Welcome to Riverside Community Care

Privacy Notice: Short Version

Effective Date:

April 13, 2003

This Notice describes how medical information about you may be used and disclosed and how you can gain access to this information.

Please review this notice carefully.

If you have any questions about this material, please contact the Program Director or our

Privacy Officer at (781) 329-0909 x 183.

I. Introduction

We are required by law to maintain the privacy of your health information and to provide you with this notice of Riverside’s legal duties and privacy practices with respect to your health information.

If you have a legal guardian, we will also provide them with this information, including their right to act on your behalf in these matters.

II. Uses and Disclosures of Your Health Information, With Your Permission

Uses and disclosures not discussed in Section III will generally be made with your permission, which you will give us by signing an authorization. (i.e. we will ask for your written authorization to share information with other organizations/clinicians who provide you with services.) You may revoke an authorization at any time.

III. How We Will Use and Disclose Protected Health Information

A. Uses and disclosures that may be made without your written authorization:

For treatment purposes (i.e. to share information with the other Riverside staff who work with you)

For payment purposes (i.e. to provide your insurance company or other payor with required information to obtain payment for the services we provide for you)

For health care operations (i.e. for monitoring of the quality of services provided)

In emergency situations

When we are required by law to provide the information

To avert a serious health and safety risk

To fulfill public health requirements

If you are an inmate of a correctional institution or under the custody of a law enforcement official we may disclose health information to the correctional institution or the law enforcement official.

B. Uses and disclosures that may be made without your authorization, but you have the opportunity to object:

Information is shared with others involved in your care/treatment (i.e. family caretakers)

For fundraising/marketing purposes, Riverside may disclose basic non-health related information about you in fundraising campaigns and to an organization which assists us to raise funds.

IV. Your Rights Regarding Protected Health Information (PHI)

You have the right to:

Inspect and obtain a copy of your Protected Health Information (PHI)

Amend (Change) your PHI

An accounting of disclosures— a list of disclosures we have made of your PHI

Request Restrictions on the information we will share

Have confidential communications—i.e. if you wish, we will not leave the name of our organization if we leave you a telephone message.

Rescind your authorization to release your PHI at any time.

V. Confidentiality of Substance Abuse Records

For people who receive treatment or services from a drug or alcohol abuse program, the confidentiality of related records is protected by federal law and regulations.

VI. Complaints

If you believe your privacy rights have been violated, you may file a complaint by writing our Privacy Officer at:

Attention: Privacy Officer
Riverside Community Care
450 Washington Street
Dedham, MA 02026

You may also file a complaint with the Secretary of the United States Department of Health and Human Services

VII. Changes to this Notice

We reserve the right to change the terms of our Privacy Notice.

This Privacy Notice is in effect at all Riverside Community Care programs.