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Jeren is 9 years old and has been living in a Barium Springs foster home since a family member dropped him off on the steps of the Department of Social Services (DSS) 2 years ago. Recently, his biological parents’ rights were terminated and he became available for adoption.
NOTICE OF PRIVACY PRACTICES OF BARIUM SPRINGS HOME FOR CHILDREN
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.
Effective: April 14, 2003
Updated: December 27, 2005
Updated: June 17, 2008; April 18, 2013
If you have any questions or requests, please contact:
Barium Springs Home for Children
P.O. Box 1
Barium Springs, NC 28010
Privacy Officer: Bill P. Smith
A. We Have A Legal Duty to Protect Health Information About You
We are required by law to protect the privacy of health information about you and that can be identified with you, which we call “protected health information,” or “PHI” for short. We must give you notice of our legal duties and privacy practices concerning PHI:
This Notice describes the types of uses and disclosures that we may make and gives you some examples. In addition, we may make other uses and disclosures that occur as a byproduct of the permitted uses and disclosures described in this Notice. If we participate in an “organized health care arrangement” (defined in subsection B.3 below), the providers participating in the “organized health care arrangement” will share PHI with each other, as necessary to carry out treatment, payment or health care operations (defined below) relating to the “organized health care arrangement”.
We are required to follow the procedures in this Notice. We reserve the right to change the terms of this Notice and to make new notice provisions effective for all PHI that we maintain by first:
B. We May Use and Disclose PHI About You Without Your Authorization in the Following Circumstances
1. We may use and disclose PHI about you to provide health care treatment to you.
We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care and service providers regarding your treatment and coordinating and managing your health care with others. For example, we may use and disclose PHI about you when you need a prescription, lab work, a x-ray, or other health care services. For example we may use and disclose your PHI when you need a referral for mental health or other health care services.
2. We may use and disclose PHI about you to obtain payment for services.
Generally, we may use and give your medical information to others to bill and collect payment for the treatment and services provided to you by us or by another provider. Before you receive scheduled services, we may share information about these services with your health plan(s). Sharing information allows us to ask for coverage under your plan or policy and for approval of payment before we provide the services. We may also share portions of medical information about you with the following:
EXAMPLE: If you have insurance with ABC insurance, we will report information regarding the medical treatment and services provided to you, along with information supporting the reasons why the medical goods and services were provided, to ABC insurance in order to receive payment.
3. We may use and disclose PHI about you for health care operations.
We may use and disclose PHI in performing business activities, which we call “health care operations”. These “health care operations” allow us to improve the quality of care we provide and reduce health care costs. We may also disclose PHI for the “health care operations” of any “organized health care arrangement” in which we participate. An example of an “organized health care arrangement” is the care provided by BSHC and the therapists who see clients for counseling services. In addition, we may disclose PHI about you for the “health care operations” of other providers involved in your care to improve the quality, efficiency and costs of their care or to evaluate and improve the performance of their providers. Examples of the way we may use or disclose PHI about you for “health care operations” include the following:
4. We may use and disclose PHI under other circumstances without your authorization or an opportunity to agree or object.
We may use and/or disclose PHI about you for a number of circumstances in which you do not have to consent, give authorization or otherwise have an opportunity to agree or object. Those circumstances include:
5. You can object to certain uses and disclosures.
Unless you object, we may use or disclose PHI about you in the following circumstances:
If you would like to object to our use or disclosure of PHI about you in the above circumstances, please call or write to our contact person listed on the cover page of this Notice.
6. We may contact you to provide appointment reminders.
We may use and/or disclose PHI to contact you to provide a reminder to you about an appointment you have for treatment or medical care.
7. We may contact you with information about treatment, services, products or health care providers.
We may use and/or disclose PHI to manage or coordinate your healthcare or service provision. This may include telling you about treatments, services, products and/or other healthcare providers. We may also use and/or disclose PHI to give you gifts of a small value.
EXAMPLE: If you are diagnosed with Attention Deficit Hyperactivity Disorder, we may tell you about nutritional and other counseling services that may be of interest to you.
8. We may contact you for fundraising activities.
We may use and/or disclose PHI about you, including disclosure to our foundation, to contact you to raise money for our facility and its operations. We would only release contact information and the dates you received services at our facility. If you do not want to be contacted in this way, you must notify in writing our contact person listed on the cover page of this Notice to opt out of fundraising communications.
9. Psychotherapy notes disclosures:
We are required to obtain written authorization from you for the following uses and disclosures of PHI: 1. If the PHI is used or disclosed for marketing purposes; 2. If the disclosure constitutes a sale of PHI; 3. Most uses and disclosure of psychotherapy notes
10. Client information protected by the Federal Substance Abuse Confidentiality Regulations may not be re-disclosed by the recipient without further written authorization by the client or the client’s legally responsible person.
** Uses and disclosures of PHI not covered by this Notice of Privacy Practices (NPP) will only be made with your written permission. This authorization may be revoked as provided in the regulations.
**ANY OTHER USE OR DISCLOSURE OF PHI
ABOUT YOU REQUIRES YOUR WRITTEN AUTHORIZATION **
Under any circumstances other than those listed above, we will ask for your written authorization before we use or disclose PHI about you. If you sign a written authorization allowing us to disclose PHI about you in a specific situation, you can later cancel your authorization in writing by contacting The Privacy Officer. If you cancel your authorization in writing, we will not disclose PHI about you after we receive your cancellation, except for disclosures that were being processed before we received your cancellation.
C. You Have Several Rights Regarding PHI About You
1. You have the right to request restrictions on uses and disclosures of PHI about you.
You have the right to request that we restrict the use and disclosure of PHI about you. We are not required to agree to your requested restrictions. However, even if we agree to your request, in certain situations your restrictions may not be followed. These situations include emergency treatment, disclosures to the Secretary of the Department of Health and Human Services, and uses and disclosures described in subsection B.4 of the previous section of this Notice. You may request a restriction by sending it, in writing, to the Privacy Officer. We have the right to limit or deny services in the event you decide to restrict us in the necessary disclosure or your PHI (e.g., the disclosure of information for payment purposes).
2. You have the right to restrict certain disclosures of PHI about you.
You have the right to request that we restrict the use and disclosure of PHI about you to a health plan if you have paid for the health care item or services out-of-pocket. You may request a restriction by sending it, in writing, to the Privacy Officer. We have the right to limit or deny services in the event you decide to restrict us in the necessary disclosure or your PHI (e.g., the disclosure of information for payment purposes).
3. You have the right to request different ways to communicate with you.
You have the right to request how and where we contact you about PHI. For example, you may request that we contact you at your work address or phone number or by email. Your request must be in writing. We must accommodate reasonable requests, but, when appropriate, may condition that accommodation on your providing us with information regarding how payment, if any, will be handled and your specification of an alternative address or other method of contact. You may request alternative communications by a written request to the Privacy Officer or at the time of admission.
4. You have the right to see and copy PHI about you.
You have the right to request to see and receive a copy of PHI contained in clinical, service, billing and other records used to make decisions about you. Your request must be in writing. We may charge you related fees. Instead of providing you with a full copy of the PHI, we may give you a summary or explanation of the PHI about you, if you agree in advance to the form and cost of the summary or explanation. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial. You may request to see and receive a copy of PHI by written request to the Privacy Officer.
5. You have the right to request amendment of PHI about you.
You have the right to request that we make amendments to clinical, service, billing and other records used to make decisions about you. Your request must be in writing and must explain your reason(s) for the amendment. We may deny your request if: 1) the information was not created by us (unless you prove the creator of the information is no longer available to amend the record); 2) the information is not part of the records used to make decisions about you; 3) we believe the information is correct and complete; or 4) you would not have the right to see and copy the record as described in paragraph 3 above. We will tell you in writing the reasons for the denial and describe your rights to give us a written statement disagreeing with the denial. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment, including persons you name who have received PHI about you and who need the amendment. You may request an amendment of PHI about you by contacting the Privacy Officer at BSHC.
6. You have the right to a listing of disclosures we have made.
If you ask our contact person in writing, you have the right to receive a written list of certain of our disclosures of PHI about you. You may ask for disclosures made up to six (6) years before your request (not including disclosures made prior to April 14, 2003). We are required to provide a listing of all disclosures except the following:
If you request a list of disclosures more than once in 12 months, we can charge you a reasonable fee. You may request a listing of disclosures by making a written request to the Privacy Officer.
7. You have the right to a copy of this Notice.
You have the right to request a paper copy of this Notice at any time by contacting the Privacy Officer at BSHC. We will provide a copy of this Notice no later than the date you first receive service from us (except for emergency services, and then we will provide the Notice to you as soon as possible).
Breach Notification: hould your unsecured PHI be compromised, you will be notified via certified mail.
D. You May File A Complaint About Our Privacy Practices
If you think we have violated your privacy rights, or you want to complain to us about our privacy practices, you can contact the person listed below:
Privacy Officer, Bill P. Smith
Barium Springs Home for Children
P.O. Box 1
Barium Springs, NC 28010
(704) 832-2218 (firstname.lastname@example.org)
You may also send a written complaint to the United States Secretary of the Department of Health and Human Services.
If you file a complaint, we will not take any action against you or change our treatment of you in any way.
E. Effective Date of this Notice
This Notice of Privacy Practices is effective on April 14, 2003 and updated December 27, 2005, June 17, 2008 and April 18, 2013.