This notice describes how medical and mental health care information about you may be used and disclosed and how you can get access to this information.

FOR CASE MANAGEMENT ONLY

Please review it carefully

Understanding your client record/information:

An ongoing record of all client interaction is maintained for each client. Typically, this record contains the reasons for intake to our program, your symptoms, examinations and test results, medication information, diagnoses, task or service plan, notes with progress in addressing your goals, periodic task or service plan reviews, and a plan for future care. At The Dennelisse Corporation this information, often referred to as your Client Record, serves as a basis for planning your care and services and as a means of communication among the many health and social service professionals who contribute to your care. Knowing what is in the record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

Your health information rights:

Unless otherwise required by law, your client record is the physical property of The Dennelisse Corporation as the program that compiled it. However, the information in the record belongs to you. You have the right to request a restriction on certain uses and disclosures of your information, and request changes or additions to your client record. This includes the right to obtain a paper copy of this Privacy Notice, inspect and obtain a copy of your client record, obtain an accounting of disclosures of your health information, request copies of your health information by alternative means (e.g. by fax, e-mail or another form) or at other locations, and revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities:

The Dennelisse Corporation is required to maintain the privacy of your health information. In addition, it is our legal duty to provide you with this notice of privacy practices with respect to information we collect and maintain about you. This organization must abide by the terms of this notice, notify you if we are unable to agree to requested restrictions, and accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. We reserve the right to change our practices and to make the new provisions effective for all protected health information (PHI) we maintain. Should our information practices change, we will provide you with a revised notice. We will also post our new notice on The Dennelisse Corporation website: www.dennelisse-lhcsa.org that provides information about our client services and benefits. With the exception of uses for treatment, payment, or healthcare operations as described in this notice, we will not use or disclose your health information without your authorization.

For more information or to report a problem:

If you have questions and would like additional information, you may contact The Dennelisse Corporation Privacy Officer, Jeanine Hernandez, at 212-265-8320 Ext. 19. If you believe your privacy rights have been violated, you can also file a complaint with our QI staff or follow the instructions on the Patient Rights Posters that are posted in all Program locations. There will be no retaliation for filing a complaint.

Privacy Notice Effective Date April 2003

Examples of disclosures for treatment, payment, and health operations:

We will use your health information for service delivery. For example, information obtained by The Dennelisse Corporation staff who provides Homemaker or Case Management services will be recorded in your client record and used to determine the course of services that are most appropriate for you. By way of example, your worker will document in your record their expectations of the members of your treating team. Members of the team will then record the actions they took and their observations. This information may be shared with other programs within The Dennelisse Corporation where you receive services.

We will use your health information for payment. For example, the information on the billing may include information that identifies you, as well as your diagnosis. Medicaid will be billed for case management services rendered.

We will use your health information for regular health operations. For example, members of the social service staff or the quality assurance staff may use information in your client record to assess the care and outcomes of your case. The information may be used in Program Evaluation studies to assess the care provided and to measure effectiveness of different program models. Client record information may be shared with staff of HASA, ACS, the AIDS Institute and NYSDOHMH. In efforts to improve the quality and effectiveness of the service you receive, the outcome of the program evaluations will be applied. Also, emergency medical information may be provided as needed and we may disclose information to the NYS Central Registry.

Business Associates: There are some services provided in our organization through contracts with Business Associates. One example is the insurance company who we use when making reports of accidents/injures on work premises the NYSDOHMH, ACS, HASA and the AIDS Institute are also Business Associates whose surveyors need to review a sample of our case records to confirm the quality of care provided and to assess our compliance with the DOHMH standards. When our services are contracted, we may disclose some or all of your health information to our Business Associates so that they can evaluate the job they’ve asked us to do. To protect your health information, however, we require the Business Associates to appropriately safeguard your information and we only provide them with the “minimum necessary” information to serve their needs.

Communication with family: In accordance with The Dennelisse Corporation policies and procedures governing consents to release information, social service professionals may disclose your health information to family members, close personal friends or any other person you identify. Unless it is an emergency, your consent will be secured prior to these disclosures.

Food and Drug Administration (FDA): As required by law, we may disclose to the FDA health information relative to adverse events with respect to medication and/or product defects.

Worker’s Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. We may also release information to the NYS Central Registry and may disclose information for emergency medical care.

Correctional Institution: Should you become an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals. An inmate does not have the right to the Notice of Privacy Practices.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provision for your health information to be released to appropriate health oversight agencies, public health authorities or attorneys, provided that an employer or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more clients, workers or the public.

Notice of Privacy Practices availability: This notice will be prominently posted in the office for your review. Clients will be provided a hard copy and the notice will be maintained on our web site: www.dennelisse-lhcsa.org for downloading.

Privacy Notice Effective Date April 2003