Privacy Policy

CONFIDENTIAL - PROTECTED BY FEDERAL LAW 42 CFR PART 2
UNAUTHORIZED DISCLOSURE IS A FEDERAL CRIME
Penalties: $250,000 fine + 5 years imprisonment

Somerset Treatment Services
PRIVACY PRACTICES NOTICE

Important Information Before You Submit Your Information

YOUR PRIVACY IS IMPORTANT TO US

SOMERSET Treatment Services is required by federal and state law to protect your health information. This notice explains how we use and protect your information, and what rights you have.

WHAT INFORMATION DO WE COLLECT?

When you complete our prescreening or referral form, we collect:
- Your name, date of birth, and contact information
- Information about substance use and mental health
- Insurance information
- Your readiness for treatment and availability
- Emergency contact information

HOW DO WE USE YOUR INFORMATION?

We use your information to:
- Determine if we can help you with your treatment needs
- Schedule your intake appointment
- Verify your insurance coverage
- Create your treatment plan
- Contact you about your appointment and treatment

SPECIAL FEDERAL PROTECTIONS - 42 CFR PART 2

Because you are seeking substance use treatment, your information receives EXTRA protection under federal law (42 CFR Part 2).

HOW DO WE USE YOUR INFORMATION?

What this means for you:
✓ We CANNOT share your substance use information with anyone without your written permission, except in emergencies
✓ Your information stays completely separate from your general medical records
✓ We MUST keep all information confidential and secure
✓ Breaking these rules is a federal crime with serious penalties

WHEN CAN WE SHARE YOUR INFORMATION?

We can only share your information:
- With your written permission (we will ask you first)
- With your insurance company to process payment (with your consent on this form)
- In a medical emergency to protect your life
- If required by a court order or law
- To report child abuse, elder abuse, or threat of serious harm

WHAT ARE YOUR RIGHTS?

You have the right to:
- See and get a copy of your health records
- Ask us to correct information you believe is wrong
- Know who we have shared your information with
- Ask us to limit how we use or share your information
- Ask us to contact you in a private way (phone, mail, encrypted email)
- Take back your authorization at any time

HOW DO WE PROTECT YOUR INFORMATION?

We protect your information by:
- Using secure, encrypted technology (HTTPS)
- Limiting who can see your information
- Keeping it in a locked, password-protected system
- Training our staff on privacy rules
- Having a plan to respond if there is ever a problem

QUESTIONS?

If you have questions about your privacy or how we use your information:

Call us:
908-722-1232

Email us:
intake@stscares.org

Mail us:
SOMERSET Treatment ServicesPrivacy Officer[Address]

IF YOU HAVE A PRIVACY COMPLAINT

You can file a complaint with the U.S. Department of Health & Human Services (HHS) Office for Civil Rights if you believe your privacy rights have been violated.
You do NOT have to file a complaint with us first.
HHS Office for Civil Rights:
Website:
https://www.hhs.gov/ocr/privacy/hipaa/complaints/
Phone:
1-800-368-1019

YOUR CONSENT FOR FORMS

ALL FORMS ON THIS WEBSITE WILL INCLUDE THE SAMPLE BELOW

By completing our prescreening or referral form, you acknowledge that:
☐ You have read and understand this Privacy Notice
☐ You understand that your substance use information is protected by federal law
☐ You consent to SOMERSET using your information for treatment, payment, and scheduling
☐ You know you can ask questions at any time

You will need to check a box confirming you understand this notice before you can submit any form.