Colonial Behavioral Health
Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Your Privacy is Important * Understanding Your Medical/Health Record Information * How do we use and disclose your health information? * Your Rights Defined by Federal and State Law * Changes to Privacy Notice * If I have a Complaint * If you need more information

Your Privacy is Important
Colonial Behavioral Health understands your privacy is important. We are required by law to maintain the privacy of your protected health information. We are required to provide a notice of our legal duties and privacy practices with respect to your protected health information. We are committed to treating and using protected health information about you responsibly. We strive to safeguard your private health information through administrative, physical and technical means allowed by federal and state law, agency policy and adherence to the most stringent laws that protects your health information. This notice will also describe your rights related to your protected health information. We are required to abide by the terms of this notice. This notice is effective April 14, 2003, and applies to all protected health information as defined by the regulations.

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Understanding Your Medical /Health Record Information
Each time you receive services from Colonial Behavioral Health, we make a record of your visit. Typically this record contains your assessment, service plan, progress notes, diagnosis, treatment, response to medications and plan for future care or treatment. This information is referred to as your health information or medical record. The record serves as a:
 

  • Basis for planning your care and treatment.
  • Means of communication among health professionals who contribute to your care.
  • Legal document describing the care you receive.
  • Means by which you, a third party payor or insurance company can verify that services billed were actually provided.
  • A tool by which we can assess and continually work to improve the care we render and the outcomes we achieve.

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How do we use and disclose your health information?
Upon signing Colonial Behavioral Health’s consent to treatment, you are allowing us to use and disclose necessary information about you within the agency and with our business associates in order to provide treatment, receive payments for provided services and conduct our day to day health care operations.
Listed below are examples of how we use your health information for Treatment, Payment and Healthcare Operations.

Treatment – In order to provide treatment, we disclose this information, within the agency, to your case manager/counselor, physician, nurses, other service providers and administrative staff in order to meet your needs. For example, your Case Manager/Counselor may consult with the various service providers within the agency. At the time of the consultation, your health information may be shared during treatment planning.

Payment – We document the services you receive at each visit so that you, your insurance company or other third party payors can pay us. For example, we may provide copies of your medical record to your insurance company or tell your health plan about upcoming services or services received that require their approval. We also may send you a bill that may include information that identifies you.

Health Care Operations – Health Information is used to improve services we provide to train staff, and students, for business management, quality improvement and for customer service. For example, we may use your health information to review our treatment and services and to evaluate the performance of our staff in caring for you.

There are some services provided in our organization through an agreement with business associates. When these services are contracted, we may disclose your health information to our business associates so they can perform the job we have asked them to do. We require business associates to safeguard your information.

Colonial Behavioral Health is also allowed by federal and state laws to disclose specific health information about you in certain circumstances. We may disclose your health information to:

  • Comply with federal, state or local laws that require disclosure.
  • Assist in public health activities; for example, required reports for health purposes.
  • Inform authorities to protect victims of abuse or neglect.
  • Comply with federal and state health oversight activities such as fraud investigations.
  • Report to the Department of Behavioral Health and Developmental Services statistical data elements in our computer system; and upon request provide and/or allow access to your medical records for oversight review.
  • Respond to law enforcement officials or to judicial orders, subpoenas or other processes.
  • Avert a serious threat to health or safety.
  • Assist in specialized government functions such as national security, intelligence and protective services.
  • Inform military and veteran authorities if you are an armed forces member (active or reserve).
  • Inform a correctional institution if you are an inmate.
  • Inform workers’ compensation carriers to facilitate processing and payment.
  • Communicate with other providers, health plans or their related entities for their treatment or payment activities, or health care operations activities relating to quality assessment, licensing or accreditation.
  • Coroners or medical examiners for identification of a deceased person or to determine cause of death.

We may also use or disclose your personal health information for the following operational purposes to enhance your health care. We may contact you to provide:

You may tell your primary care providers that you do not want us to use or disclose your information for the above three activities.

All other uses and disclosures for reason other than for treatment, payment and health care operations not previously described may only be done with your written authorization. You may revoke your authorization; however, this will not affect prior uses and disclosures. Request for revoke of your authorization must be done in writing.

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Your Rights Defined by Federal and State Law
Although your medical record is the property of Colonial Behavioral Health, the protected health information belongs to you. You have the right to:

  • Inspect or request copies of your medical records. This right is not absolute. In certain situations, if accessing your information would cause harm, we can deny access. If you are denied access, you will receive a written notice of the decision and reason. If you receive copies of your medical records, we can charge a reasonable fee for the copying. Request must be in writing. *
  • Request amendment of your medical records if you believe information in the record is inaccurate or incomplete. We may deny the request for certain reasons but you will be provided with a written explanation of the denial. *
  • Obtain an account of disclosures of your medical record information made after April 14, 2003 that were not for the purpose of treatment, payment, health care operations or that were not authorized by you. *
  • Request that we communicate with you about your health information/medical matters in a certain way or at a certain location. For example, specific telephone number and/or address. *
  • Request a restriction with regard to use or disclosure of your protected health information. You will be informed promptly whether we will be able to honor the request restriction. We will still offer effective services, receive payment and maintain health care operations. We are not required to agree to any restrictions that you request. However once an agreement is made, we are bound by that agreement except under certain emergency circumstances. *
  • Obtain a paper copy of this Privacy Notice at any time upon your request.
  • Revoke any authorization to disclose confidential information except to the extent that action has already been taken. *

Fees may apply to request followed by a asterisk (*). Contact your primary care provider if you wish to exercise your rights.

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Changes to Privacy Notice
Colonial Behavioral Health reserves the right to change privacy practices, and make the new practices effective for all the information we maintain. Revised notices will be posted in our facilities and we will offer you a copy when you receive services.

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If I have a Complaint
If you believe that your privacy has been violated, you may file a complaint with the agency Privacy Officer or with the Secretary of Health and Human Services in Washington, D.C. We will not retaliate or penalize you for filing a complaint with the facility or the Secretary.

To file a complaint or receive more information write or contact:

Jacque Jamason, Compliance Officer
1657 Merrimac Trail
Williamsburg, Virginia 23185
(757) 220-3200
(757) 229-7173 fax

 To file a complaint with the Secretary of Health and Human Services call or write to:

Region III OCR
Health and Human Services
150 S. Independence Mall West, Suite 372
Philadelphia, PA 19106-9111
(215) 861-4441 Main Line
(800) 368-1019 Hotline
(215) 861-4431 Fax
(215) 861-4440 TDD

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If you need more information

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