This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

PRIVACY NOTICE TO OUR CUSTOMERS:

Northbrook Behavioral Health Hospital is committed to protecting the privacy of patients. We treat all health information confidentially as required by law. This Notice will tell you about the ways in which we may use and disclose medical information about you. We will also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to protect your health information. If there is a security breach of your protected health information (PHI), in most instances, we are required by law to notify you. We are also required to give you this Notice of our legal duties and privacy practices with respect to medical information about you and follow the terms of the Notice currently in effect.

HOW WE COLLECT INFORMATION:

Information is collected directly from you and from the treatment and care that we provide you with during your stay at Northbrook Behavioral Health Hospital.  The information you supply us with upon admission to our facility provides us with demographic, financial and health information.  Additional information may be obtained from third parties such as adult family members, employers, insurance agencies, physicians, hospitals and other healthcare personnel.  The information collected will relate to your health, insurance, employment, finances, avocations or other personal characteristics.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:

For Treatment, Payment, and Health Care Operations (TPO)

We may use or disclose your health information for TPO purposes without your written authorization. This means that those who are involved in your care and treatment will have access to your health information. For example, for treatment purposes, information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. For us to receive payment for the care we provide to you, we will tell your insurance company about that care by sending a bill which will include demographics, diagnoses, procedures, and supplies we used. We may also use your health information for our own purposes, such as monitoring, planning and developing our care services, and educating our staff.

Other Uses and Disclosures Not Requiring Your Written Authorization

We may also use or disclose your health information for the following:

• To inform you about treatment options or alternatives, or health-related benefits or services that we think may be of interest to you.
• To provide you with appointment reminders, such as voicemail messages, postcards or letters.
• To business associates that perform certain key functions or processes for us. Business associates must provide written assurances that they will safeguard and protect the privacy of your health information.
• To communicate with authorities when we are required to do so by law, for health oversight activities conducted for or by governmental agencies, such as participating in surveys to improve quality of care and patient satisfaction and for public health activities, such as to report suspected child abuse, communicate diseases for certain types of injuries.
• For workers compensation or similar programs as permitted or required by law.
• For certain research purposes, provided that certain established measures are taken to protect your privacy.
• To military command authorities as required by law if you are or were a member of the armed forces.
• To prevent or lessen a serious threat to your health and safety or the health and safety of someone else.
• For law enforcement purposes, if we are permitted to do so by law, and to authorized federal officials for purposes of national security, if we are directed to do so by court order.
• To respond to a court order if you are involved in a lawsuit or a dispute.
• To provide certain information to a coroner, medical examiner, or funeral director.
• To correctional institutions if required to do so by law, if you are a prisoner.
• To a family member, relative or friend—or anyone else you identify— as follows: (i) if you are present at the time and agree; or (ii) if you are not present (or you are incapacitated or in an emergency situation) and, in the exercise of our professional judgment and in our experience with common practice, we determine that the disclosure is in your best interest. In these cases, we will only disclose the PHI that is directly relevant to the person’s involvement in your health care.
• Unless prohibited by law, we may disclose your PHI to your personal representative, if any. A personal representative has legal authority to act on your behalf in making decisions related to your health care if you are unable to act on your own behalf. For example, a health care proxy.
• For disaster relief purposes to appropriate organizations involved.
• Unless you opt out, for our patient directory, for purposes of notification of your location in the hospital, your religious affiliation to members of the clergy, your general condition or death.

If one of the above reasons does not apply, we will not use or disclose your PHI without your written permission (“authorization”). You may give us written authorization to use or disclose your PHI to anyone for any purpose. You may later change your mind and revoke your authorization in writing; however, your written revocation will not affect actions we’ve already taken in reliance on your authorization. Where state or other federal laws offer you greater privacy protections, we will follow those more stringent requirements.

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU

• Right to Access, Inspect, and Copy: You have a right to review and request copies of your health information with limited exceptions. You must submit your request in writing to the medical records department. We may deny your request to look at or get a copy of your health information in certain very limited circumstances. If we do, we will explain the reasons to you. If we maintain your information electronically you may request a copy of your records via a mutually agreed-upon electronic format. If we fail to agree upon an electronic format for delivery of electronic copies we will provide you with a paper copy for your records. If you request a copy of your records, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
• Patients who are in the hospital may access their health information within 24 hours (excluding weekends and holidays) upon a written request to the Medical Records Director provided that their attending does not believe it will interfere with treatment. A second review by the Medical Director may follow should the attending approve. Such information will be disclosed to the patient following written notification of the attending physician and a health care professional may be with the patient and assist with the reading of the documents. Access may be limited if the attending physician feels that the information would be detrimental to the Patient; however, it may be released to the patient’s current physician. 
• Right to Amend: You have a right to request corrections to your health information if you believe the information is incorrect or incomplete. You must provide a reason that supports your request. We may deny your request for an amendment if it is not done in writing or does not include a reason to support the request or for other reasons. The attending physician will review the written request and will determine the validity of the requested amendment. If approved, the attending physician will write the amendment, which will be incorporated into your healthcare record along with the request letter, and a copy will be sent to you. If the attending physician feels the request is not justified, you will be notified by the Medical Records Director.
• Right to an Accounting of Disclosures: You have the right to know when we have shared your health information. You may request an accounting of all disclosures made from your medical record through a written letter to the Medical Records Director. If you request this listing more than once in a 12-month period, we may charge you a fee for the additional requests.
• Right to Request Restrictions: You have the right to request that we restrict or limit some of our uses or disclosures of your health information. We are not required to agree to those restrictions except that you may restrict health information to your health plan when paying out of pocket, in full, to Northbrook Behavioral Health Hospital.
• Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work, or hard copy, or e-mail. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

FOR MORE INFORMATION OR TO REPORT A PROBLEM:

If you have any questions about the Privacy Practices for Protected Health Information, please contact:

Privacy Officer
Northbrook Behavioral Health Hospital
425 Woodbury-Turnersville Rd Blackwood, NJ 08012
856.374.6718

If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer at the above address and phone number or the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.  

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you’ve supplied us.

Current as of December 2024