ShelterCare NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW CLINICAL 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 notice, please contact your program counselor/advocate or Chris Steele, ShelterCare Privacy Officer, at 686-1262

 WHO WILL FOLLOW THIS NOTICE:

This notice describes the information privacy practices followed by all program employees.

 YOUR HEALTH INFORMATION:

This notice applies to the information and records we have about your mental health, mental health status, and the care and services you receive at this program.  This information may include information created and received by this office, may be in the form of written or electronic records or spoken words, and may include information about your mental health history, status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, and similar types of health-related information.

We are required by law to give you this notice.  It will tell you about the ways in which we may use and disclose health information about you and will describe your rights and our obligations regarding the use and disclosure of that information.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

We may use and disclose health information for the following purposes:

·    For Treatment.  All clinicians working within this program work with and have access to information about all clients of this program.  If you move from this program to another long-term residential program within ShelterCare, information will not be shared with that other program without your permission.  If, while receiving services at a long-term program, you require short-term crisis related services at either Royal Avenue Program or the Heeran Center we would provide those programs with information necessary to provide care without your written consent.

If yIf you are receiving mental health services from another agency then staff from this program will share information with staff from that other agency.  This is to ensure that all of the services you receive are compatible and that everybody is working together to help you.  This will be done only with your permission.

      For example: A client of this program may have a therapist with an agency such as OPTIONS or Center for Family Development or may be participating in a vocational or day treatment program at Laurel Hill Center.  In such cases, this program would provide these other agencies with information about services being provided by this program to help make sure that our work is supportive of the work being done at this other agency.

While this program’s primary focus is on clients’ mental health issues, we sometimes become aware of clients having difficulty with medical issues. In such situations we may provide information to medical providers in order to assist them in treating you. This will be done only with your permission.

For example: A person may have difficulty describing their physical symptoms to their doctor. Program staff may tell the doctor what they have observed or what the client has told them they are feeling.  Another example: A program client may not remember to inform their doctor  of all of the medications they are taking.  Program staff would then provide this information to the doctor.

For Payment.  We may use and disclose health information about you so that the treatment and services you receive at this program may be billed to and payment may be collected from you, an insurance company or a third party. 

For example: We may need to give information to your health plan provider about a service you received here so that your health plan will pay us or reimburse you for the service.  We may also tell your health plan provider about a treatment you are going to receive in order to obtain prior approval, or to determine whether your plan will pay for treatment. The information provided to the insurance company would include: name, age, birth date,  medical card number, social security number, diagnosis, the types and amounts of services received, the dates the services were performed and the staff person providing the services

For Health Care Operations.  We may use and disclose health information about you in order to monitor and improve the services provided by this program. 

For example: We may use your health information in order to evaluate the performance of our staff in caring for you.  We may also use health information about all or many of our clients to help us decide what additional services we should offer or how we might adjust our services in order to better meet the needs of our clients

We may also disclose your health information to health plan providers that provide your insurance coverage and other health care providers that care for you.  Our disclosures of your health information would be for the purpose of helping these health plan health care providers improve care, reduce cost, coordinate and manage health care and services, train staff and comply with the law.

Appointment Reminders.  We may contact you as a reminder that you have an appointment with a staff person or other provider.

Treatment Alternatives.  We may tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Please notify us in writing if you do not wish to be contacted for appointment reminders, or if you do not wish to receive communications about treatment alternatives.  If you advise us in writing that you do not wish to receive such communications, we will not use or disclose your information for these purposes.  

SPECIAL SITUATIONS:

We may use or disclose health information about you for the following purposes subject to all applicable legal requirements and limitations

 To Avert a Serious Threat to Health or Safety.  We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Required By Law.  We will disclose health information about you when required to do so by federal, state or local law.

Research.  We may use and disclose health information about you for research projects that are subject to a special approval process.  We will ask you for your permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the office.

Military, Veterans, National Security and Intelligence.  If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you.  We may also release information about foreign military personnel to the appropriate foreign military authority.

Workers’ Compensation.  We may release health information about you for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness. 

Public Health Risks.  We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products.

Health Oversight Activities.  We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes.  These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order.  Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.

Law Enforcement.  We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.

Information Not Personally Identifiable.  We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

Family and Friends.  We may disclose health information about you to your family members or friends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection.  We may also disclose health information to your family or friends if we can infer from the circumstances, based on our professional judgment, that you would not object.  For example, we may assume you agree to our disclosure of your personal health information to a parent if you bring a parent to a meeting with program staff in which your treatment is being discussed.

In situations where you are not capable of giving consent due to absence, incapacity or need for medical assistance program staff may, using their professional judgment, determine that a disclosure to your family member or friend is in your best interest.  In such a situation only health information relevant to the person’s involvement in your care would be provided.  For example: If a parent is closely involved in your treatment and you are experiencing an increase in severity of symptoms requiring emergency intervention program staff may provide your parent information which may assist in your treatment and resolving the emergency

OTHER USES AND DISCLOSURES OF HEALTH INFORMATION:

If you sign an authorization permitting program staff to use or disclose health information about you, you may revoke that authorization, in writing, at any time.  If you revoke your authorization, we will no longer use or disclose information about you for the reasons covered by your written authorization, but we cannot take back any uses or disclosures already made with your permission.

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU:

You have the following rights regarding health information about you produced by this program:

Right to Inspect and Copy.  You have the right to inspect and copy your health information, such as clinical and billing records we keep and use to make decisions about your care.

We may require a written request in order for you to be permitted to inspect and/or copy records of your health information. Such requests should be made to your program counselor or may be made to ShelterCare’s privacy officer by calling 686-1262. If you request a copy of your records we may charge a fee in order to cover copying, mailing or other associated costs.

We may deny your request to inspect and/or copy in certain circumstances.  If you are denied access to or copies of health information you may ask that our denial be reviewed.  If the law gives you the right to have our denial reviewed, we will select a licensed health care professional to review your request and our denial.  The person conducting the review will be someone other than the person who denied your request   We will comply with the outcome of the review.

Right to Amend.  If you believe health information about you  that this program has produced is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment as long as the information is kept by this office.

To request an amendment, complete and submit a CLINICAL RECORD AMENDMENT/CORRECTION FORM to ShelterCare’s privacy officer. This document is available from program staff or may be obtained from the privacy officer

We may deny your request for an amendment if your request is not in writing or does not include a reason to support the request.  In addition, we may deny your request if you ask us to amend information that:

·        We did not create, unless the person or entity that created the information is no longer available to make the amendment

·        Is not part of the health information that we keep

·        You would not be permitted to inspect and copy

·        Is accurate and complete

Right to an Accounting of Disclosures.  You have the right to request an “accounting of disclosures.”  This is a list of the disclosures we made of clinical information about you for purposes other than treatment, payment, health care operations, and a limited number of special circumstances involving national security, correctional institutions and law enforcement.  The list will also exclude any disclosures we have made based on your written authorization.

To obtain this list, you must submit your request in writing to your program counselor or to ShelterCare’s privacy officer.  It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003.  Your request should indicate in what form you want the list (for example, on paper, electronically).  The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the cost of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred.

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 for it, such as a family member or friend.  For example: you could ask that we not use or disclose information about medications you take.

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 emergency treatment.  To request restrictions, you may complete and submit the REQUEST FOR RESTRICTION ON USE/DISCLOSURE OF CLINICAL INFORMATION to your program counselor or ShelterCare’s privacy officer .

Right to Request Confidential Communications.  You have the right to request that we communicate with you about clinical matters in a certain way or at a certain location.  For example, you can ask that such communication happen only in person and not over the telephone.  To request confidential communications, you may complete and submit the REQUEST FOR RESTRICTION ON USE/DISCLOSURE OF CLINICAL INFORMATION AND/OR CONFIDENTIAL COMMUNICATION to your program counselor or ShelterCare’s privacy officer.  We will not ask you the reason for your request.  We will accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted.

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 it electronically, you are still entitled to a paper copy.To obtain such a copy, contact your program counselor or ShelterCare’s privacy officer

 CHANGES TO THIS NOTICE:

We reserve the right to revise this notice and to make the revised notice effective for clinical information that we already have about you as well as any information we receive in the future.  A summary of the current notice will be posted in the office with its effective date in the top right hand corner.  You are entitled to a copy of the notice currently in effect.

COMPLAINTS:

If you believe your privacy rights have been violated, you may file a complaint with ShelterCare’s Administration office or with the Secretary of the Department of Health and Human Services.  To file a complaint with our office, contact Chris Steele, ShelterCare Clinical Supervisor and Privacy Officer at 686-1262, You will not be penalized for filing a complaint.