privacy Practices. It also excludes disclosures made
pursuant to your signed authorization.
Restriction: You have the right to request that we
place additional restrictions on our use or disclosure of your PHI.
We are not required to agree to these additional restrictions, but
if we do, we will abide by our agreement except in an emergency. Any
agreement we make to a request for additional restrictions must be
in writing signed by a person authorized to make such an agreement
on our behalf.
Confidential Communication: You have the right to
request that we communicate with you about your PHI by alternative
means or to alternative locations. You must make your request in writing
and you must state that the information could endanger you if the communication
means or location is not changed. We may condition this accommodation.
Amendment: You have the right, with limited exceptions,
to request that we amend your PHI. Your request must be in writing
and it must explain why the information must be amended. We may deny
your request if we did not create the information you want amended,
and for certain other reasons. If we deny your request, we will provide
you with a written explanation. You have a right to file a statement
of disagreement with CARS and we may prepare a rebuttal to your statement
and will provide you with a copy of the rebuttal.
Right to Receive a Copy of this Notice: You may request
a copy of this notice at any time by contacting our Privacy Officer.
If you believe your privacy rights have been violated, you may file a complaint
to one or both of the following departments: UNMHSC Privacy Officer or U.S.
Dept. of Health and Human Services.
UNMHSC Privacy Officer
2211 Lomas Blvd., NE
Albuquerque, NM 87106
Phone: (505) 272-2121
Fax: (505) 272-1827
TDD: (505) 272-2111
Ralph Rouse, Regional Mgr (Region VI-NM)
Office of Civil Rights; US Dept of Health& HR
1301 Young Street, Suite 1169
Dallas, TX 75202
Phone: (214) 767-4056
Fax: (214) 767-0432
TDD: (214) 767-8940
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