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Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Pledge Regarding Health Information
We understand that medical information about you and your health is personal. The Family Center is committed to protecting medical information about you.
This Notice describes how we protect the personal health information (PHI) we have about you which relates to the services you receive at our clinic.
PHI includes 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.
This Notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of medical information. We are required by law to:
- Maintain the privacy of PHI;
- Give you this Notice of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the Notice that is currently in effect.
How We May Use And Disclose Health Information About You.
The following categories describe different ways that we use and disclose medical information without your consent. For each category of uses or
disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the
ways we are permitted to use and disclose information will fall within one of the categories.
- For Treatment at The Family Center. We may use and disclose PHI to provide you with medical treatment or services at the Family
Center. For example, information obtained from a nurse, physician or other member of your health care treatment team will be recorded in your record
and used to determine the course of treatment for you. Members of your treatment team will then record the actions they took and their observations.
- For Payment. We may use and disclose PHI so that the treatment and services you receive at the clinic may be billed and payment may
be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about treatment you received from
our clinic so your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive to
obtain prior approval or to determine whether your plan will cover the treatment. However, the information disclosed will be limited to the nature of
services provided, the dates of services, the amount due and other relevant financial information. If it becomes necessary to use collection processes
due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.
- For Health Care Operations. We may use and disclose PHI for operations of the Family Center. These uses and disclosures are
necessary to run the Family Center and make sure that all of our clients receive quality care. For example, we may use medical information to review
our treatment and services and to evaluate the performance of our staff in caring for you. For employee training or teaching purposes, PHI will be
disclosed only with your authorization.
- Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for
treatment at our clinic. We may also tell family or close friends, involved in your care, your appointment time (ex: Spouse calls to see what time an
appointment is for his/her spouse).
- To Avert a Serious Threat to Health or Safety. We may use or disclose your PHI to the extent which is necessary to protect your
safety or the safety of others, if (1) you present a clear and present danger to yourself, or (2) you have communicated an explicit threat to kill or
inflict serious bodily injury upon another person, and there is a basis for reasonable belief that the threat may be carried out. If information is
disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including
the target of the threat.
- As Required by Law. We may disclose PHI as required by law, such as the mandatory reporting of child abuse or neglect or mandatory
government agency audits or investigations.
- Business Associates. Some services in our organization we obtain through contracts with business associates. When we contract with a
business associate, (ex: Attorneys, Accountants or Billing Companies) we may disclose health information to our business associate so it can do the job
we've asked it to do. To protect your health information, we require the business associate to appropriately safeguard your health information.
- Judicial and Administrative Proceedings. In any judicial or administrative proceeding, you have the right to refuse to authorize the
disclosure of any communication between you and a social worker, psychiatrist or psychologist relating to your care and treatment. There are a few
instances in which this privilege would not apply, and in those instances, the care provider could testify in the judicial or administrative proceeding.
For example, such communications may be disclosed during judicial or administrative proceedings, if (i) the care provider determines that you need
hospitalization or are a threat to yourself or to others; (ii) the communications were made in the course of a court-ordered psychiatric examination;
(iii) you are a party to a case and you have introduced your mental or emotional state as an element of a claim or defense; or (iv) in connection with
any malpractice action brought by you against the care provider. The communications may also be disclosed in judicial or administrative proceedings if
they relate to your ability to provide care or custody in a child custody or adoption case; in court proceedings involving the care and protection of
children or to dispense with the need for parental consent to adoption; or if the care provider believes a child, a disabled person, or an elderly
person in your care is suffering abuse or neglect.
- In an Emergency. We may disclose your PHI to a physician who requests such information in the treatment of a medical or psychiatric
emergency. If it is not possible to obtain your consent to this disclosure, then notice of the disclosure will be provided to you as soon as possible.
- If Required by Court Order. We may disclose your PHI in a judicial proceeding if required by a Court order.
Other Uses Of Health Information
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your
written authorization. If you provide us an authorization to use or disclose medical information about you, you may revoke that authorization, in writing,
at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by the written
authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to
retain our records of the care that we provide to you.
Your Rights Regarding Health Information About You
- Right to Inspect and Copy. You (or your authorized representative) have the right to inspect and copy medical
information that may be used to make decisions about your care. To inspect and copy medical information that may be used to make decisions about you,
you must submit your request in writing to The Family Center, 366 Somerville Ave., Somerville, MA 02143. If you request a copy of the information, we may
charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request. The Family Center will act on this request
within thirty days. Your right to inspect and copy your PHI will be restricted only in those situations where there is compelling evidence that access
would be reasonably likely to endanger the life or physical safety of you or another person.
- Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the
information, although we are not required to agree to the amendment. To request an amendment, your request must be made in writing and submitted to
The Family Center, 366 Somerville Ave., Somerville, MA 02143.
- Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of certain
disclosures we made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to The
Family Center, 366 Somerville Ave., Somerville, MA 02143. The first list you request within a 12-month period will be free. For additional lists, we will
notify you of the charge involved for the costs of providing the list or you may 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 medical information we use or
disclose about you for treatment, payment or health care operations. We are not required by federal regulation 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 The Family Center, 366 Somerville Ave., Somerville, MA 02143. In your request, you must tell us (1) what information you want to limit; (2)
whether you want to limit our use, disclosure, or both; and (3) to whom you want the 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 medical 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 The Family Center, 366 Somerville Ave., Somerville, MA 02143. We will not ask you the reason for your request.
We will accommodate all reasonable requests.
- Right to Paper Copy of this Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this
Notice at any time. To obtain a paper copy of this Notice, contact the Receptionist at 617-628-8815.
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 medical
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 the clinic.
In addition, you may request a copy of the revised Notice by writing to The Family Center, 366 Somerville Ave., Somerville, MA 02143.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Office for Civil Rights. To file
a complaint with us, you must submit your complaint in writing to: The Family Center, 366 Somerville Ave., Somerville, MA 02143. To file a complaint with
the Office of Civil Rights, you must submit your complaint in writing to: Office for Civil Rights, U.S. Department of Health and Human Services,
Government Center, J.F. Kennedy Federal Building--Room 1875, Boston, Massachusetts 02203. Voice phone (617) 565-1340. FAX (617) 565-3809. TDD
(617) 565-1343. We will not retaliate against you for filing a complaint.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT THE PRIVACY OFFICER AT THE FAMILY CENTER, 366 SOMERVILLE AVE., SOMERVILLE MA,
02143, 617-628-8815.
Client's Rights
Every such patient or resident of said facility shall have, in addition to any other rights provided by law, the right to freedom of
choice in his selection of a facility, or a physician or health service mode, except in the case of emergency medical treatment or as otherwise provided
for by contract, or except in the case of a patient or resident of a facility named in section fourteen A of chapter nineteen; provided, however, that
the physician, facility, or health service mode is able to accommodate the patient exercising such right of choice.
Every such patient or resident of said facility in which billing for service is applicable to such patient or resident, upon reasonable request, shall
receive from a person designated by the facility an itemized bill reflecting laboratory charges, pharmaceutical charges, and third party credits and
shall be allowed to examine an explanation of said bill regardless of the source of payment. This information shall also be made available to the
patient's attending physician.
Every Client Of Our Clinic Shall Have The Right:
- upon request, to obtain from the facility in charge of his care the name and specialty, if any, of the physician
or other person responsible for his care or the coordination of his care;
- to confidentiality of all records and communications to the extent provided by law;
- to have all reasonable requests responded to promptly and adequately within the capacity of the facility;
- upon request, to obtain an explanation as to the relationship, if any, of the facility to any other health care facility or educational institution
insofar as said relationship relates to his care or treatment;
- to obtain from a person designated by the facility a copy of any rules or regulations of the facility which apply to his conduct as a patient or
resident;
- upon request, to receive from a person designated by the facility any information which the facility has available relative to financial assistance
and free health care;
- upon request, to inspect his medical records and to receive a copy thereof in accordance with section seventy, and the fee for said copy shall be
determined by the rate of copying expenses, except that no fee shall be charged to any applicant, beneficiary or individual representing said applicant
or beneficiary for furnishing a medical record if the record is requested for the purpose of supporting a claim or appeal under any provision of the
Social Security Act or federal or state financial needs-based benefit program, and the facility shall furnish a medical record requested pursuant to a
claim or appeal under any provision of the Social Security Act or any federal or state financial needs-based benefit program within thirty days of the
request; provided, however, that any person for whom no fee shall be charged shall present reasonable documentation at the time of such records request
that the purpose of said request is to support a claim or appeal under any provision of the Social Security Act or any federal or state financial
needs-based benefit program;
- to refuse to be examined, observed, or treated by students or any other facility staff without jeopardizing access to psychiatric, psychological, or
other medical care and attention;
- to refuse to serve as a research subject and to refuse any care or examination when the primary purpose is educational or informational rather than
therapeutic;
- to privacy during medical treatment or other rendering of care within the capacity of the facility;
- to prompt life saving treatment in an emergency without discrimination on account of economic status or source of payment and without delaying
treatment for purposes of prior discussion of the source of payment unless such delay can be imposed without material risk to his health, and this right
shall also extend to those persons not already patients or residents of a facility if said facility has a certified emergency care unit;
- to informed consent to the extent provided by law;
- upon request to receive a copy of an itemized bill or other statement of charges submitted to any third party by the facility for care of the patient
or resident and to have a copy of said itemized bill or statement sent to the attending physician of the patient or resident; and
- if refused treatment because of economic status or the lack of a source of payment, to prompt and safe transfer to a facility which agrees to receive
and treat such patient. Said facility refusing to treat such patient shall be responsible for: ascertaining that the patient may be safely transferred;
contacting a facility willing to treat such patient; arranging the transportation; accompanying the patient with necessary and appropriate professional
staff to assist in the safety and comfort of the transfer, assure that the receiving facility assumes the necessary care promptly, and provide pertinent
medical information about the patient's condition; and maintaining records of the foregoing.
Every Client Of The Clinic Shall Be Provided By The Clinician In Our Clinic The Right:
- to informed consent to the extent provided by law;
- to privacy during medical treatment or other rendering of care within the capacity of the facility;
- to refuse to be examined, observed, or treated by students or any other facility staff without jeopardizing access to psychiatric, psychological or
other medical care and attention;
- to refuse to serve as a research subject, and to refuse any care or examination when the primary purpose is educational or informational rather
than therapeutic;
- to prompt life saving treatment in an emergency without discrimination on account of economic status or source of payment and without delaying
treatment for purposes of prior discussion of source of payment unless such delay can be imposed without material risk to his health;
- upon request, to obtain an explanation as to the relationship, if any, of the physician to any other health care facility or educational
institutions insofar as said relationship relates to his care or treatment, and such explanation shall include said physician's ownership or financial
interest, if any, in the facility or other health care facilities insofar as said ownership relates to the care or treatment of said patient or resident;
- upon request to receive an itemized bill including third party reimbursements paid toward said bill, regardless of the sources of payment;
- in the case of a patient suffering from any form of breast cancer, to complete information on all alternative treatments which are medically viable.
Except in cases of emergency surgery, at least ten days before a physician operates on a patient to insert a breast implant, the physician shall inform the
patient of the disadvantages and risks associated with breast implantation. The information shall include, but not be limited to, the standardized written
summary provided by the department. The patient shall sign a statement provided by the department acknowledging the receipt of said standardized written
summary. Nothing herein shall be construed as causing any liability of the department due to any action or omission by said department relative to the
information provided pursuant to this paragraph. The department of public health shall:
- develop a standardized written summary, as set forth in this paragraph in layman's language that discloses side effects, warnings, and cautions for a
breast implantation operation within three months of the date of enactment of this act;
- update as necessary the standardized written summary;
- distribute the standardized written summary to each hospital, clinic, and physician's office and any other facility that performs breast implants; and
- provide the physician inserting the breast implant with a statement to be signed by the patient acknowledging receipt of the standardized written summary.
Every maternity patient, at the time of pre-admission, shall receive complete information from an admitting hospital on its annual rate of primary
caesarian sections, annual rate of repeat caesarian sections, annual rate of total caesarian sections, annual percentage of women who have had a caesarian
section who have had a subsequent successful vaginal birth, annual percentage of deliveries in birthing rooms and labor-delivery-recovery or
labor-delivery-recovery-postpartum rooms, annual percentage of deliveries by certified nurse-midwives, annual percentage which were continuously
externally monitored only, annual percentage which were continuously internally monitored only, annual percentage which were monitored both internally
and externally, annual percentages utilizing intravenous, inductions, augmentation, forceps, episiotomies, spinals, epidurals and general anesthesia,
and its annual percentage of women breast-feeding upon discharge from said hospital.
A facility shall require all persons, including students, who examine, observe or treat a patient or resident of such facility to wear an identification
badge which readily discloses the first name, licensure status, if any, and staff position of the person so examining, observing or treating a patient or
resident; provided, however, that for the purposes of this paragraph, the word facility shall not include a community day and residential setting
licensed or operated by the department of mental retardation.
Any person whose rights under this section are violated may bring, in addition to any other action allowed by law or regulation, a civil action under
sections sixty B to sixty E, inclusive, of chapter two hundred and thirty-one.
No provision of this section relating to confidentiality of records shall be construed to prevent any third party reimburser from inspecting and copying,
in the ordinary course of determining eligibility for or entitlement to benefits, any and all records relating to diagnosis, treatment, or other services
provided to any person, including a minor or incompetent, for which coverage, benefit or reimbursement is claimed, so long as the policy or certificate
under which the claim is made provides that such access to such records is permitted. No provision of this section relating to confidentiality of records
shall be construed to prevent access to any such records in connection with any peer review or utilization review procedures applied and implemented in
good faith.
No provision herein shall apply to any institution operated by and for persons who rely exclusively upon treatment by spiritual means through prayer for
healing, in accordance with the creed or tenets of a church or religious denomination, or patients whose religious beliefs limit the forms and qualities
of treatment to which they may submit.
No provision herein shall be construed as limiting any other right or remedies previously existing at law.
Information About Confidentiality
In general, information discussed during therapy is confidential, unless the client signs a written release of information to be
shared with another individual or agency. However, there are exceptions which we feel you should know.
- If a child under age eighteen (18), a disabled person, or an elderly person is suffering significant injury due to physical or emotional abuse,
the clinician is legally required to file a report with the appropriate state agency.
- If a client is threatening harm to himself/herself, the clinician is required to take the appropriate steps to maintain the client's safety. These
steps might include seeking hospitalization of the client and contacting people who can help.
- If a client is seriously threatening physical violence toward another person, the clinician must take the appropriate steps to maintain the client's
safety. These steps might include seeking hospitalization of the client and contacting people who can help.
- In order to provide the best possible treatment, all clinicians at The Family Center receive supervision in their clinical work, collaborate with a
team of other clinicians, and utilize special consultants when they feel it will be helpful to the therapy they provide. All clinicians, supervisors and
consultants are legally bound by the same limits of confidentiality.
- If an evaluation is being provided under a contract with the Department of Social Services, clients should be aware that their DSS worker will be
included in the evaluation process and a report will be submitted to DSS upon completion of the evaluation. Clients are entitled to see a copy of this
report.
- Should the court subpoena your clinician or your clinical record, the legal requirement will vary depending on the professional discipline to which
your clinician belongs.
- If a client plans to use health insurance or Medicaid to pay for therapy, The Family Center will be required to provide certain information,
including a clinical diagnosis and, at times, a treatment plan or summary. On a rare occasion, the insurance company may require the entire record.
Although Massachusetts law prevents insurers from releasing information about outpatient mental health services without your permission, once it has
been released to them, please note The Family Center cannot be responsible once said information has been released to insurers. (However, Massachusetts
law prohibits insurers from releasing information regarding outpatient mental health services without patients' permission. Clients may request to
receive copies of reports provided to insurers.)
Should you have any questions about confidentiality, please feel free to discuss them with your clinician.
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