860-421-6829

CLIENTS IN TREATMENT AT WATERVIEW BEHAVIORAL HEALTH HAVE THE FOLLOWING RIGHTS:

RIGHTS OF THOSE IN SERVICES:

When it comes to rehabilitation from alcohol or drugs, no person is the same. Under HIPAA the person has the right to request restrictions on certain uses and disclosures of their health information. Waterview Behavioral Health is not required to agree to any restrictions requested, but if it does agree, then it is bound by that agreement and may not use or disclose any information which the person restricted except as necessary in a medical emergency (See Notice of Privacy Practices below).

The person has the right to request that we communicate with them by alternative means or at an alternative location. Waterview Behavioral Health will accommodate such requests that are reasonable and will not request an explanation from the person. They are asked to make the request in writing. Under HIPAA the person also has the right to inspect and copy their own health information maintained by Waterview Behavioral Health, except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal or administrative proceeding or in other limited circumstances (See Notice of Privacy Practices).

Under HIPAA the person also has the right, with some exceptions, to amend health care information in Waterview Behavioral Health records, and to request and receive an accounting of disclosures of health-related information made by Waterview Behavioral Health during the six years prior to their request. They have a right to receive a paper copy of this notice, which is the Notice of Privacy Practices. The Notice of Privacy Practices is given to each person that begins services at Waterview Behavioral Health. When the person signs the Consent to Treatment, they initial that they have received this notification. Each person’s addiction comes with its unique challenges and behaviors. Because of this, at Waterview Behavioral Health, we believe the time frames and treatment plans for each person MUST be individualized.

 Should I be dissatisfied with the steps taken to resolve my complaint; I may notify the Connecticut Regulatory Body.

HIPAA NOTICE:

 The Notice includes individual’s rights (HIPAA regulations 42 U.S.C. 1320d et seq., 45 C.F.R. Parts 160 & 164, and the Confidentiality Law, 42 U.S.C. 290dd-2, 42 C.F.R.Part 2) pertaining to his or her PHI and records, and how such rights may be exercised. It covers Waterview Behavioral Health’s legal duties, describes the types of uses and disclosures that are permitted under this law, and how to file a formal grievance.

Waterview Behavioral Health’s Release of Information form complies with state and federal regulations and contains the name of the client, content to be released, purpose of information to be released, party to whom the information will be released, date on which the release if signed, the expiration date of the release, information on how to revoke the release, and signature of the client or guardian. Limitations on information desired released may be indicated on the form. Psychotherapy notes are covered under HIPAA, thus are considered Waterview Behavioral Health’s property and are not required to be disclosed to the client. In cases when a client’s information is subpoenaed follow the RESPONDING TO A REQUEST FOR CLIENT RECORDS (INCLUDING SUBPOENAS AND COURT MANDATES). All other PHI in the client’s chart is their property and can be requested by and copied for the client.

HIPAA requires an accounting if disclosures, which is a list of disclosures made without consent or authorization (in order for treatment, payment, or health care operations). All Qualified Service Organization / Business Associate Agreements state that all inadvertent re-disclosures need to be reported to Waterview Behavioral Health within 24 hours of the incident. If there are cases where information is disclosed without an authorization a disclosure log needs to be implemented in the client’s chart.

HIPAA allows for unintended or incidental disclosure of PHI; however, it is absolutely imperative that any use, submission, or disclosure be documented on an Accounting of Disclosure form and remains in the person’s chart. Documentation should be specific as to what PHI was released, to whom it was released, reason for release, and why a consent for release of information was not obtained. The client and all appropriate parties involved should be notified of the accidental disclosure. An incident report should be completed and submitted to management. Clients may update their records by completing the Request for Amending Personal Health, transfer or use PHI for gain is a $25,000 fine and up to 10 years imprisonment

Client Notice – Confidentiality of Alcohol and Drug Abuse Patient Records:

Federal law and regulations protect the confidentiality of alcohol and drug abuse patient records maintained by Waterview Behavioral Health. Generally, Waterview Behavioral Health may not say to a person outside the program that you attend the program, or disclose any information identifying you as an alcohol or drug abuser unless:

  • You consent in writing; OR
  • The disclosure is allowed by a court order; OR
  • The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation; OR
  • You commit or threaten to commit a crime at the program against any person who works for the program, or an individual.

Violation of the law and regulations by a program is a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs.

Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.

(See 42 U.S.C. Sections 290dd-3, 290ee-3 for Federal laws and 42 CFR Part 2 for Federal regulations.)

NOTICE OF PRIVACY PRACTICES:

This notice describes how medical information regarding your health care, including payment for health care is protected by two federal laws: The Health Insurance Portability and Accountability Act of 1966 (“HIPAA”), 42 U.S.C. & 1320d et seq., 45 C.R.F. Part 160 & 164, and the confidentiality Law, 42 U.S.C. & 290dd-2, 42 C.F.R. Part 2. Under these laws, Waterview Behavioral Health may not say to a person outside of Waterview Behavioral Health that you attend the program, nor may Waterview Behavioral Health disclose information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by federal law.

PLEASE REVIEW IT CAREFULLY

This Notice Describes Our Practices and Those of:

  • Any health care professional allowed to enter information into your chart
  • Any employee we allow to help you while you are here; and
  • All employees of any hospital, clinic, laboratory, or other facility affiliated with Waterview Behavioral Health.

All of these people follow the terms of this notice. They also share protected health information with each other for treatment; payment of health care operations as described in this notice.

OUR PLEDGE REGARDING HEALTH INFORMATION:

Waterview Behavioral Health uses health information about you for treatment, to obtain payment for treatment for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Waterview Behavioral Health.

We understand that health information about you and your health is personal. We are committed to protecting health information about you. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.

Waterview Behavioral Health IS REQUIRED BY LAW TO: 

  • Make sure that medical information that identifies you is kept private.
  • Give you this notice of our legal duties and privacy practices with respect to medical information about you.
  • Accommodate reasonable requests you may make to communicate health information by alternative means or alternative locations.

Follow the terms of this notice that is currently in effect For Treatment: 

Waterview Behavioral Health may use your health information to provide you with medical treatment for services. For Example, information obtained by a health care provider, such as physician, nurse, or other person providing health care services to you, will need record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.

For Payment: 

Waterview Behavioral Health may use and disclose your health information to others for purposes of receiving payments for treatment and services that you receive. For example, a bill may be sent to you or a third party, such as an insurance company, HMO, or health plan. The information of the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

For Health Care Operations: 

Waterview Behavioral Health may use and disclose health care information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk, or quality improvement personnel, and others to:

  • Evaluate the performance of our staff
  • Assess the quality of care and outcomes in your case and similar cases
  • Learn how to improve our facilities and services
  • Determine how to continually improve the quality and effectiveness of the health care we provide

Appointments/Health Related Products and Services: 

Waterview Behavioral Health may use your information to contact you to provide appointment reminders.

Waterview Behavioral Health may also contact you to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you. 

Others Involved in Your Care:

Waterview Behavioral Health may release relevant health information to a family member, friend, or anyone else you designate in order for that person to be involved in your case or payment related to your case. Waterview Behavioral Health may also disclose health information to those assisting in disaster relief efforts so that others can be notified about your condition, status and location.

Fundraising 

Waterview Behavioral Health does not use information for fundraising unless authorized, in writing, by you.

Required by Law:

Waterview Behavioral Health may use and disclose information about you as required.

For example, Waterview Behavioral Health may disclose information for the following purposes:

  • For judicial and administrative proceedings pursuant to a court order.
  • To prevent or control disease, injury, or disability
  • To report births and deaths
  • To report reactions to medications or problems with products
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease
  • To notify the proper authorities if we believe a client has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Public Health: 

Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities (State Health Department, Center for Disease Control, Etc.) to prevent or control disease, injury, or disability, or for other public health activities.

Health Oversight Activities: 

Waterview Behavioral Health may disclose your health information to a health oversight agency for activities authorized by law. Examples of these activities include audits, investigations, and inspections to monitor the health care system and compliance with laws and regulations.

Decedents:

Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.

Health and Safety: 

Your health information may be disclosed to avert a serious threat to the health and safety of you and any person pursuant to applicable law.

Workers Compensation:

Your health information may be used or disclosed in order to comply with laws and regulations related to Worker’s Compensation.

Other Uses:

Other uses and disclosures will be made only with your written authorization. You may revoke an authorization except to the extent Waterview Behavioral Health has taken action in reliance to it.

YOUR HEALTH INFORMATION RIGHTS UNDER HIPAA YOU HAVE THE RIGHT TO: 

  • Obtain a copy of this notice of information practices upon request
  • Request an amendment to your health information under certain circumstance
  • Request a confidential communication of your health information by alternative means or at alternative locations. Please be advised that this request for alternative means or locations of communications applies only to this provider or location.
  • Receive an accounting of disclosures made of your health information
  • Request a restriction on certain uses and disclosures of your information; however, Waterview Behavioral Health is not required to agree to a requested restriction.

Change to This Notice: 

Waterview Behavioral Health reserves the right to change the terms of this notice and make the new terms effective for all protected health information kept by Waterview Behavioral Health. Waterview Behavioral Health will post a copy of the current notice in the facility. You may also get a current copy by contacting our Human Resources Department. (address at the end of this statement). The effective date of the notice is at the bottom of each page of this document.

If you have any questions about this notice, want to exercise one of your rights that are described in this notice, or want to file a complaint, please contact Waterview Behavioral Health at:

Waterview Behavioral Health
300 Church Street

Wallingford CT 06492

Consent for Treatment 

I authorize Waterview Behavioral Health to evaluate, treat, and perform all clinical services, including but not limited to individual therapy, group therapy, coaching, family therapy, holistic therapies, and adjunctive therapies deemed necessary in the evaluation and treatment of substance use and co-occurring mental health disorders.

Waterview Behavioral Health does not discriminate on the basis of race, sex, creed, color, sexual orientation, or national origin when admitting clients to its programs. Waterview Behavioral Health provides an outpatient and/or intensive outpatient level of care (between 1-25 hours of service per week).

Clients who require medical services, detoxification, psychiatric or inpatient treatment may be referred to another agency. I understand that if admitted to Waterview Behavioral Health, I will be offered ongoing resources to ensure my recovery post-discharge.

Waterview Behavioral Health believes that to provide the highest level of care possible, assessment and evaluation (initial and ongoing) is vital to my successful treatment episode. As services are customized to each client, the assessment and evaluation process must be completed prior to treatment services being offered. I understand that there will be ongoing evaluation during my treatment episode to maintain the most comprehensive understanding of my needs during treatment.

Treatment planning and treatment recommendations are based off a person-centered, collaborative process between client and treatment team. Waterview Behavioral Health believes in an empowering and motivational approach, always taking into consideration what I want out of treatment. I understand that Waterview Behavioral Health may make suggestions based off assessment, evaluation, behavior, and other factors, but will always strive to work together with me in order to create the most effective treatment planning process possible.

By signing this Consent, I am agreeing to accept the care provided by Waterview Behavioral Health. I have the right at any time to rescind this consent and discontinue my treatment. I have the freedom to choose what I would like to address as my goals in treatment and to refuse suggestions and/or treatments as I see fit. I also understand that continued refusal to participate in treatment, recommendations, or clinical indicated services may lead to clinical intervention and potential discharge from the program.

Therapeutic services involve interventions at emotional, mental, and social levels. Even in successful interventions, I may experience unsettling interruptions in normal patterns, feelings, and social relationships. I understand the risk of these interventions. I understand that I have the right to meet with my therapist or any member of my treatment team individually to discuss uncomfortable feelings and alter my person-centered plan as necessary.

I have been advised that as a client of Waterview Behavioral Health, I am protected under Federal laws of confidentiality, which means that the program may not disclose any information without my written consent. I further understand that is required to disclose to state authorities any information if the following conditions exists: Information about a crime committed by me or another client of the program or against any staff member. Threats to commit a crime or an act of violence. Information concerning actual or suspected, child or elder, abuse or neglect. I understand that my records are protected under Federal Confidentiality Regulations (42 U.S.C 290dd-3 and 42 U.S.C. 290ee-3 for Federal Laws and 42 CFR Part 2 for Federal Regulations) published August 10, 1997; and cannot be disclosed without written consent unless other provided in the regulations. I understand that my medical records may contain information concerning my psychiatric, psychological, drug or alcohol abuse, HIV/AIDS and or related conditions. In the case of severe medical emergency, I have listed my emergency notification person on the Client Intake Sheet and do authorize Waterview Behavioral Health to contact the party. 

I understand that Waterview Behavioral Health staff work as a team in order to provide the highest quality services to me. This means that my treatment team will consist of a variety of professionals, multi-disciplinary in nature, that will be discussed, sharing information, strategizing, and working together so I may have a successful treatment episode. I understand information shared with one staff member will not be confidential from the rest of the treatment team members.