Walden Behavioral Care Notice for Use and Sharing of Protected Health Information

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.

We at Walden Behavioral Care pledge to give you the highest quality healthcare and to have a relationship with you that is built on trust. This trust includes our commitment to respect the privacy and confidentiality of your health information.

The word "Walden" in this Notice includes all of the organizations listed at the end of this notice.

This Notice is being given to you because federal law gives you the right to be told ahead of time about:

• How Walden will handle your medical information
• Walden's legal duties related to your medical information
• Your rights with regard to your medical information.

Please note that treatment at Walden Behavioral Care provides you with additional protections, as explained throughout this Notice.

This Internet communication is limited to the dissemination of general information about the services provided by Walden Behavioral Care. Information in this Internet communication (Web site) is for informational purposes only and should not be construed as medical advice. Please obtain relevant professional advice before making any healthcare decisions.

A. HOW WE MAY USE AND DISCLOSE (SHARE) YOUR PROTECTED HEALTH INFORMATION

When you need healthcare, you give information about yourself and your health to doctors, nurses, and other healthcare workers and staff. This information, along with the record of the care you receive, is "protected health information" (or "health information"). This information is kept in a paper form such as your medical record and in an electronic form on the computer.

Walden uses your health information within its system, and shares your health information outside its system in order to give you excellent medical care. Walden uses and shares your health information for other reasons that can include medical research and training new healthcare workers. For example, Walden may share your health information with outside healthcare providers for purposes such as treatment or research; in some cases, these providers have a specific relationship with Walden and physicians who have outside private practices but also occasionally work at a Walden hospital. In addition, other outside parties who receive your information in order to perform services on Walden's behalf ("business associates") must also take steps to keep your health information private.

This Notice will tell you how Walden uses and shares your health information for these and other purposes. It will also tell you when we need to get your specific permission to do so.

1. Treatment, Payment, and Healthcare Operations

Except where prohibited by Massachusetts state or federal laws (see section 4), Walden may legally use and share your health information for treatment, payment, and healthcare operations. We do not need to ask for your specific permission to do these things, as explained below:

Treatment

Walden healthcare providers will use and share your health information to provide and manage your healthcare and related services. For example, your primary care doctor may refer you to a specialist such as a radiologist or surgeon. The specialist may tell you that you need to be admitted to the hospital for treatment or surgery. All of the doctors in this example, whether they are in the Walden system or not, will share medical information about you. This is to coordinate your care before, during and after you go into the hospital. Walden will share information with other third parties, such as home health agencies, visiting nurses, rehabilitation hospitals, and ambulance companies. It will also share information with those who treated you before you went into the hospital and those who will treat you in the future. This helps to make sure that everyone caring for you has the information they need.

Walden Behavioral Care and/or its providers will not share information with other Walden entities and/or healthcare providers without an authorization signed by you to release information.

Payment

Walden will use and share your health information to bill and collect payment for the healthcare services it gives to you. For example, if you have health insurance, your healthcare provider will share your medical information with the insurance company or government agency. The insurance company uses the information to tell if you are eligible for benefits or if the services you received were medically needed.

Healthcare Operations

Walden may use and share your health information for activities that are known as healthcare operations. These are activities that are needed to operate its facilities and carry out its mission. Some of the information is shared with outside parties who perform these healthcare operations or other services on behalf of Walden ("business associates"), such as lawyers, auditors, consultants, and transcription services. We require these business associates, by contract, to take steps to keep your health information private. Examples of activities that make up healthcare operations include:

• monitoring the quality of care and making improvements where needed
• making sure healthcare providers are qualified to do their jobs
• reviewing medical records for completeness and accuracy
• meeting standards set by regulating agencies; such as, Joint Commission on Accreditation of Healthcare Organizations
• teaching health professionals

Walden may use your health information to contact you:

• at the address and telephone numbers you give to us (including leaving messages at the telephone numbers) about scheduled or cancelled appointments, registration/insurance updates, billing or payment matters, pre-procedure assessment or test results
• with information about patient care issues, treatment choices and follow up care instructions
• with other health-related benefits and services that may be of interest to you
• to raise funds to support the Walden system and its missions of excellence, but we will use only demographic information (such as name, address, phone number, age, or gender) to contact you for such purposes.

2. Uses and Disclosures (Sharing) of Your Health Information for Other Purposes

Walden may legally use and/or share your health information with others in the following areas without your specific permission:

• For research that is approved by a Walden Research Committee when written permission is not required by federal or state law. This also may include preparing for research or telling you about research studies in which you might be interested
• As required by state and federal laws and regulations
• For public health activities, including required reports to the state public health and child protection authorities, and to agencies such as cancer registries and the federal Food and Drug Administration
• With regard to elder victims of abuse and neglect, and in some instances to disabled victims of abuse or neglect
• For health oversight activities
• For legal and administrative proceedings
• For law enforcement purposes under specific conditions, such as reporting when someone is the victim of a crime
• With regard to people who have died, to coroners, medical examiners and funeral directors so they can carry out their lawful duties
• For organ, eye or tissue donation at death
• To avert a serious threat to health or safety
• For specialized government operations
• As authorized by and as necessary to comply with workers' compensation laws

3. Uses and Disclosures (Sharing) You May Ask To Be Limited, or Request Not Be Made

Patient Directories

If you are admitted to the hospital, your name, room location, general condition, and religion may be listed in that hospital's directory (information desk). This will be shared with members of your family, friends, members of the clergy, and others who ask for you by name. You may ask to have your name taken off the directory list. You may also ask to restrict the information that is given out about you. If you are in an emergency situation and are not able to make your wishes known, we will put this information in the directory if we think it is in your best interest. We will not put the information in the directory if you have been admitted to the hospital before and asked that it not be shared.

Walden Behavioral Care does not have a patient directory and will not give out any information regarding your care. Dedicated Substance Abuse Facilities also will not release any directory information without your specific authorization.

Disclosures to Family, Friends or Others

• Walden may share relevant health information about you with a family member or other person close to you if that person is involved in your care or payment for your care.
• Walden may use or share your health information to notify a family member or other person responsible for you of your location, general medical condition or death.
• If you are present and are able to make healthcare decisions, we will try to find out if you want us to share your health information with your family members or others. If you are in an emergency situation or not able to make your wishes known, we will use our best judgment to decide whether to share information. If it is thought to be in your best interest, we will share only information that others really need to know.
• Walden also may use or share your health information with a public or private agency assisting in disaster relief. This is to coordinate efforts to notify someone on your behalf. If we can reasonably do so while trying to respond to the emergency, we will try to find out if you do want us to share this information.

Walden Behavioral Care and dedicated Substance Abuse Facilities/Providers will not give out any information to family or friends without an authorization signed by you.

4. Uses and Disclosures (Sharing) of Information that Require Your Written Permission (Authorization)

Except as described in this Notice and as permitted by law, we cannot use or share your health information without your written permission.

Massachusetts state or federal laws require that we obtain your written permission before using or disclosing the information listed below:

• Sharing information about genetic testing (as defined by state law) or genetic test results
• Sharing information about HIV testing or test results
• Sharing information from substance abuse rehabilitation treatment programs
• Sharing information about treatment for sexually transmitted diseases
• Using and sharing health information for research, research preparation, or recruitment, when the appropriate Walden Human Research Committee determines this is required under federal and state laws
• Information that state law recognizes as "privileged" (sensitive) information can only be shared in administrative and judicial proceedings if you give written permission.
  • Privileged (sensitive) information includes information that relates to domestic violence, sexual assault counseling, confidential communications between a patient and a social worker, or confidential details of psychotherapy (from a psychiatrist, psychologist, or licensed mental health nurse clinical specialist);
  • such proceedings may include civil or criminal trials and their preliminary proceedings, or hearings before a state, county or local administrative agency
• Using and sharing psychotherapist notes (notes maintained outside of the medical record for the therapist's own use); however, specific permission is not required for use or sharing of these notes for your therapist to treat you, for training programs, for legal defense in an action you bring, or for oversight of the therapist
• Using information regarding diagnosis, nature of service and treatment information to raise funds to support the Walden system and its missions of excellence

Note: If you have given permission for your medical information in the above categories to be used or shared, you may withdraw your permission in writing at any time except to the extent that the providers have already acted on it.

B. YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION AND HOW TO EXERCISE THEM

The Right to Ask for Limits on the Use and Sharing of Your Health Information.

You have the right to ask for restrictions on the use and sharing of your health information for treatment, payment or healthcare operations. You can also ask for restrictions on using this information to notify you about appointments and sharing your information with family members and close friends.

Walden is not required to agree to your request. If we do, we must put the restriction in writing and abide by it, except if you need to be treated in an emergency. You may not ask us to restrict uses and sharing of information that we are legally required to make.

The Right to Ask that Walden Communicate Your Health Information to you in a Confidential Manner.

You have the right to ask for your health information to be sent to you in different ways. For example, you may ask that Walden not contact you with appointment reminders by telephone, or only call at your work or cell telephone number rather than home. When we request an address and telephone numbers to contact you, it is your responsibility to give us telephone numbers and an address that will allow us to carry out our needs to reach you and care for you. We may request that the method and location where you wish to be contacted be in writing and that you contact us with any changes to this information. Walden must agree to any reasonable request and cannot ask you to explain the reason for your request. Walden can require you to give information as to how a payment will be handled, and what address a bill should be mailed to.

The Right to Look at and Get a Copy of Your Health Information.

You have the right to look at and get a copy of your health information that Walden keeps of your medical treatment and bills. You must ask for this in writing. We will respond within thirty (30) days from receipt of your request. If you ask for a copy of your records, you will be charged a fee for them.

If your request is denied, we will explain the reasons in writing and tell you which rights you have, if any, to a review of the denial. We may offer to give you a summary or explanation of the information you requested, as long as you agree in advance to this and to any fees that it might cost. If you ask for information that we do not have, but we know where it is, we must tell you where to direct your request.

The Right to Change Your Health Information.

• You have the right to ask us to change your health information related to your treatment and bills if you think there has been a mistake or that information is missing.
• You must make your request in writing and give the reason for why you want the change.
• We have 60 days to respond to your request.
• If we are not able to act on the request within the 60 days, we will notify you that we are extending the response time by 30 days.
• If we extend the response time, we will explain the delay to you in writing and give you a new date of when to expect a response.
• We may deny your request.
• If we deny your request, we must give you a written statement with the reasons for the denial, and what other steps are available to you.
• If we grant the request, we will ask you to tell us the persons you want to receive the changes. You need to agree to have us notify them along with any others who received the information before corrections were made, and who may have relied on the incorrect information to give you treatment.

The Right to Receive An Accounting of Disclosures (Record of When Your Health Information was Shared without Your Written Permission or Authorization).

You have the right to get a record of the times that your health information has been shared. You must make your request in writing. You may request this information as far back as six years, but not for periods prior to April 14, 2003. The listing you get will include the date, name, and address (if known) of the person receiving your information. It will also include a brief description of the information given, and a brief statement of why the information was shared.

The following exceptions apply:

• The listing will not include instances when we shared your health information for the purpose of treatment, payment, or healthcare operations.
• The listing will also not include those instances when we:
  • shared your health information because you gave your permission in writing (signed an authorization form);
  • shared the information in a facility directory with people who asked for you by name;
  • shared information with persons involved in your care;
  • used your information to communicate with you about your health condition;
  • shared information for national security or intelligence purposes, or with correctional institutions or law enforcement officials who have custody of you; or
  • shared information based on instances that occurred before the date shown on this Notice.
• We have 60 days to respond to your request. If we have not been able to act on the request within the 60 days, we will notify you that we are extending the response time by 30 days.
• If we do extend the response time, we will explain the delay to you in writing and give you a new date of when to expect a response.
• Your first request for a record in any 12-month period is free.
• We will charge a fee for any other requests in that period.
• We will notify you of the fee before we do the work. This will give you a chance to stop the request if you do not wish to pay the fee.

The Right to Ask for a Paper Copy of this Notice.

You may ask for a paper copy of this Notice from the contact listed below. You can ask for a paper copy even if you agreed to receive the Notice by email.

C. OUR DUTIES WITH RESPECT TO YOUR HEALTH INFORMATION

Walden is required by law to keep your health information private. We are required to give people notice of our legal duties and privacy practices with respect to your health information.

Walden must abide by the terms of the Notice currently in effect. Walden reserves the right to change its privacy practices and the terms of this Notice at any time. Walden reserves the right to make the new Notice provisions effective for all protected health information that it maintains. If Walden makes a material change to this Notice, the updated Notice will be posted on the Walden Web site and in all Walden registration areas for public viewing. You may request a copy of the current Notice at any time by calling any of the people listed at the end of this Notice, or you may view it on our Web site at www.waldenbehavioralcare.com.

D. HOW TO COMPLAIN IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED

If you think that we may have violated your privacy rights or you disagree with any action we have taken with regard to your health information, we want you, your family, or your guardian to speak with us. If you present a complaint, your care will not be affected in any way. It is the goal of Walden Behavioral Care to give you the best care while respecting your privacy.

You may file a complaint by contacting a representative at any of the Walden sites that are listed at the bottom of this notice. You may also send a written complaint to the Secretary of the Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC 20201, or email to HHS.Mail@hhs.gov. We will take no retaliatory action against you if you file a complaint about our privacy practices.

E. PERSON TO CONTACT FOR INFORMATION OR WITH A COMPLAINT

If you have any questions about this Notice or any complaints, please contact a representative at any of the Walden sites that are listed at the bottom of this notice.

F. EFFECTIVE DATE OF THIS NOTICE

This Notice is effective as of April 14, 2003.

WALDEN BEHAVIORAL CARE MEMBER ORGANIZATIONS
This Notice applies to the following Walden organizations:

Walden Behavioral Care - Waltham
Nine Hope Avenue
Suite 500
Waltham, MA 02453-2711
781-647-6700