Delaware Health and Social Services Division of Substance Abuse and Mental Health For Behavioral Health Programs Effective April 14, 2003 Delaware Health and Social Services Division of Substance Abuse & Mental Health NOTICE OF PRIVACY PRACTICES Effective April 14, 2003 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. Understanding the Type of Information We Have. We get information about you when you are treated by our health providers. It includes your date of birth, sex, ID number, and other personal information. We also get bills, reports from your doctor, and other data about your medical care. Our Privacy Commitment to You. We care about your privacy. The information we collect about you is private. We are required by law to give you a notice of our privacy practices and to maintain the privacy of your protected health information. Only people who have both the need and the legal right may see your information. Unless you give us permission in writing, we will only disclose your information for purposes of treatment, payment, business operations or when we are required by law to do so. * Treatment. We may disclose medical information about you to coordinate your health care. For example, we may notify your doctor about care you get in a clinic or we may contact you to remind you of an appointment. * Payment. We may use and disclose information so the care you get can be properly billed and paid for. For example, we may send a bill to your insurance company for payment. * Health Care Operations. We may need to use and disclose information for our health care operations. For example, we may use information to review the quality of care you get. * As Required By Law. We will release information when we are required by law to do so. Examples of such releases would be for law enforcement or national security purposes, subpoenas or other court orders, abuse or neglect reporting, communicable disease reporting, disaster relief, review of our activities by government agencies, to avert a serious threat to health or safety or in other kinds of emergencies. * With Your Permission. If you give us permission in writing, we may use and disclose your personal information in ways other than those described above. If you give us permission, you have the right to change your mind and revoke it. This must be in writing, too. We cannot take back any uses or disclosures already made with your permission. Your Privacy Rights You have the following rights regarding the health information that we have about you. Your requests must be made in writing to the Division of Substance Abuse and Mental Health at the address below. * Your Right to Inspect and Copy. In most cases, you have the right to look at or get copies of your records. You may be charged a fee for the cost of copying your records. * Your Right to Amend. You may ask us to change your records if you feel that there is a mistake. We can deny your request for certain reasons, but we must give you a written reason for our denial. * Your Rights to a List of Disclosures. You have the right to ask for a list of disclosures made after April 14, 2003. This list will not include the times that information was disclosed for treatment, payment, or health care operations. The list will not include information provided directly to you or your family, or information that was sent with your authorization. * Your Right to Request Restrictions on Our Use or Disclosure of Information. You have the right to ask for limits on how your information is used or disclosed. We are not required to agree to such requests. * Your Right to Request Confidential Communications. You have the right to ask that we share information with you in a certain way or in a certain place. For example, you may ask us to send information to your work address instead of your home address. You do not have to explain the basis for your request. Changes to this Notice We reserve the right to revise this notice. A revised notice will be effective for medical information we already have about you as well as any information we may receive in the future. We are required by law to comply with whatever notice is currently in effect. Any changes to our notice will be published on our web site. Go to: http://www.state.de.us/dhss/dsamh/dmhhome.htm If the changes are material, a new notice will be given to you before it takes effect. How to Use Your Rights Under This Notice If you want to use your rights under this notice, you may call us or write to us. If your request to us must be in writing, we will help you prepare your written request, if you wish. * Complaints and Communications to Us. If you want to exercise your rights under this notice or if you wish to communicate with us about privacy issues or if you wish to file a complaint, you can write to: Privacy Officer Division of Substance Abuse and Mental Health 1st Floor, Main Building 1901 N. DuPont Highway New Castle, DE 19720 (302) 255-9399 You will not be penalized for filing a complaint. * Complaints to the Federal Government. If you believe that your privacy rights have been violated, you have the right to file a complaint with the federal government. You may write to: Region III Office for Civil Rights U.S. Dept. of Health & Human Services 150 S. Independence Mall West Suite 372, Public Ledger Building Philadelphia, PA 19106-9111 Phone: 215 861-4441 Hotline: 800 368-1019 Fax: 215 861-4431 TDD: 215 861-4440 Email: OCRComplaint@hhs.gov You will not be penalized for filing a complaint with the federal government. Copies of this Notice You have the right to receive an additional copy of this notice at any time. Please call or write to us to request a copy. Delaware Health and Social Services Division of Substance Abuse and Mental Health