CARROLL COUNTY COUNCIL FOR THE PREVENTION OF CHILD ABUSE
DBA FAMILY RESOURCE CENTER
NOTICE OF PRIVACY PRACTICES
Effective: July 2013
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.
Family Resource Center’s HCBS Waiver Program is “we” in this notice. The Waiver Program provides services to individuals who qualify for waivers and habilitation.
This notice will tell you how we may use and disclose protected health information about you. Protected health information means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In this notice, we call all of that protected health information, “health information.”
This notice also will tell you about your rights and our duties with respect to health information about you. If you have a guardian, the guardian will make decisions concerning your health information. Lastly, this notice will tell you how to complain to us if you believe we have violated your privacy rights.
How We May Use and Disclose Your Health Information
We use and disclose health information about you for a number of different purposes. Each of those purposes is described below.
- For Services
We may use health information about you to provide, coordinate, or manage your services by both us and other health care providers. We may disclose health information about you to doctors, hospitals, and health facilities who become involved in your services. We may consult with other health care providers concerning you and as part of the consultation share your health information with them. Similarly, we may refer you to another health care provider and as part of the referral share health information about you with that provider. For example, we may conclude you need to receive services from a therapist. When we refer you to that therapist, we also will contact that office and provide health information about you to them so they have the information they need to provide services to you.
- For Payment
We may use and disclose health information about you so we can be paid for the services we provide to you. This can include billing you, your insurance company, or a third party payer. We also may need to provide your insurance company or a government program, such as Medicare or Medicaid, with information about your medical condition and the services you need to receive to determine if you are covered by that insurance or program.
- For Operations
We may use and disclose health information about you for our own operations. These are necessary for us to operate FRC’S Waiver Program and to maintain quality services for our consumers. For example, we may use health information about you to review the services we provide and the performance of our providers who support you. We may disclose health information about you to train our staff, volunteers, and students working in FRC’S Waiver Program. We also may use the information to study ways to more efficiently manage our organization.
- How We Will Contact You: Appointment Reminders
Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail. If you want to request that we communicate to you in a certain way or at a certain location, see, “Right to Receive Confidential Communications” in this notice. We may use and disclose health information about you to contact you to remind you of an appointment you have with us.
We may use and disclose health information about you to contact you to raise funds for Family Resource Center. We may disclose health information to a business associate of the agency or a foundation related to Family Resource Center so that business associates or foundations may contact you to raise money for the benefit of the agency’s programs. We will only release demographic information, such as your name, address, age, gender, date of birth, other contact information, your outcomes, and the dates you received services from FRC’S Waiver Program. If you do not want the agency or its foundation to contact you for fundraising, you may opt out by calling the Quality Assurance Specialist in the Carroll office or completing the Request Form.
- Individuals Involved in Your Care
We may disclose to a family member, another relative, a close personal friend, or any other person identified by you, health information about you that is directly relevant to that person’s involvement with your services or payment related to your services. We also may use or disclose health information about you to notify, or assist in notifying, those persons of your location, general condition, or death. If there is a family member, another relative, or close personal friend that you do not want us to disclose your health information to, please notify your service coordinator for a Request Form.
- Other Ways We may Use or Disclose Your Health Information
- Disaster Relief
- Required by Law
- Public Health Activities
- Health Oversight Activities
- To An Employer
- Security Clearances
- Persons in Custody
- Workers Compensation
- Proof Of Immunization
- To Avert Serious Threat to Health or Safety National Security and Intelligence
- Victims of Abuse, Neglect, or Domestic Violence Protective Services for the President
- Judicial and Administrative Proceedings
- Disclosures for Law Enforcement Purposes
- Family Resource Center
We will not sell your health information to others. We also will not use or disclose your health information for research purposes. Certain uses and disclosures require your written authorization
- Other Uses and Disclosures
Other uses and disclosures will be made only with your written authorization. You may revoke such an authorization at any time by notifying the Quality Assurance Specialist in the Carroll office in writing of your desire to revoke it. However, if you revoke such an authorization, it will not have any effect on actions taken by us in reliance on it.
- Psychotherapy Notes
Your authorization is required before we may use or disclose psychotherapy notes unless the use or disclosure is: (a) by the originator of the psychotherapy notes for treatment; (b) for our own training programs for students, trainees, or practitioners in mental health; (c) to defend ourselves in a legal action or other proceeding brought by you; (d) when required by law; or, (e) permitted by law for oversight of the originator of the psychotherapy notes.
We may use and disclose your health information to communicate with you about a service to encourage you to use the service. This may be to describe a service that is provided by us. This may occur without authorization.
Your authorization is required for use or disclosure of your health information for marketing purposes if the marketing involves direct or indirect payment to us from a third party. You have the right to opt out of marketing.
Your Rights With Respect to Your Health Information
You have the following rights with respect to health information that we maintain about you. If you have a guardian, the guardian will make decisions.
- Right to Request Restrictions
You have the right to request that we restrict the uses or disclosures of your health information to carry out services, payment, or operations. You also have the right to request that we restrict the uses or disclosures we make to: (a) a family member, another relative, a close personal friend or any other person identified by you; or, (b) to public or private entities for disaster relief efforts.
- If you request a restriction, you may do so at any time. To request a restriction, you should do so by speaking to your service coordinator and completing the Request Form. Tell us: (a) what information you want to limit; (b) whether you want to limit use or disclosure or both; and, (c) to whom you want the limits to apply (for example, disclosures to your spouse).
With one exception, we are not required to agree to any requested restriction. The exception is that we will agree to a request to restrict disclosures to a health plan if: (a) the disclosure is for the purpose of carrying out payment or operations and is not otherwise required by law; and, (b) the information relates solely to a service for which you or someone on your behalf (other than the health plan) has paid us in full.
If we agree to a restriction, we will follow that restriction unless the information is needed to provide emergency treatment. Even if we agree to a restriction, either you or we can later terminate the restriction.
- Right to Receive Confidential Communications
You have the right to request that we communicate your health information to you in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at home. We will not require you to tell us why you are asking for specific communication.
If you want to request specific communication, you must complete a Request Form for your service coordinator. Your request must state how or where you can be contacted.
We will accommodate your request. However, we may, when appropriate, require information from you concerning how payment will be handled. We also may require an alternate address or another method to contact you.
- Right to Inspect and Copy
With a few very limited exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of health information about you.
To inspect or copy your health information, you must complete a Request Form for your service coordinator. The coordinator will give it to the Quality Assurance Specialist in the Carroll office. Your request should state specifically what health information you want to inspect or copy. If you request a copy of the information, we may charge a fee for the costs of copying and, if you ask that it be mailed to you, the cost of mailing.
We will act on your request within thirty (30) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copies.
We may deny your request to inspect and copy health information if the health information involved is psychotherapy notes or information compiled in anticipation of, or use in, a civil, criminal or administrative action or proceeding.
If we deny your request, we will inform you of the basis for the denial, how you may have the denial reviewed, and how you may file a complaint. See the Complaint Policy and Procedure.
- Right to Amend
You have the right to ask us to amend health information about you. You have this right for so long as the health information is maintained by us.
To request an amendment, you must complete the Request Form for your service coordinator. The coordinator will give it to the Quality Assurance Specialist in the Carroll office. Your request must state the amendment desired and provide a reason in support of that amendment.
We will act on your request within sixty (60) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying.
If we grant the request, in whole or in part, we will seek your identification of and agreement to share the amendment with relevant other persons. We also will make the appropriate amendment to the health information by appending or otherwise providing a link to the amendment.
We may deny your request to amend health information about you. We may deny your request if it is not in writing and does not provide a reason in support of the amendment. In addition, we may deny your request to amend health information if we determine that the information:
- Was not created by us, unless the person or entity that created the information is no longer available to act on the requested amendment;
- Is not part of the health information maintained by us;
- Would not be available for you to inspect or copy; or,
- Is accurate and complete.
If we deny your request, we will inform you of the basis for the denial. You will have the right to file a complaint concerning our denial.
You may ask that we include your request for amendment and our denial with any future disclosures of the information. We will include your request for amendment and our denial (or a summary of that information) with any subsequent disclosure of the health information involved.
- Right to an Accounting of Disclosures
You have the right to receive an accounting of disclosures of health information about you. The accounting may be for up to six (6) years prior to the date on which you request the accounting but not before July 2013.
Certain types of disclosures are not included in such an accounting:
a. Disclosures to carry out services, payment, and operations;
b. Disclosures of your health information made to you;
c. Disclosures that are incident to another use or disclosure;
d. Disclosures that you have authorized;
e. Disclosures to persons involved in your care;
f. Disclosures for disaster relief purposes;
g. Disclosures for national security or intelligence purposes;
h. Disclosures to correctional institutions or law enforcement officials having custody of you;
i. Disclosures that are part of a limited data set for purposes of research, public health, or health care operations (a limited data set is where things that directly identify you have been removed);
j. Disclosures made prior to July 2013.
Under certain circumstances, your right to an accounting of disclosures to a law enforcement official or a health oversight agency may be suspended. Should you request an accounting during the period of time your right is suspended, the accounting would not include the disclosure or disclosures to a law enforcement official to a health oversight agency.
To request an accounting of disclosures, you must complete a Request Form for your service coordinator. The request form must state a time period for the disclosures. It may not be longer than six (6) years from the date we receive your request and may not include dates before January 2013.
Usually, we will act on your request within sixty (60) calendar days after we receive your request. Within that time, we will either provide the accounting of disclosures to you or give you a written statement of when we will provide the accounting and why the delay is necessary.
There is no charge for the first accounting we provide to you in any twelve (12) month period. For additional accountings, we may charge you for the cost of providing the list. If there will be a charge, we will notify you of the cost involved and give you an opportunity to withdraw or modify your request to avoid or reduce the fee.
- Right to Copy of this Notice
You have the right to obtain a paper copy of our Notice of Privacy Practices. You may request a copy of our Notice of Privacy Practices at any time. To obtain a paper copy of this notice, contact the Quality Assurance Specialist at the Carroll office by calling 1-800-999-5101.
We are required by law to maintain the privacy of your health information and to provide individuals with notice of our legal duties and privacy practices with respect to health information.
We are required to notify affected individuals following a breach of unsecured health information. We are required to abide by the terms of our Notice of Privacy Practices in effect at the time.
- Our Right to Change Notice of Privacy Practices
We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the revised notice’s provisions effective for all health information that we maintain, after the effective date of the revised notice.
- Availability of Notice of Privacy Practices
A copy of our current Notice of Privacy Practices will be posted in the meeting room and available in the reception area of the Carroll office.
At any time, you may obtain a copy of the current Notice of Privacy Practices by contacting the Quality Assurance Specialist at the Carroll office by calling 1-800-999-5101.
You may complain to us and to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You will not be retaliated against for filing a complaint.
To file a complaint with us, contact your FRC Waiver Program coordinator. If the coordinator is not able to resolve the complaint, please contact the Human Resources Manager, 502 W 7th Street, Carroll IA 51401, 712-792-6440. Submit the complaint to the Human Resources Manager in writing.
To file a complaint with the United States Secretary of Health and Human Services, send your complaint to him or her in care of: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201. Complaints also may be filed online. Go to: http://www.hhs.gov/ocr
- Questions and Information
If you have any questions or want more information concerning this Notice of Privacy Practices, please contact the Waiver Services Manager at the Carroll office.
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