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Notice of Privacy Practices
Effective January 15, 2016
 

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.

As a licensed child placing and counseling agency, we will possess medical and mental health information in the course of providing our services which include counseling and assistance for unplanned pregnancies, adoptions, foster care and professional counseling.  Some of this information in our files we generate and some we simply receive from others. 

Protected Health Information or PHI

In the law, the information we have regarding your medical, physical and mental health is called “Protected Health Information.”    This is information that identifies who you are and relates to your past, present and future health conditions.  PHI does not include information about you that is publicly available or that is in a summary form that does not identify who you are.  At this agency, PHI in your file will likely include information like your social and psychological history, medical information from doctor’s reports or exams, treatment plans and progress notes documenting our services and the contacts we have with you.

Purpose of this Notice

We understand that privacy is a very important concern and we understand the importance of keeping this information confidential and secure.  This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) in accordance with applicable laws and professional ethics.  It also describes your rights regarding how you may gain access to and control your PHI.

We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI.  We are required to abide by the terms of this Notice of Privacy Practices.  We reserve the right to change the terms of our Notice of Privacy Practices at any time.  Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time.  A copy will be posted in our office.  We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending you a copy in the mail upon request or providing one to you at your next appointment with our staff.  If you have any questions or want to know more about anything in this Notice, please ask our Privacy Officer for more details.

How We Protect Your PHI

We restrict access to your PHI to those employees who need access in order to serve you.  We have established and maintain physical and procedural safeguards to protect your PHI against unauthorized use or disclosure.  We have established a training program for our employees and have assigned a Privacy Officer with overall responsibility for implementation and enforcement of our policies and procedure.

How Your PHI May be Used and Disclosed

Federal and state laws allow us to use and disclose your PHI in order to provide services to you.  All clients of the agency are required to sign a consent allowing us to use and disclose their PHI for Treatment (services), payment or other business functions called health care operations.  This is referred to as TPO.  Your PHI can be used and disclosed for TPO to covered entities working with our agency for your treatment and care.  If your PHI needs to be used for other than TPO or disclosed to anyone outside our agency who is not a covered entity, a written release (authorization) will be required to do so.

A.  Using and Disclosing PHI for Treatment, Care or Services

Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating or managing services being provided to you.  This might include case management for services such as treatment planning or for securing counseling services.  We may use your PHI in the course of consultation with clinical supervisors or other social service team members in our office.  We may disclose your PHI to a therapist or doctor in the course of doing our necessary work.  We may disclose information between professional staff and state licensing officials as we facilitate our foster and adoptive placement program. 

B.  Using or Disclosing PHI for payment 

We may use and disclose PHI so that we can receive payment for services provided to you.  For example,we may need to inform payees of the dates of service and the kinds of services you received in order to receive payment.

C.  Using and Disclosing PHI for Health Care (Agency) Operations 

We may use or disclose your PHI for what are called health care operations, which for us means our general agency operations.  The 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 your PHI to review and evaluate our programs.  We may use your PHI in evaluating the performance of our staff.  We may use and disclose your PHI for resolution of any grievance or appeal that you file in the rare instance you are unhappy with the services you received.  We may use and disclose your PHI to perform certain business functions with our business associates, who must also agree to safeguard you PHI as required by law.   We may use and disclose your PHI to reschedule or remind you of appointments.  We may use and disclose your PHI to do research to improve services.  In all cases, your name, address and other personal information will be removed from the information.  We may be required to supply some information to some government health agencies so they can study disorders and treatment and make plans for services that are needed.  If we do, your name and personal information will be removed from what we send.

Uses and Disclosures of PHI that Require Authorization

If we want to use or disclose your PHI for any purpose besides TPO or those we described above, we need your permission on an Authorization form.  We don’t expect to need this very often.

If you need an authorization form, we will send you one or you can pick one up from our office.  You should fill it out fully and return it to the agency.

If you do authorize us to use or disclose your PHI, you can revoke (cancel) that permission in writing at any time.  After that time, we will not use or disclose your information for the purposes that we agreed to in the authorization.  However, of course, we cannot take back any information we had already disclosed with the permission you give with your authorization. 

Verbal permission – We may use or disclose your information to family members that are directly involved in your care or treatment with your verbal permission.

Uses and Disclosures that Do Not Require Your Authorization

We are allowed by law to use and disclose some of your PHI without your consent or authorization for the following purposes:

When required by law

There are some federal, state, or local laws which require us to disclose PHI.  They are regarding the following:

  • We have to report suspected child or elder abuse or neglect to those who by law are authorized to receive these reports.
  • We may disclose your PHI to the governmental entity or agency authorized to receive domestic violence reports.
  • If you are involved in a lawsuit or legal proceeding and we receive a subpoena, discovery request, or other lawful process, we may have to release some of your PHI.  We will only do so after trying to tell you about the request, consulting your lawyer, if desired, or trying to get a court order to protect the information they requested, if appropriate and necessary.
  • We have to disclose some information to the government agencies which check on us to see that we are obeying the privacy laws.

For Law Enforcement Purposes

We may release protected health information if asked to do so by a law enforcement official to investigate a crime or criminal activity.

For public health activities

We might disclose some of your PHI to agencies which investigate diseases or injuries.

For specific government functions

We may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment.

To prevent a serious threat to health or safety (duty to warn)

If we come to believe that there is a serious threat to your health or safety of that of another person or the public, we can disclose some of your PHI to persons who can prevent the danger.

For sharing anonymous stories or treatments

We may share stories or results of treatments or services which involve your information in an anonymous way, i.e., names and information that could be used to identify you not given.

For emergencies

We may share PHI in the event of an emergency to any treatment provider who provides emergency treatment to you.

For lawsuits and disputes

We may share PHI in order to defend ourselves in a legal action or other legal proceeding brought by you against our agency or staff.

For legal representative

We may share your information to a person who, under law, has the authority to represent you in making health care decisions.

For national security and intelligence/military activities

We may share PHI to authorized federal officials for the conduct of lawful intelligence, counter-intelligence and other national security activities.

For public health

We may share PHI to a public health authority that is authorized by law to collect or receive such information for the purposes of preventing or controlling a disease, injury or disability, including, but not limited to, the reporting of disease, injury, vital events such as birth, death, and the conduct of public surveillance, public health investigations and public health interventions.

For workers compensation

We may share PHI to the extent authorized by and the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Regarding parents of minor children

You as a parent can generally control your minor child’s PHI.  In some cases, however, we are permitted or even required by law to deny your access to your child’s PHI, such as when your child can legally consent to medical services without your permission.

For stricter laws

There are some types of PHI, such as HIV test results or mental health information, which are protected by stricter laws.  However, even such PHI may be used or disclosed without your written authorization if required or permitted by law.

Your Rights Regarding Your PHI

You have the following rights regarding PHI we maintain about you.  To exercise any of these rights, please submit your request in writing to our Privacy Officer, at 3094 Mercer University Drive, Suite 200, Atlanta, GA  30341.

Right to Access Your PHI

You have the right, which may be restricted only in exceptional circumstances, to review and copy your PHI we maintain.  If you wish to access your PHI, you must put this request in writing to us using our form, “Request for Access to Health Information.”  Return this form to us.  For information maintained on-site, we will respond to your request for access to PHI within thirty (30) days of receipt of your written request.  For information maintained off-site, we will respond within sixty (60) days.  If needed, we can extend the time it takes for us to respond to your request by another thirty (30) days for information maintained both on or off site. 

If we approve your request for access to information, we will tell you when and where you can review your PHI in our possession within our normal business hours.  If you would like a copy of the information we have, please write us at the same address.  If we provide you a copy, we may charge a reasonable administrative fee for copying your PHI to the extent permitted by applicable law.  If we deny your request for review or copy of your PHI, we will explain the reason in writing.  If we don’t have your PHI, but know who does, we will tell you whom to contact.

We may deny your request to review and copy your information in very limited circumstances.  Denial of access can be for the following situations:

  • Danger to the life or physical safety of the client or another person;

Psychotherapy notes if maintained in a separate file;

  • If the information is compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding;
  • Information obtained in the course of research;
  • Information subject to the Federal Privacy Act, 5 U.S.C. 552(a);
  • Information obtained from a third party under a promise of confidentiality and such access would be reasonably likely to reveal the source of the information; or
  • Certain information maintained by certain laboratories that is subject to or exempted from the Clinical Laboratory Improvements Amendments of 1988 (CLIA).

If you are denied access to PHI, you may appeal this denial by requesting that the denial be reviewed.  Another licensed 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.  We will comply with the outcome of the review.

Right to Amend Your PHI

You have the right to request amendments to your PHI.  If you wish to have your PHI corrected or updated, please write to us and request our form, “Request for Amendment of Health Information.”  Return that form to us.  We are required to act on your request to amend your PHI within sixty (60) days, but this deadline may be extended for another thirty (30) days upon written notice to you.  We will respond to you in writing, either accepting or denying your request.  If we deny your request, we will explain why.  You will have the right to submit a statement of disagreement with our decision which will be maintained with your PHI.

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 PHI 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 Receive an Accounting of Disclosures

You have the right to request an accounting of certain of the disclosure we make of your PHI.  You can request that for up to the past six years of your request, but no further back than April 14, 2003.  We may charge you a reasonable fee if you request more than one accounting in any 12-month period. 

An accounting of disclosures does not have to be made when these disclosures are:

to carry out treatment, payment and health care operations (TPO);

to individuals receiving information about themselves;

as a result of signed authorization;

to persons involved in the individual's care

for national security or intelligence purposes;

for correctional institutions or law enforcement officials;

made prior to April 14, 2003; or

made more than six years prior to the request.

We are required to act on your request for an accounting within sixty days, but this deadline may be extended for another thirty (30) days upon written notice to you of the reason for the delay and the date by which we will provide the accounting.

Right to Request Restrictions

You have the right to request a restriction or limitation on the use and disclosure of your PHI for treatment, payment or health care operations.  We are not required to agree to your request.  All requests for restrictions must be made in writing.  Upon receipt, we will review your request and notify you whether we have accepted or denied your request.

Right to Request Confidential Communications

You have the right to request in writing that we provide your PHI to you in a confidential manner.  For example, you may request that we send your PHI by an alternative means, such as sending correspondence to an alternate address than your home address.  We will accommodate any reasonable requests.

Right to Breach Notification

If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.

Right to a Copy of this Notice

You have a right to receive a paper copy of this Notice.

Right to Complain

If you believe we have violated your privacy rights, you have the right to file a complaint in writing with our Privacy Officer at 3094 Mercer University Drive, Suite 200, Atlanta, GA  30341.  You also have the right to file a complaint with the Secretary of Health and Human Services.  We will not retaliate against you for filing a complaint.

The effective date of this notice is January 15, 2016

 

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                                                           3094 Mercer University Drive    |    Suite 200    |    Atlanta, GA  30341    |  770-452-9995                                      Copyright © 2016 Georgia AGAPE