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This document outlines how medical information about individuals may be used and disclosed by the NYC 9/11 Benefit Program for Mental Health and Substance Use Services, detailing the rights of individuals
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How to fill out NYC 9/11 Benefit Program for Mental Health and Substance Use Services - Notice of Privacy

01
Visit the NYC 9/11 Benefit Program website.
02
Locate the 'Mental Health and Substance Use Services' section.
03
Download the Notice of Privacy form.
04
Read through the instructions carefully.
05
Fill out your personal information, including your full name and contact details.
06
Provide information about your eligibility and connection to the 9/11 events.
07
Document any mental health or substance use services you have received or plan to receive.
08
Sign and date the form to confirm its accuracy.
09
Submit the completed form through the specified channels indicated on the website.

Who needs NYC 9/11 Benefit Program for Mental Health and Substance Use Services - Notice of Privacy?

01
Individuals who were affected by the 9/11 attacks and experienced mental health or substance use issues.
02
First responders who provided aid during the 9/11 recovery efforts.
03
Survivors who lived or worked in the vicinity of the World Trade Center on 9/11.
04
Families of those who lost loved ones in the attacks and are facing mental health challenges.
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Cancers Blood and lymphoid tissue (including lymphoma, myeloma, and leukemia) . Childhood cancers. Digestive system (including colon and rectum) Eye and orbit. Ovary. Head and neck (oropharynx and tonsil) Prostate.
Benefits of Enrolling in the Program Free treatment for any WTC-related health condition or cancer. The Program covers expenses for approved prescription medications, hospitalizations, and outpatient producers for treatment of a WTC-related condition.
The WTC Health Program was created by the Zadroga 9/11 Health and Compensation Act to provide free health care for first responders, recovery workers, and volunteers affected by the terrorist attacks on September 11, 2001. The WTC Health Program replaces the Mount Sinai WTC Medical Monitoring and Treatment Program.
Most Common VCF "Covered Conditions" The VCF covers a wide range of physical conditions, including over 70 types of cancer (including cancer of the , prostate, skin, blood, and just about any other type of cancer), breathing difficulties, digestive issues, and other related health issues.
Claims should be submitted electronically if possible, using WTC Payor ID # 31172.

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The NYC 9/11 Benefit Program for Mental Health and Substance Use Services - Notice of Privacy is a document that outlines how personal health information will be used and disclosed, as well as the rights of individuals regarding their health information in relation to mental health and substance use services provided to individuals affected by the events of September 11, 2001.
Entities that provide mental health and substance use services under the NYC 9/11 Benefit Program, such as healthcare providers and organizations that support individuals impacted by the 9/11 events, are required to file the Notice of Privacy.
To fill out the Notice of Privacy, healthcare providers should include information about their privacy practices, how health information is used and shared, the rights of the individuals receiving services, and any specific protocols associated with the 9/11 Benefit Program.
The purpose of the Notice of Privacy is to inform individuals about their privacy rights, how their personal health information can be used, who can access that information, and the procedures in place to protect their privacy while receiving necessary services.
The information that must be reported includes details about the types of information collected, how that information may be used, the circumstances under which it may be shared, the rights of individuals regarding their information, and how to file a complaint if they feel their privacy has been violated.
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