Complete Privacy Notice Acknowledgment
This notice is effective as of April 14, 2003. If you have any questions about this notice, please contact the Privacy Officer at 315-539-5067.
At Seneca Cayuga ARC, we understand that information about you and your family is personal. We are committed to protecting your privacy and sharing information only with those who need to know and are allowed to see the information to assure quality services for you. This notice tells you how Seneca Cayuga ARC uses and discloses information about you. It describes your rights and access to this information if and when you want it. By law, we are required
This notice applies to all programs and services of Seneca Cayuga ARC. It applies to all employees, volunteers, contractors, business associates, students, interns, aides and assistants affiliated with Seneca Cayuga ARC.
All information we create or keep that relates to your health or care and treatment; including your name, address, birth date, social security number, your medical information, your individualized service plan, and other information about your care in our programs.
You have the following rights concerning your health information. When we use the word "you" in this notice, we also mean your personal representative. Depending on your circumstances and in accordance with state law, this may be your guardian, involved parent, spouse, adult child, or your advocate.
You have a right to see or inspect your health information Seneca Cayuga ARC acknowledges and supports your right to have access to, review of, and to receive copies of information contained within your formal records and charts. In order to receive access, copies, or the opportunity to review your information, you must submit a written request, specifically identifying dates and content, to the director of the program where the records are that you wish to see. We encourage you to use your service coordinator to assist you in this process. If the information you are requesting is located in more than one program or site, we will provide you access to it at the site or location where you first requested it or from which the information was initially generated. If access is permitted, copies are provided at a cost of $.25 per page. Some exceptions to the record apply and are not accessible, such as psychotherapy notes, records regarding incident reports and investigations, and information compiled for use in court or administration proceedings.
If Seneca Cayuga ARC permits your access, it will provide such access in the form specified and requested by you if it is readily producible in such form. If not, access will be provided in a form and format that you and Seneca Cayuga ARC agree to.
Prior to allowing you access to, review of, or copies of your information, we reserve the right to verify your identity or the identity of your representative. This is to insure that we are not disclosing your private health information to someone who has no right to receive it.
If we do not maintain the information about you that you are requesting but we know where it is, we will tell you where you may request it.
If we deny your request to see your health information, we will notify you in writing, providing the reasons why. You have the right to file a complaint, in writing. This should be directed to the Associate Executive Director and must be submitted in writing. He/she will conduct a review of the circumstances regarding the denial, and will render a written, final decision within 60 days. The Associate Executive Director's address is
You have the right to ask to change or amend your health information that you believe is inaccurate or incomplete. You must make these requests in writing to the director of the program where the records are that you are asking us to amend. We may deny your request in some cases, for example,
You have the right to request an accounting of disclosures Seneca Cayuga ARC has made of your health information. We will not, however, keep or provide you with a list of certain disclosures, for example, disclosures made for treatment, payment, and health care operations, or disclosures made to you or made to others with your permission.
To request this accounting, you must submit a written request clearly identifying the period of time you want the accounting for, to the Privacy Officer. This period can not exceed six (6) years and cannot include any dates prior to April 14, 2003. The Privacy Officer's address is:
You have the right to request a restriction on uses or disclosures of your health information related to treatment, payment, health care operations and disclosures to involved family. Seneca Cayuga ARC, however, is not required to agree to your request.
Seneca Cayuga ARC will terminate restrictions on use and disclosure of your information if you agree, in writing, to terminate the restriction; if you orally agree to terminate the restriction and such oral agreement is documented or we inform you in writing that we are terminating the restriction. In this latter case, the termination would only apply to any information about you which is created or received after we have told you we are terminating restriction.
To request a restriction on the use and disclosure of your information, you must submit a written request to the director of the program involved. You must specify what information you want limited, whether you are asking us to limit use, disclosure, or both and to whom the limits apply. You will then be notified by Seneca Cayuga ARC, in writing, as to whether or not the restriction is being agreed to or not.
You have the right to request confidential communication Seneca Cayuga ARC will communicate with you in a way that will help keep your information confidential. For example, you can ask that we not leave a message with your mother, father or housemate about such things as clinic appointments or ISP review dates and times.
You must make your request for confidential communications to the director of the program involved. It needs to be in writing, specifying how or where you wish to be contacted. We do not need to have a reason stated. We will accommodate all reasonable requests.
You have the right to receive a paper copy of this notice at any time. You may access a copy on our website, www.sencayarc.org, or you can find a copy of this notice at every program site. You may ask Seneca Cayuga ARC staff to give you another copy or to request access to your health information or to request any of the rights listed here, you may contact the Privacy Officer at 315-539-5067.
Seneca Cayuga ARC is required by law to:
Seneca Cayuga ARC may use and disclose health information without your permission or authorization for the purposes described below. For each of the categories of uses and disclosures, we explain what we mean and offer an example. Not every use or disclosure is described, but all of the ways we will use or disclose information will fall within these categories.
In addition to treatment, payment and health care operations, Seneca Cayuga ARC will use your health information without your permission for the following reasons:
Prior to using or disclosing your health information for purposes other than those noted above, Seneca Cayuga ARC will be required to obtain a signed authorization from you allowing us to do so. For example, if you ask us to send a copy of your clinical evaluations to another agency or service provider with whom we do not have an established business agreement, we will ask you to sign a very specific authorization which states:
If Seneca Cayuga ARC asks you to authorize disclosure of your health information to us from another provider, the request will include the following information:
You may revoke your authorization at any time. If you revoke your authorization in writing, we will no longer use or disclose your health information for the reasons stated in your authorization. We cannot, however, take back disclosures we made before you revoked and we must retain health information that indicates the services we have provided to you.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice apply to information we already have about you as well as any information we create or receive in the future. The current version of our notice can be found on our website at www.sencayarc.org. In addition, whenever a revision to this notice occurs, you shall be informed within 60 days of a material revision to the notice and we will ask you to sign a copy and return it to us so that we know you received it. You are entitled to receive a copy of our Privacy Notice at anytime.
If you believe your privacy rights have been violated,
You will not be penalized for filing a complaint.