Effective April 14, 2003, as revised January 21, 2008
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.
Sweetser is required by law to maintain the privacy of your health care information and to provide you with a notice of Sweetser’s privacy practices. Sweetser is required to follow the terms of the privacy notice in effect at any particular time, but Sweetser reserves the right to change its privacy practices at any time. Any change will apply to all health care information maintained by Sweetser and will be set forth in a new notice of privacy practices which will be available at your next visit following the change. At any time, you may obtain a copy of the notice of privacy practices currently in effect by requesting a copy in writing from Sweetser’s Privacy Officer at the address specified below.
Use and disclosure of your health care information
Sweetser may use your health care information for purposes of treatment, payment and health care operations. For example:
- Your information may be used to assess your needs and develop an individualized service plan or to coordinate a referral to another health care provider.
- Portions of your information may be submitted to a state agency, insurance carrier, or other third-party payer to secure payment for services provided to you, unless you have arranged personally to pay in full all charges for services provided to you.
- Your information may be used for operations of Sweetser related to health care activities, such as quality assurance, evaluation, training, audits, and administration.
- Sweetser may use your health care information to contact you to remind you of an appointment or to provide information about treatment alternatives or other health services or about Sweetser and our programs. We may also use it to contact you for fundraising purposes.
Sweetser may disclose your health care information to another person or entity performing services on Sweetser’s behalf which relate to treatment, payment, or health care operations and which require access to your information. That person or entity will have access to your information only to perform those services and must agree in writing to maintain the confidentiality of your information.
Sweetser may disclose your health care information without your authorization as permitted or required by applicable law, including any of the following: to comply with public health statutes and rules; to make any required reports of abuse or neglect; to comply with health care oversight activities of a government agency (such as licensing); to comply with a court order, search warrant, or other lawful process; to allow approved research projects to be conducted; to provide information to a medical examiner in the event of your death; to avert a serious threat to your or anyone else’s health or safety; or to provide information for workers’ compensation purposes.
Except as described above, Sweetser will not use or disclose your health care information, except with your written authorization. You may revoke any authorization at any time, in writing or verbally, by communicating the revocation to the clinician or caseworker principally responsible for your care, or to a supervisor or manager within the program from which you receive services, or to a member of Sweetser’s Client Records Department staff. Revocation will not, however, be effective with regard to actions already taken in reliance on your authorization.
Your privacy rights
You may request restrictions on the use or disclosure of your health care information, but Sweetser is not required to agree to any requested restriction. It is Sweetser’s policy not to agree to such a restriction unless Sweetser determines, in its sole discretion, that there is compelling need for the restriction and the restriction can feasibly be implemented.
You may request that communications to you be given in a way which will help keep them confidential, for example, by using a particular address or telephone number to contact you. Sweetser will comply with such a request if it is reasonable and feasible.
To request restrictions or a confidential manner of communicating, you should submit a written request to the clinician or caseworker principally responsible for your care, or to a supervisor or manager within the program from which you receive services, or to a member of Sweetser’s Client Records Department staff.
You have the right:
- to receive an accounting of any disclosures of your health care information apart from ones which you authorized or which were made for treatment, payment, or health care operations;
- to inspect and copy your health care information;
- to amend your health care information; and
- to receive a paper copy of this Notice of Privacy Practices.
To exercise any of the above rights, please submit your request in writing to Sweetser’s Privacy Officer at the address below. You may also contact the Privacy Officer to obtain further information about Sweetser’s privacy policies and practices.
If you believe your privacy rights have been violated, you may complain to Sweetser or to the Secretary of the U.S. Department of Health and Human Services. To file a complaint with Sweetser, please submit your complaint in writing to Sweetser’s Compliance Officer at the address below. A complaint form will be supplied on request but is not required. Nobody is permitted to retaliate against you for filing a complaint.
To exercise rights or obtain information:
50 Moody Street
Saco, ME 04072
To file a complaint with Sweetser:
50 Moody Street
Saco, ME 04072