title
Notice of Privacy Practices
This notice describes how Child Saving Institute (CSI) will be using your medical information for purposes of treatment, payment and operations and how you can get access to this information. Please review it carefully.
Effective April 14, 2003, this notice describes Child Saving Institute's practices and that of:
Any mental health professional or social worker authorized to enter information into your service record; All mental health services and units of the agency; Any member of a volunteer group allowed to help you during the time you receive services from this agency; All employees, staff and other agency personnel; The employees, staff and personnel of partnering agencies. These entities, sites and locations will all follow the terms of this notice and may share medical/mental health information with each other for treatment, payment, or operations described in this notice.
Our Pledge Regarding Privacy Practices:
We understand that information about you and your mental health is personal and we are committed to protecting this information about you. To provide you with quality care and to comply with certain legal requirements, we create a record of the care and services you receive from this agency. This notice applies to all of the records of your care generated by the agency, whether made by agency personnel or your personal referring physician. Your personal physician may have different policies or notices regarding use and disclosure of your personal health and mental health information created in the physician's office or clinic.
This notice will tell you about the ways in which we may use and disclose medical/mental health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of that information.
Child Saving Institute is required by law to:
Make sure that medical/mental health information that identifies you is kept private; Give you this notice of our legal duties and privacy practices with respect to medical/mental health information about you; Abide by the terms of this notice; Notify you if we are unable to agree to a requested restriction; and Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
How CSI May Use and Disclose Medical Information about You:
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain and give examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories.
For treatment – CSI may use medical or mental health information about you to provide you with treatment or other services. We may disclose medical information about you to doctors, nurses, social workers, therapists, or other agency personnel involved in providing CSI's services to you. For example, our consulting psychologist may receive a summary of your concerns in an attempt to provide supervisory consultation to the therapist or social worker providing direct services to you.
For payment – CSI may use and disclose medical or mental health information about you so that the treatment and services you receive at the agency 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 your health plan information about services you received at the agency so that your health plan provider will pay us for the services. We may also tell your health plan provider about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For health care operations – CSI may use and disclose medical or mental health information about you for agency operations. These uses and disclosures are necessary to run the agency and make sure that all of our clients receive quality care. For example, we may use information from your service record to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine information about many agency clients to decide what additional services the agency should offer, what services are not needed, and whether certain new treatments are effective. We may also combine the information we have with information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer.
For treatment alternatives – CSI may use and disclose medical or mental health information to tell you about or recommend possible treatment options that may be of interest to you.
For health-related benefits and services – CSI may use and disclose medical or mental health information to tell you about benefits or services that may be of interest to you.
For fundraising activities – CSI may use information about you to contact you in an effort to raise money for the agency and its operations, however, we would only release contact information (such as name, address, phone number, and the dates you received services at the agency). If you do not want the agency to contact you for fundraising efforts, you must notify the Development Department at Child Saving Institute in writing.
To individuals involved in your care or making payment for your care – CSI may release contact information about you to a friend or family member who is involved in your care. We may also give information to someone who helps pay for your care (e.g., costs of services provided).
For research activities – Under certain circumstances, CSI may use and disclose information about you for research purposes. For example, a research project may involve comparing the recovery and current status of all clients who received one service with those who received another service. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, attempting to balance the research needs with patients' need for privacy of their information. Before we use or disclose any information for research, the project will have been approved through this research approval process. If the researcher will have access to your name, address, or other information that reveals who you are, CSI will always ask for you specific permission to provide this information.
As required by law – CSI will disclose medical, mental health, or contact information about you when required to do so by federal, state or local law.
To avert a serious threat to health or safety – CSI may use and disclose 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. Any disclosure, however, would only be to someone able to help prevent the threat.
Your Rights Regarding Medical Information About You:
You have the following rights regarding medical or mental health information that we maintain about you:
Right to inspect and copy – You have the right to inspect and copy medical or mental health information that may be used to make decisions regarding your care. Usually, this includes client and billing records, but does not include psychotherapy notes. To inspect and copy information that may be used to make decisions about you, you must submit your request in writing to the Director of Child and Family Services. If you request a copy of the information, a fee may be charged for the costs of copying, mailing or other supplies associated with your request.
CSI may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your client records or other information, you may request that the denial be reviewed. Another licensed mental health professional chosen by the agency will review your request and the denial. The person conducting the review will not be the person who denied your request. CSI will comply with the outcome of the review.
Right to amend – If you feel that information that CSI has about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the agency.
To request an amendment, your request must be made in writing and submitted to the Director of Child and Family Services. In addition, you must provide a reason that supports your request. CSI may deny your request for an amendment if it 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:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the information kept by or for the agency;
- Is not part of the information which you would be permitted to inspect and copy; or
- 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 information about you. To request this list or accounting of disclosures, you must submit your request in writing to the Director of Child and Family Services. Your request 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, or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to request restrictions – You have the right to request a restriction or limitation on the 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 information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a specific service you received.
It is important that you know that CSI is not required to agree to your request.
To request restrictions, you must make your request in writing to the Director of Child and Family services. In your request, you must tell us:
- What information you want to limit.
- Whether you want to limit our use, disclosure, or both.
- To whom you want the limits to apply.
An example would be to request a restriction of disclosure to your spouse of the number of therapy sessions you received.
Right to request confidential communications – You have the right to request that we communicate with you about medical or mental health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the Director of Child and Family Services. We will not ask you the reason for this request, and 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 this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website, www.childsaving.org.
To obtain a paper copy of this notice, contact the HIPAA Privacy Officer at Child Saving Institute.
Changes to this Notice
Child Saving Institute will post a copy of the current notice in the agency. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you are admitted to receive any of the agency's mental health services, CSI will offer you a copy of the current notice in effect.
Child Saving Institute reserves the right to change our practices and to make the new provisions effective for all protected health/mental health information we maintain. Should our information practices change, we will mail a revised notice to the address you've supplied. We will not sue or disclose your health information without your authorization, except as described in this notice.
Complaints
If you believe that your privacy rights have been violated, you may file a complaint with the agency or with the Secretary of the Department of Health and Human Services. To file a complaint with the agency, contact the HIPPA Privacy Officer at Child Saving Institute, 4545 Dodge Street, Omaha, Nebraska 68132, or call (402) 553-6000. All complaints must be submitted in writing.
In all cases, you will not be penalized for filing a complaint.
Other uses and disclosures of medical or mental health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical or mental health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have made with your permission, and that we are required to retain our records of the care that we provided to you.
