Privacy Notice Required Under Federal Law

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

Graydon Manor has always recognized the importance of keeping any information we have about you secure and confidential.  Under applicable law, we are providing you the notice below.  We will continue to make sure that your personal information is used and disclosed appropriately.

Under various state and federal statutes, different requirements apply to the information we collect, develop, use and disclose.  We use the term “health information” to mean individually identifiable information regarding clinical services we provide to you.  This information is protected by statute; hence it is referred to as protected health information (PHI).  Other personal information (address, telephone number, social security number) that is not related to your clinical treatment, but is necessary for providing services, is also safeguarded as PHI.

Should you have any questions about this policy, wish to comment about a disclosure issue or have concerns about any of our procedures related to information, you should tell your primary therapist or send a written statement to the Executive Director, Graydon Manor, 801 Children’s Center Road, Leesburg, VA 20175 or call the Director, Business and Support Services at (703) 777-3485.  Complaints about an actual disclosure must be written.   

You may also file a compliant with the Secretary of the Department of Health and Human Services at 200 Independence Ave., S.E., Washington DC 20201 or call 1-877-696-6775.

HEALTH INFORMATION PRACTICES and PRIVACY RIGHTS

You or your legal representative (collectively you) have the right to expect that Graydon Manor’s communications, treatment records, and education reports will be protected as confidential.  You have a right to know how your personal individually identifiable protected health information (PHI) will be used and to whom it is released.  You have a right to request that communications and disclosure of information be restricted; you also have a right to know that we are not required to agree to restrict disclosure.

While Graydon Manor protects PHI, we may be required to release or disclose PHI when required by federal or state law and or court order; for health oversight activities such as audits and utilization management; civil, administrative or criminal investigation; inspections, licensure or disciplinary actions; and abuse reporting requirements, with or without your consent.

In providing treatment, the medical, clinical and other direct care staff responsible for providing care will have access to PHI.  During the course of treatment, we will release information you specify in writing to whomever you designate. You may revoke any consent or authorization for the release of PHI, except where required by law, by sending written notice to Graydon Manor.  Revocation cannot be retroactive.

In the conduct of health care operations, we may release selected PHI to individuals or other organizations that provide necessary services, including but not limited to: pharmacy for medications; laboratory for analysis; pediatric and/or special medical providers for specific procedures; statistical organizations for accreditation; and to your health care or insurance plan for case management and payment.  By health care or insurance plan, we include governmental entities that are or may be asked to pay for Graydon Manor’s services. 

Upon written request, Graydon Manor will provide you a list of those individuals or entities, not included in treatment or health operations, to whom we have provided your PHI.

Graydon Manor will not disclose PHI for fundraising activities, marketing, or research without your written authorization.

Finally, you have a right to see, read and get a copy of those records maintained on you by Graydon Manor. You may request that the record be amended or corrected.  Should Graydon Manor not agree to make changes, upon your request, a statement explaining your position will be filed in the record.  If needed, Graydon Manor will help you write your statement.