Notice of Privacy Practices for
University Behavioral HealthCare ("UBHC")
for Spanish language version
An Operating Unit of the University of Medicine and Dentistry
of New Jersey ("UMDNJ"), a body corporate and politic
of the State of New Jersey, a public entity
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
If you have any questions about this Privacy Notice, please
contact our Privacy Liaison at 671 Hoes Lane, P.O. Box 1392,
Piscataway, New Jersey 08855, (732) 235-4278.
We at University Behavioral HealthCare understand that health
information about you and the care you receive is personal. We
are committed to and are required by law to maintain the privacy
of your health information. This Notice applies to all of the
records of your care maintained by us and we will abide by the
terms of this Notice for as long as it is in effect.
This Notice of Privacy Practices describes how we may use and
disclose your protected health information to carry out treatment,
payment, or health care operations and for other purposes that
are permitted or required by law. This Notice also describes your
rights regarding health information we maintain about you and
a brief description of how you may exercise these rights.
How We Will Use and Disclose Your Health Information
We will use and disclose your health information as described
in each category listed below. We will provide a general explanation
of each category; however this is not meant to describe all specific
uses or disclosures of health information.
- Uses and Disclosures That May Be Made Without Your Authorization
or Opportunity To Object
We may use health information about you to provide you with
medical treatment or services. We may disclose information about
you to physicians, nurses, technicians, health care trainees,
or other personnel who are involved in taking care of you.
For example, our doctors may need to know if you have high blood
pressure before prescribing certain medications for you. Different
areas of the organization may also share medical information
about you in order to coordinate your care, such as prescriptions,
lab work, and test results. In addition, our staff may discuss
your care at treatment team meetings.
We may use and disclose health information about you so that
treatment and services you receive may be billed to and payment
may be collected from you, an insurance company or a third party
involved in the payment of your medical bill. For example, we
may disclose protected health information to your insurer or
the party responsible for payment of your care for the following
activities: making a determination of eligibility or coverage
for health insurance; reviewing your services to determine if
they were medically necessary, which may include copies or excerpts
of your medical records; reviewing your services to determine
if they were appropriately authorized or certified in advance
of your care; reviewing your services for purposes of utilization
review (to ensure the appropriateness of your care).
- Health Care Operations
We may use and disclose health information about you for healthcare
operations. Your health information may be used and disclosed
for activities including quality assurance, utilization review,
medical review, internal auditing, accreditation, social services
certification, licensing or credentialing activities, medical
research, and education purposes. These disclosures are necessary
to run the organization and make sure that all of our patients
receive quality care. For example, we may use health information
to review our treatment and services and to evaluate the performance
of the staff caring for you. We may also disclose information
to physicians, nurses, technicians, medical students, and other
personnel for review and learning purposes.
- Appointment Reminders
We may use and disclose limited health information (such as
your name, address, and telephone number) to contact you as
a reminder that you have an appointment for treatment or medical
- Treatment Alternatives
We may use and disclose health information to tell you about
or recommend possible treatment options or alternatives that
may be of interest to you.
- Health Related Benefits and Services
We may use or disclose health information to tell you about
health-related benefits or services that may be of interest
- Fundraising Activities
We may use or disclose your name, address, and dates of service
to contact you in an effort to conduct fundraising activities
for our programs, services, and operations. If you do not want
us to contact you for fundraising efforts, you may notify the
Privacy Liaison at University Behavioral HealthCare, 671 Hoes
Lane, P.O. Box 1392, Piscataway, NJ 08855-1392.
- To Another Healthcare Provider
We may use or disclose health information about you to another
healthcare provider that may treat you and/or receive payment
for services provided to you. For example, we may share your
health information with a hospital where you will be receiving
- Business Associates
We may use or disclose health information about you to entities
that assist us in providing services related to treatment, payment,
or healthcare operations. We are required to have a Business
Associate Contract in place with all entities with which we
will share your protected health information.
- De-Identified Data/Limited Data Sets
We may use or disclose health information about you if we remove
all information that could be used to identify you (what is
known as "de-identified" information). We may also
use or disclose a limited amount of health information about
you (that is, a "limited data set") for the purposes
of research, public health, or health care operations if we
enter into a data use agreement with the recipient of the data.
We may use and disclose your health information in an emergency
treatment situation. For example, we may provide your health
information to a paramedic who is transporting you in an ambulance.
While most uses and disclosures related to research require
your authorization, in some limited situations we may disclose
your health information to researchers when their research has
been approved by an Institutional Review Board or a similar
privacy board that has waived the individual authorization requirement
in accordance with the regulations covering this area.
- As Required By Law
We will disclose health information about you when required
to do so by federal or state law.
- To Avert a Serious Threat to Health or Safety
We may use and disclose health information about you to prevent
a serious and imminent threat to your health or safety or to
the health or safety of the public or another person.
- Organ and Tissue Donation
If you are an organ donor, we may use or disclose your health
information to an organ procurement organization or to an entity
that conducts organ, eye or tissue transplantation, or serves
as an organ donation bank, as necessary to facilitate organ,
eye or tissue donation and transplantation.
- Public Health Risk
We may disclose your health information for public health activities
involved in preventing or controlling disease, injury, or disability.
For example, we are required by state law to report the existence
of a communicable disease, such as acquired immune deficiency
syndrome ("AIDS"), to the New Jersey State Department
of Health and Senior Services to protect the health and well
being of the general public. Other activities generally disclosed
include the following:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse and neglect;
- to report reactions to medication or problems with products;
- to notify a person who may have been exposed to a communicable
disease or may be at risk for contracting or spreading a
disease or condition;
- to notify the appropriate governmental authority if we
believe a patient 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.
- Health Oversight Activities
We may disclose health information to a health oversight agency
for activities authorized by law. These oversight activities
include, for example, audits, investigations, inspections, and
licensure. These activities are necessary for the government
to monitor the health care system, government programs, and
compliance with civil rights.
- Law Enforcement
We may release medical information if asked to do so by a law
- in response to a court order;
- to identify or locate a suspect, fugitive, material witness,
or missing person;
- about the victim of a crime if, under certain limited
circumstances, we are unable to obtain the persons
- about a death we believe may be the result of criminal
- about criminal conduct at our facility;
- in emergency circumstances to report a crime; the location
of the crime or victims; or identity, description or location
of the person who committed the crime.
- Coroners, Medical Examiners and Funeral Directors
We may release health information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person
or determine the cause of death. We may also release health
information about patients to funeral directors as necessary
to carry out duties.
- Disclosures in Legal Proceedings
We may disclose health information about you to a court or
administrative agency when a judge or administrative agency
orders us to do so.
- Military and Veterans
If you are a member of the armed forces, we may disclose your
health information as required by military command authorities.
We may also disclose your health information for the purpose
of determining your eligibility for benefits provided by the
Department of Veterans Affairs. Finally, if you are a member
of a foreign military service, we may disclose your health information
to that foreign military authority.
- National Security and Protective Services for the President
We may disclose health information about you to authorized
federal officials for intelligence, counterintelligence, and
other national security activities authorized by law. We may
also disclose health information about you to authorized federal
officials so they may provide protection to the President, other
authorized persons, or foreign heads of state or so they may
conduct special investigations.
If you are an inmate of a correctional institution or under
the custody of a law enforcement official, we may disclose health
information about you to the correctional institution or law
- Workers Compensation
We may disclose health information about you to comply with
the states Workers Compensation Law.
We may disclose your health information to your employer if
your healthcare is part of an evaluation relating to medical
surveillance of the workplace, or to evaluate whether you have
a work-related illness or injury.
- Uses and Disclosures That May Be Made Without Your Authorization,
But For Which You Will Have An Opportunity To Object.
- Facility Directory
It is the policy of University Behavioral HealthCare not
to provide confirmation of names of patients being treated by
our facilities except to persons involved in your care (see
- Persons Involved In Your Care
Unless you object, we may release health information about
you to someone, including a family member, legal guardian, or
caregiver, who is involved in your medical care or payment of
your medical care.
- Disaster Relief
Unless you object, we may disclose health information about
you to an entity assisting in a disaster relief effort so that
your family can be notified about your condition, status, and
- Uses and Disclosures of Your Health Information with Your
Other uses and disclosures of health information not covered
by this Notice or the laws that apply to us will be made only
with your written permission, called an "authorization."
If you provide us permission to use or disclose health information
about you, you may revoke that permission, in writing, at any
time. If you revoke your permission, we will no longer use or
disclose health information about you. You understand that we
are unable to take back any disclosures we have made with your
permission, and that we are required to retain our records of
the medical care that we have provided to you.
- Special Notice for Licensed Psychologists and Licensed
Marriage and Family Therapists
If you are receiving care from a licensed psychologist or licensed
marriage and family therapist, to protect your confidentiality
and the confidentiality of your mental health records, in most
circumstances we will not disclose information about you and
your treatment here without first obtaining your consent. If
you provide us with permission to disclose your health information,
you may revoke that permission, in writing, at any time. If
you revoke your permission, we will no longer disclose health
information about you, although we will be unable to take back
the disclosures we made with your permission.
It is important for you to know that in limited situations
we must release the information without your prior consent.
These situations are as follows:
- to secure emergency treatment for you;
- to prevent serious and imminent threat to your health and
safety or the health and safety of another person or to the
- as required by Federal or New Jersey Law, such as responding
to requests from Medicare, Medicaid, the Attorney Generals
office, and the coroners office, and reporting communicable
diseases and child abuse and neglect; or
- as directed by a court order signed by a judge.
- Your Rights Regarding Your Health Information
- Right to Inspect and Copy
You have the right to request an opportunity to inspect or
obtain a copy of health information in our possession. Usually,
this will include clinical and billing records, but not psychotherapy
notes. You must submit your request in writing on a form specified
by us addressed to Department of Clinical Records, University
Behavioral HealthCare, 671 Hoes Lane, P.O. Box 1392, Piscataway,
NJ 08855-1392. If you request a copy of the information, we
may charge a fee for the cost of copying, mailing, and supplies
associated with complying with your request
We may deny your request to inspect or obtain a copy of your
health information in certain limited circumstances. In some
cases, you will have the right to have the denial reviewed by
another health care professional chosen by us and who was not
directly involved in the original decision to deny access. If
you are denied access, we will inform you in writing if the
denial of your request may be reviewed. If it is reviewable
and you request a review in writing, when the review is completed,
we will comply with the outcome of the review.
- Right to Amend
For as long as we keep records about you, you have the right
to request us to amend any health information used to make decisions
about your care or payment for your care. To request an amendment,
your request must be in writing on a form specified by us addressed
to the Privacy Liaison at University Behavioral HealthCare,
671 Hoes Lane, P.O. Box 1392, Piscataway, NJ 08855-1392, and
must explain why you believe the information is incorrect or
We may deny your request under certain circumstances. If we
deny your request to amend, we will send you a written notice
of the denial stating the basis for the denial and offering
you the opportunity to provide a written statement disagreeing
with the denial. If you do not wish to prepare a written statement
of disagreement, you may ask that the requested amendment and
our denial be attached to all future disclosures of the health
information that is the subject of your request.
If you choose to submit a written statement of disagreement,
we have the right to prepare a written rebuttal to your statement
of disagreement. In this case, we will attach the written request
and the rebuttal (as well as the original request) to all future
disclosures of the health information that is the subject of
- Right to an Accounting of Disclosures
You have the right to request that we provide you with an accounting
or list of disclosures we have made of your health information.
This list will not include disclosures of your health information
made for treatment, payment, or health care operations, made
to you, or made as a result of an authorization signed by you.
To request an accounting of disclosures, you must submit your
request in writing on a form specified by us to the Privacy Liaison at University Behavioral HealthCare, 671 Hoes Lane,
P.O. Box 1392, Piscataway, NJ 08855-1392. The request should
state the time period for which you wish to receive an accounting.
This time period should not be longer than six (6) years and
not include dates before April 14, 2003.
The first accounting you request within a twelve (12) month
period will be free. For additional requests during the same
twelve (12) month period, we will charge you for costs of the
accounting. We will notify you of the amount we will charge
and you may choose to withdraw or modify your request before
we incur any costs.
- Right to Request Restrictions
You have the right to request a restriction or limitation on
the health information we use or disclose about you for treatment,
payment, or health care operations. You also have the right
to request a limit on the health information we disclose about
you to someone who is involved in your care or the payment of
your care, like a family member or friend. We are not
required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide
you with emergency treatment. To request restrictions, you must
inform us at time of registration or in writing on a form specified
by us addressed to the Privacy Liaison at University Behavioral
HealthCare, 671 Hoes Lane, P.O. Box 1392, Piscataway, NJ 08855-1392.
- 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
by mail, or at a specified telephone number. To request confidential
communications, you must notify us at the time of registration
or in writing on a form specified by us addressed to the Privacy Liaison at University Behavioral HealthCare, 671 Hoes Lane,
P.O. Box 1392, Piscataway, NJ 08855-1392. We will not ask you
the reason for the request. We will accommodate all reasonable
requests. Your request must specify how or where you wish to
- Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice. You may
ask us to give you a copy of this Notice at any time. Even if
you have agreed to receive this Notice electronically, you are
still entitled to a paper copy of this Notice. You may obtain
a paper copy of this Notice by contacting the Privacy Liaison
at University Behavioral HealthCare, 671 Hoes Lane, P.O. Box
1392, Piscataway, NJ 08855-1392.
If you believe your privacy rights have been violated, you
may file a complaint with us or with the Secretary of the United
States Department of Health and Human Services. To file a complaint
with us, contact our Patient Advocate at University Behavioral HealthCare,
671 Hoes Lane, P.O. Box 1392, Piscataway, NJ 08855-1392. Filing
a complaint will not result in any change or reduction in services
or benefits to which you are otherwise entitled.
- Changes to this Notice
We reserve the right to change the terms of our Notice of Privacy
Practices. We also reserve the right to make the revised or
changed Notice of Privacy Practices effective for all health
information we already have about you as well as any health
information we receive in the future. We will post a copy of
the current Notice of Privacy Practices at all of our locations
where we provide care. You may also obtain a copy of our current
Notice of Privacy Practices by accessing our website at www.ubhc.org,
by writing us at Privacy Liaison, University Behavioral HealthCare,
671 Hoes Lane, P.O. Box 1392, Piscataway, NJ 08855-1392 and
requesting that a copy be sent to you in the mail, or by asking
for one any time you are at our offices.
- Who Will Follow This Notice
This Notice of Privacy Practices will be followed by us at
all of our locations. Please note that any of University Behavioral
HealthCares entities, sites, or locations may share health
information with each other for treatment, payment, or health