Medical privacy regulations issued by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) become effective April 14, 2003. We are required by law to maintain the privacy of your mental health information and to provide you with this notice of our legal duties and privacy practices with respect to your mental health information.

This notice is designed to inform you about the Ackerman Institute for the Family’s Privacy Practices. These privacy practices will be followed by our employees, staff, and all office personnel. We are required by law to give you this notice. This notice will describe how we may use and disclose information that is called “protected health information” (PHI). PHI is any information, whether it is oral, recorded, or demographic data that may identify you (i.e., name, address, diagnosis) or that may relate to your past, present or future mental health. We will also outline your rights and our obligations regarding the use and disclosure of that information.

The Ackerman Institute for the Family is required to abide by the terms of this Notice of Privacy Practices, in effect as of April 14, 2003

Any changes to this notice will be posted at the Ackerman Institute and will be available on our website www.ackerman.org.

IF YOU HAVE ANY QUESTIONS OR ISSUES REGARDING THIS NOTICE PLEASE CONTACT ACKERMAN INSTITUTE’S PRIVACY OFFICER:

Melanie Benvenue, MPA
212-879-4900, ext 120

This notice describes your rights regarding health information we maintain about you and a brief description of how you may exercise these rights. This notice further states the obligations we have to protect your mental health information.

Uses and Disclosures of your Mental Health Information Without your Permission:

We will use and disclose your mental health information for treatment, payment and operations purposes within our Institute, with appropriate staff members only, without any authorization from you.

Treatment includes:

• direct provision of mental health services
• consultation (e.g. with treatment team, psychiatrist)
• transfer between therapists

Payment includes:

• obtaining eligibility verification, pre-authorization, ongoing authorization
• billing
• claims
• collection

Health Care Operations include:

• matters related to quality improvement
• utilization review
• general administration
• business planning and management
• legal and auditing services
• site visits pertaining to licensing and accreditation

In all of the above situations, we will make reasonable efforts to limit protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure or request.

We may also use and disclose your mental health information without your authorization or opportunity to object in the following situations:

1. Emergencies: We may use and disclose your information in emergency treatment situations (for example, admission to hospital, ambulance).
   
   
2. As required by law: We will use and disclose your information when we are required to do so by federal, state or local law.
   
   
3. To avert a serious threat to health or safety: We may use and disclose your information when necessary to prevent a serious and imminent threat to your health and safety or to the health and safety of the public or another person. Under these circumstances we will only disclose health information to someone who is able to help prevent or lessen the threat.
   
   
4. Public health activities: We may disclose mental health information about you as necessary for public health activities including disclosures to:
   
   
   • report to public health authorities for the purpose of preventing or controlling disease, injury or disability;
   • report vital events such as deaths, as required by NYS law;
   • report child abuse or neglect;
   • report to the Food and Drug Administration (FDA) information about defective products or problems with medications;
   • notify a person who may have been exposed to a communicable disease or who is at risk of contracting or spreading a disease or condition.

We may disclose mental health information about you to a health oversight agency for activities authorized by law. These include government agencies that oversee the mental health care system, government benefit programs such as Medicaid, and other government programs regulating mental health care.

We may disclose mental health information about you to a court or administrative agency when a judge orders us to do so via a subpoena. We will make a reasonable effort to notify you to obtain your authorization.

In all of the above, disclosure will be limited to information necessary to carry out the purpose of the disclosure.

Uses and Disclosures of your Mental Health Information with your Permission:

Except for the above-outlined areas, Ackerman Institute for the Family would request your written authorization to release your mental health information. At any time during your treatment, you may revoke your authorization in writing. If you revoke your authorization, we will not make any further uses or disclosures of your mental health information under that authorization.

Your Rights Regarding your Mental Health Information:

Right to inspect and copy:

You have the right to request an opportunity to inspect or copy mental health information used to make decisions about your care. You must submit your request in writing to the Privacy Officer at the Ackerman Institute for the Family, 149 East 78th Street, New York, NY 10075. Since Ackerman Institute is a family institute, a letter requesting mental health information must be signed by all adults seen in treatment.

We may deny your request to inspect or copy your mental health information in certain limited circumstances. If you are denied access, you may request that the denial be reviewed.

Right to make changes:

If you believe that the Ackerman Institute for the Family has mental health information about you that is incorrect or incomplete, you may ask us to make changes to correct the information. We ask that you contact the Privacy Officer in writing and provide as much detail as possible as to what information needs to be changed and why. We may deny your request if you ask us to amend information that the Ackerman Institute did not create, or if Ackerman Institute believes the information is complete and accurate.

Right to Accounting of Disclosures:

You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you for purposes other than treatment, payment and health care operations. Please include time frames, which may not be longer than six years and may not include dates before April 14, 2003. The Ackerman Institute will review all requests individually and comply with your request within 60 days, unless circumstances require additional time. We may charge a nominal fee for this list if a request is made more than one time annually.

Right to a paper copy of this notice:

You have the right to a paper copy of this notice. To obtain a paper copy, please contact our Privacy Officer at Ackerman Institute for the Family, 149 East 78th Street, New York, NY 10075.

Complaints:

If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312, New York, NY 10278. You will not be penalized for filing a complaint. To file a complaint with us, please do so in writing to the Privacy Officer, Ackerman Institute for the Family, 149 East 78th Street, New York, NY 10075.

CHANGES TO THIS NOTICE: We reserve the right to change the terms of our Notice of Privacy Practices. You may obtain a copy of our current Notice of Privacy Practice at our website, www.ackerman.org, by calling us at 212-879-4900, ext 120 and requesting that a copy be sent to you in the mail or by asking for one any time you are in our office.