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.

Effective: April 14, 2003

Northern, as well as Northern's employees, medical staff, students, and independent affiliated health care practitioners who jointly provide services to you at Northern or through its programs, may use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive, health information includes medical and financial information. Your health information is contained in a medical record that belongs to Northern.

Information about HIV, alcohol and substance abuse treatment, mental health, and genetics is highly sensitive and has additional protections under federal and state law. You may request a copy of our policy regarding disclosure of this information.

A copy of this Notice of Privacy Practices is available on our website at: http://northernservicesgroup.com/privacy_policy/.

 

How Northern May Use or Disclose Your Health Information

Northern may use your health information and disclose it to certain others as we need to in order to treat you, to obtain payment for our services and to run our health care operations. Below are examples of such treatment, payment and operations.

For Treatment. Northern may use your health information to provide you with medical treatment or services. For example, information obtained by a doctor or nurse providing health services to you will be written in your medical record. This information is needed for health care providers to decide what treatment you should receive. Your health information may be disclosed to other health care providers who may be treating you to make sure that the health care provider has information needed to diagnose or treat you.

For Payment. Northern may use and disclose your health information to others so that there will be payment for the treatment and services provided to you. For example, a bill may be sent to an insurance company or health plan, and the bill may contain information that identifies you, your diagnosis, and treatment that you received.

For Health Care Operations. Northern may use and disclose health information about you to operate Northern. For example, your health information may be disclosed to health care providers who we employ, to risk or quality improvement personnel, and to others to evaluate the performance of our staff or to assess the quality of care and outcomes in your case. Your health information may also be shared with business associates that perform various activities for Northern (for example, billing or transcription services). When Northern has an arrangement with business associates in which the business associate may receive protected information about you, Northern and the business associate will have a written agreement to protect your privacy rights.

 

Disclosure to Family Members and Others

We may disclose certain health information about you to your family members or close personal friend, or to anyone else you ask us to tell. Such health information is information that directly relates to the specific person's involvement with your care or payment for your care. You have the right to ask Northern not to tell such person your health information. If you are unable to agree or object to such a disclosure (for example, in any emergency), we may disclose information about you if we believe it is in your best interest.

 

Other Uses and Disclosures of Health Information Without Your Permission

Below are some examples of when Northern may disclose your health information without your permission.

Appointments. Northern may remind you about appointments, and may give you information about treatment alternatives or other health related benefits and services that may interest you. You may contact our Privacy Official to request that these materials not be sent to you.

As Required by Law. Northern may use and disclose information about you as required by law. For example, Northern may disclose information for the following purposes:

• for judicial and administrative actions if the law requires such disclosure;
• to report information related to victims of abuse, neglect or domestic violence, and
• to assist law enforcement officials in their law enforcement duties.

Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities. We would also use your health information to report about product defects, recalls or performance.

Health Oversight. Health information may be disclosed to a health oversight agency for oversight activities that are permitted by law, including audits, investigations, or inspections. Oversight agencies who ask us for this information may be government agencies that oversee the health care system, government benefit programs, other government regulatory agencies, and other entities that oversee civil rights laws.

Funeral Directors. If you die, we may share your health information with funeral directors or coroners so they can care for your body and carry out their lawful duties.

Fund-Raising. Northern may contact you to raise money for Northern, or we may share information about you with Northern's related charitable foundation that may contact you to raise money on our behalf. If you do not want us (or our foundation) to contact you for fund-raising, you must tell our Privacy Official in writing. Our Privacy Official's address is listed at the end of this Notice.

Organ/Tissue Donation. If you die, and if you are an organ donor, we may share your health information with organizations that handle organ, tissue or eye donation and transplantation.

Research. We will usually ask for your permission before we disclose to a researcher information that identifies who you are. Northern may use your health information for research purposes when an institution review board or privacy board, as reviewed and approved the research proposal and established procedures to make sure that your health information is kept private.

Health and Safety. Your health information may be disclosed if there is a serious threat to the health or safety of you or any other person, according to applicable law.

Government Functions. Certain government functions, such as protection of public officials, protecting national security, or reporting to various branches of the armed services, may require use or disclosure of your health information.

Workers' Compensation. Your health information may be used or disclosed in order to comply with Workers' Compensation laws.

 

Other Uses and Disclosures May Only Be Made With Your Permission

Other uses and disclosures of your health information will be made avaible with your specific written permission. You may take back or revoke your permission at any time by writing to the Privacy Official. You understand that we are unable to take back any information we disclosed under your earlier written permission.

Your Health Information Rights

You have the right to:

• request restrictions on certain uses and disclosures of your health information; you should know that we will consider your request, but we are not required to agree to follow it,
• receive confidential communications of your health information by altenative means or at alternative locations, and we will follow reasonable requests;
• review your health report and receive a copy of it (note that to receive a copy, you will have to pay our standard fee for copying and/or mailing);
• ask Northern to amend your health record;
• receive a paper copy of this Joint Notice of Privacy Practices, if you ask for one; and
• receive an accounting of disclosures made of your health information. Note that such accounting will not include all disclosures. For example, it will not include disclosures made for treatment, payment or business operations; disclosures from the faculty directory; disclosures to you or your personal representative; and disclosures you authorized in writing.

Obligations of Northern

Northern is required to:

• keep your health information private;
• give you a copy of this Notice describing how we keep your health information private; and
• follow the terms of this Notice.

Northern may, at any time, change its health information practices and may make the new provisions a to all protected health information it has. We will post revised notices at our facilities, on our web site northernservicesgroup, and we will give you one if you ask for it.

Complaints

You may complain to Northern and/or to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated. We are prevented by law from treating you any differently if you complain. To file a complaint with Northern, notify the Privacy Official, identified below.

 

Contact Information

If you have any questions or complaints, please contact the Northern Privacy Official:

Michele Meadows
Department of Human Resources
Northern
12 College Road
Monsey, New York 10952
Telephone: (845) 356-9880, extension 243