THIS NOTICE DESCRIBES HOW MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW CAREFULLY.
During the process of providing services to you, NorthStar Transitions (“NorthStar”) will obtain, record, and use information about you that is protected health information. ‘‘Protected health information’’ means any information that we have which identifies you and relates to your health payment for health care services, and alcohol or drug, including mental health, treatment that we provide to you. NorthStar is committed to protecting the privacy and confidentiality of your personal health information (PHI). We are also mandated by federal and state law to assure that this protection occurs. The following notice outlines our privacy practices, legal duties and your rights concerning your PHI. We are required by law to provide you with a copy of this notice.
NorthStar keeps Medical Records for individuals that have received inpatient services for a period of 10 years and for those that received outpatient services for a period of seven years following the actual discharge from services. Medical Records consist of your PHI and may include but are not limited to: name, demographic information, referral information, admission notes, admission paperwork, assessments, evaluations, progress notes, treatment plan, medical and medication protocols, continuing care plan, discharge summary and financial/payment information. These records are necessary to provide you with the best interdisciplinary care, continuing care and to receive payment for treatment services from third party payers and are required by state licensing mandates.
Amendments to this notice may be made in writing by NorthStar as laws and or policies change.
Your personal health information (PHI) may be disclosed to any NorthStar staff members as needed to provide you with the best possible care, the most comprehensive treatment and to assure your physical health and safety.
Your PHI will only be disclosed to those outside of NorthStar when your express written consent or authorization has been obtained except as required by law.
NorthStar staff will disclose protected health information about you when required by law or allowable by court order. This includes, but is not limited to:
NorthStar staff will report to the appropriate law enforcement agency a crime committed by a person receiving services at NorthStar on NorthStar property or against any person who works for NorthStar or about any threat to commit such a crime. This report will include only information necessary to identify and locate the suspected perpetrator or that is directly relevant to the reported activity.
There may be instances when payment for treatment services will require disclosure of your PHI. This is most common when payment is made by a third party such as an insurance company, workman’s compensation, another family member or your personal financial officer. Your PHI will only be disclosed with your express written consent or authorization. It is important to know, however, that your refusal to give such permission may lead to non-payment by that third party as without your written consent or authorization, we will be unable to discuss payment for your treatment services with any third party.
NorthStar may use and/or disclose your PHI for healthcare operations such as: staff training and evaluation, auditing, medical reviews, compliance programs, business planning, licensing, quality assurance, accreditation, certification and credentialing activities.
We may disclose personal information in the context of teaching, trainings and the supervision of other members in the substance abuse field. Information will be disclosed ONLY when the anonymity of the person can be guaranteed.
Some services may be provided to NorthStar through business associates and ancillary personnel such as auditors, lab technicians, medical providers, pharmacists, transcriptionists, psychiatrists and state licensing representatives. Your PHI may be disclosed to staff at those agencies as needed to assure that such providers can perform the job we have asked them to do. NorthStar has a policy to disclose only that information necessary to assure that job is completed. We further require such business associates to sign a contract that states that they will appropriately safeguard your PHI in compliance with NorthStar policies and legal mandates.
Although your medical record is the physical property of NorthStar, you have the right to review and receive a copy of your medical record. NorthStar policy requires that any person who wishes to review their medical record do so in the presence of the therapist whom they have or had been working with or another assigned staff member. You may consent for NorthStar to release specific information about you in order to facilitate your treatment. A written consent or authorization signed by you regarding such medical records must be obtained prior to the copying and or delivery of those records to you.
You may also request that your PHI be disclosed to any person or agency that you choose for any purpose. You must provide a written consent or authorization for that information to be disclosed even when such a request is made by you. Such consent is valid for one year from the date originally signed unless otherwise specified by you. You have the right to revoke your consent or authorization at any time.
Only the PHI that you have specified will be disclosed and only to those for which you have provided written consent or authorization. NorthStar will not confirm or deny your presence at NorthStar to any individual that you have not signed a consent or authorization for except in the case of an emergency or as required by law. In the event of your incapacity or under emergency circumstances, we will disclose your PHI to the person you had previously designated as your “Emergency Contact Person(s)”.
We may use and disclose your PHI to contact you (i.e.: telephone calls, voicemails, e-mails, letters) as a reminder of an appointment at NorthStar, to check on you and your mental health status and regarding alumni events and associations. You have the right to request not to be contacted for such purposes.
We are not required by law to agree with your request however, whenever possible as to not cause undue hardship to the flow of business of NorthStar, we will honor such requests.
For instance, you may request that your medical record not be made available to a state-licensing representative from the Office of Behavioral Health during their standard audit of NorthStar. These audits do require that the Office of Behavioral Health have access to any record for those that have received services at NorthStar and that we do not impede in any way random audits of our medical record keeping. Under these circumstances, your request could not be honored. NorthStar does require that such Business Associates sign a written consent to adhere to NorthStar standards regarding your privacy and confidentiality so that none of your PHI will be disclosed.
All those receiving services at NorthStar are given a copy of this notice upon admission and asked to sign an acknowledgement that they have seen it. Anyone receiving services can request an additional copy at any time.
You may request a copy of your medical record. NorthStar may deny such request if it or its representatives believe that such access would cause harm to other patients, Northstar personnel or property or yourself. You also do not have the right to access your medical record from NorthStar in the following instances:
There are other situations in which NorthStar may deny you access to your medical record. If so, NorthStar is required to provide you with a review of the decision denying such access. Reviewable grounds for denial include but are not limited to:
For these circumstances another licensed professional must review the decision and provide a written response within 60 days. This second opinion will be upheld.
If NorthStar staff denies your request for amendment/ correction, we will notify you of why and how you can attach a statement of disagreement to your record (which we may argue) and how you can register a written complaint to our Privacy Officer or the Office of Behavioral Health or Department of Health and Human Services.
If we grant the request, we will make the correction and distribute it to those you identify in writing that you want notified. We do not have to grant the request if NorthStar staff did not create the record. In this case you must seek the amendment/correction from the party who originally created the record. For instance: NorthStar staff has obtained your written PHI from another treatment facility or professional, and there is information contained in those records that you disagree with, NorthStar staff may not legally amend those records in any way.
You have the right to request that we communicate with you by alternative means or at alternative locations. Requests need to be made in writing, and must specify the alternative means and location. You may ask that we call you at home, on your cell phone or at home. You may ask that we send mail to a different address.
In addition to providing you your rights as detailed above, NorthStar is required to:
NorthStar will not use or disclose your personal and mental health information without your written consent or authorization.
Maintain an account of any non-routine disclosures and uses of your medical records within 60 days of such disclosures. Information provided will include name and address of who received your PHI, a description of the information disclosed, and a statement of the purpose of such disclosure. NorthStar reserves the right to charge a reasonable fee for this service.
If you have questions, would like further information or believe your privacy rights have been violated you may contact NorthStar’s Privacy Officer.
Grievances should be made in writing and be addressed to NorthStar Privacy Officer, Dale Maugans.
You also have the right to file a grievance with:
Colorado Department of Human Services, Office of Behavioral Health
3824 Princeton Circle, Denver, CO 80236 (303) 866-7400
The U.S. Department of Health and Human Services
Region IV Office for Civil Rights
1301 Young St.Suite 1169
Dallas, TX 75202214-767-4056
NorthStar staff will not retaliate in any way if you choose to file a grievance with NorthStar or The USDHHS.