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HIPPA Statement
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.
ChildServ is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at ChildServ please contact the office of the:
Privacy Official
ChildServ
Suite 450
8765 Higgins Road
Chicago,IL 60631
773-693-0300
Download HIPPA Privacy Statement
Effective Date of This Notice: October 1, 2004
I. How ChildServ may Use or Disclose Your Health Information
ChildServ collects health information from you and stores it in a chart and/or on a computer. This is your medical record. The medical record is the property of ChildServ, but the information in the medical record belongs to you. ChildServ protects the privacy of your health information. The HIPAA law permits ChildServ to use or disclose your health information for the following purposes:
1. Treatment. Treatment means the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a client/patient; or the referral of a client/patient for health care from one health care provider to another.
Use or Disclosure of your health care information for the purposes of providing you with treatment DO NOT REQUIRE THAT WE OBTAIN YOUR AUTHORIZATION OR CONSENT.
An example of a use or disclosure for treatment purposes is described below:
Mr. New Client telephones Central Intake after hearing a radio public announcement. Mr. New Client asks for and receives an appointment for an assessment. Mr. New Client provides the intake worker with personal information including his name, address, telephone number, date of birth and specific information regarding his symptoms which he describes to include restlessness, insomnia and erratic thought patterns. Mr. New Client asks to see a counselor, and informs the intake worker that he once saw a clinical psychologist for a depressive disorder. Mr. New Client provides the name, address and telephone number of his former psychologist. The ChildServ assessor contacts Mr. New Client's medical doctor and former clinical psychologist for information pertaining to treating Mr. New Clients current presenting condition.
The detailed and confidential information necessary to fully assess Mr. New Client is gleaned from him during a formal assessment. Under the revised Privacy rules (August 14, 2002), ChildServ is not required to obtain a written consent or authorization from Mr. New Client to obtain his records from both his medical physician and his former clinical psychologist. The August 14, 2002 rules permit an exchange of information between ChildServ and the former medical doctor and clinical psychologist without having a written authorization or consent providing that the minimum necessary information is exchanged solely for the purposes of treating Mr. New Client. Under these Privacy rules (August 14, 2002) the assessor uses information from his comprehensive assessment, the records of Mr. New Client's physical condition as supplied by his medical doctor and clinical psychologist (who supplied the minimum necessary protected health information) to develop a thorough clinical picture of Mr. New Client's current needs. The assessor reviews his assessment and treatment recommendations with his supervisor before meeting again with Mr. New Client to address the recommendations and commencing treatment.
2. Payment. Payment means the activities undertaken by ChildServ to obtain or provide reimbursement for the provision of health care or social services and the activities undertaken on behalf of the individual receiving health care or social services from ChildServ to determine eligibility or insurance coverage, billing, claims management, collection activities or obtaining payment under a contract for reinsurance. These activities also include a review of health care services with respect to medical necessity, coverage under a health plan, and appropriateness of care. These activities may include, furthermore, utilization review activities, pre-certification and preauthorization services, concurrent and retrospective reviews of services. The activities may require disclosure to consumer reporting agencies of specific protected health information relating to the collection of premiums or reimbursement such as: name and address; date of birth; social security number; payment history; account number; and, name and address of health care provider and/or health plan.
An example of a use or disclosure for payment purposes is described below:
Mr. New Client provided the intake worker with a copy of his health plan card. ChildServ contacts Mr. New Client's health plan to verify his coverage and receives authorization from the plan to provide Mr. New Client with 12 weeks of individual psychological counseling services by a trained master's-level therapist (supervised by a clinical psychologist).
3. Regular Health Care Operations. Regular health care operations at ChildServ include the following: a) conducting quality assessment and improvement activities; b) reviewing the quality and competence of health care professionals, conducting training so that practitioners may, under supervision, improve their skills, and for certification, licensing or credentialing purposes; c) conducting or arranging for medical review, legal services, and auditing functions including fraud and abuse detection and compliance; d) business planning and development such as conducting cost-management and planning-related analyses to managing and operating the agency; and, e) general administrative activities such as compliance with the requirements of the HIPAA of 1996, client satisfaction, resolution of internal grievances, and, consistent with 164.514, creating de-identified health information, fundraising for the benefit of ChildServ, and marketing for which an individual authorization is not required.
An example of a use or disclosures for health care operations purposes is described below:
Mr. New Client, for the purposes of ChildServ internal quality assessment and improvement purposes, and, for the purposes of meeting the requirements of the Council On Accreditation, provides the agency with demographic information, including his: name, address, city, state, zip, social security number, sex, agegroup, yearly income, and ethnicity, which are included in a database from which ChildServ draws nonspecific characteristics of the clients it serves.
This demographic information is entered into the agency's database to develop a profile of the characteristics of the populations being served by the agency and is matched with census statistics to determine whether the agency is adequately serving all identified sub-groups within its service areas.
4. Information provided to you. ChildServ provides access to individuals to inspect and obtain a copy of protected health information about the individual except as follows: psychotherapy notes; information compiled in anticipation of, or for use in, a civil, criminal, or administrative action or proceeding; protected health information that is subject to CLIA of 1988 as may be prohibited by law or exempt from the CLIA of 1988 pursuant to 42CFR 493.3(a)(2), and under the unreviewable grounds for denial in paragraph 164.524(a)(2).
5. Directory. We may list your name, where you are located in our facilities, your general medical condition and your religious affiliation in our directory. This information may be provided to members of the clergy. This information, except your religious affiliation, may be provided to other people who ask for you by name. If you do not want us to list this information in our directory and provide it to clergy and others, you must tell us that you object.
6. Notification and communication with family. We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
7. Required by law. As required by law, we may use and disclose your health information.
8. Public health. As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems withproducts and reactions to medications; and reporting disease or infection exposure.
9. Health oversight activities. We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
10. Judicial and administrative proceedings. We may disclose your health information in the course of any administrative or judicial proceeding.
11. Law enforcement. We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.
12. Deceased person information. We may disclose your health information to coroners, medical examiners and funeral directors.
13. Organ donation. We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
14. Research. We may disclose your health information to researchers conducting research that has been approved by the Senior Team of ChildServ, this organization's approval body for research activities.
15. Public safety. We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
16. Specialized government functions. We may disclose your health information for military, national security, prisoner and government benefits [note: disclosures for government benefits purposes are limited to health plans only].
17. Worker's compensation. We may disclose your health information as necessary to comply with worker's compensation laws.
18. Marketing. We may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you.
19. Fund-raising. We may contact you to participate in fund-raising activities for ChildServ.
20. Change of Ownership. In the event that ChildServ is sold or merged with another organization, your health information/record will become the property of the new owner.
II. When ChildServ May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, ChildServ will not use or disclose your health information without your written authorization. If you do authorize ChildServ to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
III. Your Health Information Rights
1. You have the right to request restrictions on certain uses and disclosures of your health information.ChildServ is not required to agree to the restriction that you requested.
2. You have the right to receive your health information through a reasonable alternative means or at an alternative location. Requests for reasonable alternative means shall be made in writing; specifying the alternative method; how payment for such method is to be made if it is determined by ChildServ that the method incurs additional expense, etc.
3. You have the right to inspect and copy your health information.
4. You have a right to request that ChildServ amend your health information that is incorrect or incomplete.ChildServ is not required to change your health information and will provide you with information about ChildServ's procedures for contesting a denial.
5. You have a right to receive an accounting of disclosures of your health information made by ChildServ, except that ChildServ does not have to account for the disclosures described in parts 1. (treatment), 2. (payment), 3. (health care operations), 4. (information provided to you), 5. (directory listings) and 16. (certain government functions) of section I of this Notice of Privacy Practices.
6. You have a right to a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact the office of the:
Privacy Official
ChildServ
Suite 450
8765 Higgins Road
Chicago, IL 60631
773-693-0300
IV. Changes to this Notice of Privacy Practices
ChildServ reserves the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, ChildServ is required by law to comply with this Notice.
ChildServ will communicate revisions to this Notice by posting such revisions in a conspicuous place, provide the revised notice on the agency's website, and allow thirty (30) days before effective date of implementation for the new revisions.
V. Complaints
Complaints about this Notice of Privacy Practices or how ChildServ handles your health information should be directed to the office of the:
Privacy Official
ChildServ
Suite 450
8765 Higgins Road
Chicago, IL 60631
773-693-0300
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
Tel: 1-202-514-2000
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