HIPAA Privacy Notice

FAMILY SERVICE NOTICE OF PRIVACY PRACTICES

EFFECTIVE DATE OF PRIVACY NOTICE: April 14, 2003

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.

Who will follow this notice?

The privacy practices in this notice will be followed by any health care professional who treats you at any of our locations; all departments and units of our agency; all staff, trainees, volunteers or students within our agency; any business associates who perform various activities (e.g., billing, transcription services) for our agency and with whom we share health information.

Our pledge to you

We understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the services you receive in order to provide you with quality care, to comply with certain legal requirements, and to carry out the business functions of the agency. This notice applies to all of the records of your care used or generated by this Agency and describes the different ways that we use and disclose your medical information. It also describes certain rights that you have with respect to your medical information. The privacy practices described in this notice are intended to go with any privacy statements described in other booklets that are given to you. Those other documents may describe rights that you have in addition to those in this notice.

We are required by law to keep medical information about you private and to provide you with this notice of our legal duties and privacy practices with respect to your personal health information. You have the right to receive a paper copy of this notice. We will also make a copy of our current notice available on our web site at www.servingfamilies.org. We are also required to abide by the terms of this notice so long as it remains in effect.

Changes to this notice

Please be aware that we may change the terms of this notice at any time. We will post a copy of the current notice in the office waiting area. In addition, each time you visit our office for treatment, we will make a copy of the current notice in effect available to you upon your request. You will also be asked to acknowledge in writing your receipt of this notice.

How we may use and disclose medical information about you

Unless otherwise prohibited by law enacted for certain "Specially Protected Categories of Health Information" (as described below), we may use or disclose medical information about you without your formal consent or authorization to provide you with treatment such as sharing information about you with another professional who is part of your treatment team; to obtain payment for treatment such as sending billing information to your insurance company, Medicaid, or Medicare; and to support our health care operations such as comparing client data to improve treatment methods.

Subject to certain requirements, we may use or disclose medical information about you without your prior authorization for several other reasons. Unless otherwise prohibited by law enacted for certain "Specially Protected Categories of Health Information" (as described below), we may give out medical information about you:

· When required by law such as reporting suspected abuse/neglect or in Kentucky, domestic violence.

· For public health activities such as reporting vital statistics to the public health authority.

· For health oversight activities such as audits, inspections, or licensure.

· To avert a serious threat to health or safety such as sharing information with persons who can reasonably prevent or lessen the threat of harm.

· For specific government functions such as eligibility and enrollment in government benefit programs.

· Relating to decedents such as funeral arrangements and organ donation.

· For medical or behavioral research purposes, provided that we follow a specific approval process.

· For disaster relief purposes such as notification to your close family or friends, or to a public or private disaster relief entity for purposes of notifying your family and friends of your condition and location.

· In specific circumstances, in response to a request from law enforcement or in response to a valid process in a judicial, administrative, or court proceeding such as a court order.

We may also contact you for appointment reminders, or to tell you about or recommend possible treatment option alternatives, health-related benefits or services that may be of interest to you, or to support fundraising efforts.

Uses and Disclosures Requiring Your Authorization

In any other situation not covered by this notice, including most marketing purposes, we will ask for your written authorization before using or disclosing medical information about you. You may revoke this authorization at any time by providing us with written notice of such revocation. Your revocation shall become effective immediately upon our receipt of such notice, except to the extent that we have already relied upon your previous authorization.

Specially Protected Categories of Health Information

In some cases, State law(s) gives medical information related to AIDS/HIV status or testing results, mental health services, drug and alcohol treatment, and mental retardation/developmental disabilities services more stringent confidentiality protection. In these situations, we will need to obtain your consent or written authorization before we can disclose the information for most purposes. We have included additional information about these protections in our welcome booklet that is given to you.

Your rights regarding medical information about you

· Right to Request Restrictions - You may request that we not use or disclose medical information about you for treatment, payment or healthcare operations or to persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request but are not legally required to accept it. To request restrictions, you must make your request in writing to our Privacy Officer at the address below. We will inform you of our decision on your request.

· Right to Receive Confidential Communications - You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home. To request confidential communications, you must make your request in writing to the Center Secretary at the site at which you receive services.

· Right to Inspect And Copy Your Medical Information - In most cases, you have the right to look at or get a copy of medical information that we use to make decisions about your care, when you submit a written request to your therapist/worker. If you request copies, we may charge a fee for the cost of copying, mailing, or other related supplies. This fee will be based on your ability to pay. If we deny your request to review or obtain a copy, you may submit a written request to the Privacy Officer at the address below for a review of that decision.

· Right to Amend Medical Information - If you believe that information in your record is incorrect or if important information is missing, you have a right to request that we correct the records for as long as the information is maintained by the Agency. To request an amendment, your request must be made in writing and submitted to our Privacy Officer at the address below. We could deny your request to amend a record if the information was not created by us; if it is not part of the medical information maintained by us; or if we determine that the record is accurate. You may appeal a decision by us not to amend a record by submitting your requests in writing to our Privacy Officer at the address below.

· Right to Receive an Accounting of Certain Disclosures of Medical Information - You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, health care operations or where you specifically authorized a disclosure. To request this list or accounting of disclosures, you must submit your request in writing to our Privacy Officer at the address below. The request must state the time period desired for the accounting, which must be less than a 6-year period and starting after April 14, 2003. The first disclosure list request in a 12-month period is free. We may charge a reasonable fee for the costs associated with your request for any additional accountings within the same twelve-month period. This fee will be based on your ability to pay.

Complaints

If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Officer at the address or telephone number listed below. You may also file a complaint with the Secretary of the U. S. Department of Health and Human Services Office of Civil Rights. Our Privacy Officer can provide you with the address. Under no circumstance will you be penalized or retaliated against for filing a complaint.

If you have any questions about this Notice, please contact our Privacy Officer, Anita Swift. She can be reached by telephone at 513-381-6300 or by fax at 513-345-8551. Her mailing address is: Family Service, 205 West Fourth Street, Cincinnati, OH 45202.

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