Harbor Family Services

Notice of Privacy Practices

I. Who Will follow This Notice

This Notice describes the privacy practices of Harbor Family Services, its employees, volunteers, and contracted services (referred to below as "we" or "our"). It applies to services furnished to you at all Harbor Family Services business locations.

This Notice does not address the privacy practices of providers not employed by Harbor Family Services. You will receive separate Notices from each provider for dental, eye, medical, medication management, or other services not directly provided by Harbor Family Services.

II. Our Privacy Obligations

We are required by law and are committed to maintain the privacy and confidentiality of your health information ("Protected Health Information" or "PHI") and to provide you with this notice of our legal duties and your rights with respect to your Protected Health Information.

III. Acknowledgement of Receipt of this Notice

We will ask you to sign an acknowledgement that you received this Notice. The acknowledgement does not mean that you agree with our Notice, simply that you received it. When we use or disclose your PHI, we are required to abide by the terms of this Notice. We will treat you whether or not you sign the acknowledgement, and we will use and disclose your PHI as described in this Notice.

We reserve the right to change our privacy practices, and the terms of this Notice, at any time. If we do make a significant change to this Notice during your treatment, we will provide the revised Notice to you.

IV. Permissible Uses and Disclosures Without Your Written Authorization

In certain situations, which we will describe in Section IV below, we must obtain your written authorization in order to use or disclose your PHI. However, we do not need any type of authorization from you for the following uses or disclosures:

  1. When required by law

    We may release your PHI when:

    1. Harbor Family Services has received an order issued by the court for a civil proceeding.
    2. Your service provider or his/her supervisor "knows or has reasonable cause to suspect that a child has been or is likely to be abused or neglected". He or she must immediately report to the Department of Health and Human Services.
    3. Your service provider or his/her supervisor "suspects that an incapacitated or dependent person has been abused, neglected or exploited", he/she must immediately report to the Department of Human Services. The Federal Regulations do not permit making theses reports if doing so would identify and individual as a substance abuse patient. Federal law and regulation do not protect any information relating to a crime threatened or committed against the program or against any person who works for the program.
    4. Your service provider or his/her supervisor knows or has reason to believe that there is imminent danger that you might harm yourself or that a threat has been made by you to cause harm to another person or persons.

  2. For your emergency health care services

    Should you require emergency medical treatment or if an inpatient admission to another hospital is considered a medical emergency. Harbor Family Services will provide a treatment summary, including medication history, to a hospital upon admission when requested.

  3. For our health care oversight activities

    We may disclose your PHI when:

    A review or investigation is being conducted by a government health oversight agency, such as the Department of Health and Human Services, or other agencies that oversee the MaineCare programs.

  4. Parental access

    Some Maine laws concerning minors restrict, permit or require disclosure of PHI to parents and guardians. We will act consistently with Maine law and only make disclosures in accordance with these laws.

  5. Employee access

    Harbor Family Services employees will only have access to your PHI when their job description indicates that it is necessary for your treatment.

V. Uses and Disclosures That Require Your Authorization

For situations not generally described above, we will ask for you written authorization before we use or disclose your PHI. You have the right to revoke your authorization at any time, except to the extent that we have already used or disclosed your PHI according to your previous authorization.

Certain types of PHI have additional confidentiality protections under state and federal law. Examples include PHI related to HIV/AIDS and information held by dedicated mental health and substance abuse treatment programs. In many situations involving this type of PHI, we must have your written authorization to use or disclose that information. One exception is in the case of an emergency, in order to provide you/access for you the treatment you require.

VI. Your Rights Regarding Your PHI

  1. Right to request confidential communications

    You may request that we communicate with you about your PHI in a certain way or only at a certain location. For example, you may ask us not to call your house, your work or to contact you only on your cell phone. We will accommodate reasonable requests whenever possible.

  2. Right to inspect and copy

    You have the right to inspect and obtain a copy of your own PHI. The records you may view and get copies of include medical and billing records and any other records that we use to make decisions about your health care.

    If you wish to inspect or obtain a copy of your PHI, please speak with the contact person at the service site (listing of service sites and contacts is located at the end of this Notice). If you are unsure of the service location, please call any of the contact persons at the end of this Notice for assistance.

    We may deny your request to inspect and to obtain a copy of your own PHI in certain limited circumstances. For example, your right to inspect and to obtain a copy of your own PHI may be limited if providing the PHI to you could endanger your health and safety or the health and safety of others.

  3. Right to amend your records

    You have the right to submit a correction or clarification to your PHI if you believe that the information we have about you is incorrect or incomplete. You must inform us in writing of the correction or clarification. To submit a correction or clarification, please send your written request to the contact person identified at the end of this Notice who is affiliated with the service delivery site where you received services. If you are unsure where to send your request, please call any of the contact persons at the end of this Notice for assistance. We may add a written response to your amendment, and if we do so, we will provide you a copy.

  4. Right to an accounting of disclosures

    You have the right to request and receive a list of certain disclosures of your PHI during any period of time prior to the date of your request.

  5. Right to receive a copy of this Notice

    You have the right to request and receive a paper copy of this Notice from us at any time. Just ask for a copy of this Notice at any of your service delivery sites.

VII. Further information or complaint

If you desire further information about your privacy rights, are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your PHI, you may file a complaint with us by contacting any of the individuals listed at the end of this Notice., or you may contact the Secretary of the United States Department of Health and Human Services at the following address: JFK Building, Room 1875, Boston, MA 02203; phone (617)565-1340 or (617)565-1343 (TDD).

The effective date of this Notice of Privacy Practices in its entirety is March 15, 2007.

Harbor Family Services service delivery locations and contacts list:

Aspenledge
PO Box 628
25 Mayo Rd.
Hampden, ME 04444
(207)862-2384 or (888)724-2384
Program Manager: Jon Shaw
Director of Residential Services: David McDermott

Winterport
1181 N. Main St.
Winterport, ME 04496
(207)223-4200 or (877)204-3551
Program Manager: Lucinda Moore
Director of Residential Services: David McDermott

Rockport 1
PO Box 230
1180 Rockland St.
W. Rockport, ME 04865
(207)236-6179 or (800)891-6003
Program Manager: Dan Cloutier
Regional Director: David McDermott

Rockport 2
PO Box 230
1152 Rockland St.
W. Rockport, ME 04865
(207)236-2779 or (866)999-3420
Program Manager: Mike Chasse
Regional Director: David McDermott

Community and Outpatient Services
247 Commercial St., Suite C
Belfast, ME 04915
(207)470-7090
Director: Merrilee Dahm Larsen