Strawberry Fields, Inc.
HIPAA Notice of Privacy Practices

Strawberry Fields, Inc. takes pride in treating our consumers and each other with dignity and respect. Protecting your personal health information is very important to us. We want you to have a clear understanding of how we use and safeguard your protected health information (PHI). PHI and health care services for the purposes of this statement will include medical information, billing records, mental health information, early intervention services, case management and related services. This protection includes information that is oral, written, or electronic that personally identifies you.

In compliance with the Health Insurance Portability and Accountability Act (HIPAA), we are sending you this important information. This notice describes how medical information about you may be used and disclosed in order to carry out treatment, payment, and operations. It may also be used for other purposes permitted or required by law. This notice also outlines how you can get access to and control this information. Please review it carefully.

Strawberry Fields, Inc. is required to abide by the terms of this notice. However, we may modify the terms of this notice at any time, and the new notice will be effective for all PHI in our possession at the time of the change, and any received thereafter. Upon request, we will provide you with any revised notice.

USES AND DISCLOSURES OF HEALTH INFORMATION

Strawberry Fields, Inc. uses PHI about you for treatment, payment and operational purposes. We do not require authorization to use your PHI for these purposes.

Treatment is when Strawberry Fields, Inc. provides, coordinates or manages your health care and other services related to your health care. An example would be your therapist/ case manager/ worker consulting with their supervisor.

Payment is when Strawberry Fields, Inc. obtains reimbursement for your healthcare. An example is when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage. If you may be eligible for medical assistance and do not apply, you will be charged full fee for services.

Health Care Operations are activities that relate to the performance and operation of Strawberry Fields, Inc. Examples of operations include quality assessment and improvement activities, business related matters such as audits, administrative services, care coordination, and civil rights compliance.

In addition to the above-mentioned uses of your PHI related to treatment, payment and health care operations, Strawberry Fields, Inc. may also use your PHI for appointment reminders to contact and remind you of appointments.

Strawberry Fields, Inc. will use and disclose your PHI when we are required to do so by federal, state, or local law.

Uses and Disclosures Requiring Authorization

Strawberry Fields, Inc. may use or disclose PHI for purposes outside of treatment, payment, and health care operations only when your appropriate authorization is obtained. An authorization is written permission above and beyond the general consent that permits only specific disclosures. We will obtain an authorization from you before releasing any information. You may revoke all such authorizations of PHI at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) Strawberry Fields, Inc. has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage; or (3) the law provides the insurer the right to contest the claim under the policy.

Uses and Disclosures with Neither Consent nor Authorization

Strawberry Fields, Inc. may use or disclose PHI without your consent or authorization in the following circumstances: Child Abuse, Adult and Domestic Abuse, Judicial or Administrative Proceedings, Serious Threat to Health or Safety, Worker’s Compensation, Military or Other Specialized Government Functions, Law Enforcement, Coroners, Funeral Directors, Public Health, and Health Oversight.

YOUR RIGHTS

The Right to Request Restrictions:  You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, Strawberry Fields, Inc. is not required to agree to a restriction you request.

The Right to Receive Confidential Communications by Alternative Means and at Alternative Locations:  You have the right to request and receive confidential communication of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are receiving services.) Strawberry Fields, Inc. will accommodate all reasonable requests that are made in writing.

The Right to Inspect and Copy:  You have the right to inspect and obtain a copy of your PHI that we maintain and have in our possession, including mental health, medical records (if we maintain any) and billing records used to make decisions about you for as long as the PHI is maintained in the record. To inspect and copy your PHI, you must submit your request in writing. Normally, we will provide you with access within 30 days of your request.

Under certain circumstances, we may deny your request to inspect and copy your PHI. If you are denied access to information, you have the right to have that determination reviewed. A licensed health care professional chosen by Strawberry Fields, Inc. will review your request. Strawberry Fields, Inc. promises to comply with the outcome of the review.

The Right to Amend Your PHI:  If you feel that any PHI we have about you is not correct or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by Strawberry Fields, Inc. To request an amendment, your request must be made in writing. Additionally, you must provide a reason that supports your request.

Strawberry Fields, Inc. reserves the right to deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

  • Was not created by Strawberry Fields, Inc., unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the medical information kept by or for Strawberry Fields, Inc.;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.

The Right to a Paper Copy:  If you have obtained this notice electronically, you may obtain a paper copy.

The Right to an Accounting of Disclosures:  An accounting of disclosures is a list of the disclosures we have made, if any, of your PHI.

You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent or authorization.

Your request must be made in writing and state a time period that cannot be longer than six years and cannot include any dates before April 13, 2003. We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

How to Contact Us or File a Complaint

If you have any questions or are concerned that Strawberry Fields, Inc. has violated your privacy rights or you disagree with a decision made by Strawberry Fields, Inc. about access to your records, you may contact us:

Staff Related Concerns

Cindy Polinski
Privacy Officer and
Human Resource Director
Strawberry Fields, Inc.
3054 Enterprise Dr.
State College, PA 16801
(814) 234-6023

Consumer Related Concerns

Richard Gadsby, Associate Director of Mental Health Services
Strawberry Fields, Inc.
3054 Enterprise Dr.
State College, PA 16801
(814) 234-6023

Or, you may contact the Secretary of Health and Human Services. Under no circumstances will Strawberry Fields, Inc. retaliate against you for filing a complaint.