NOTICE OF
PRIVACY PRACTICES- effective March 18, 2005
THIS NOTICE DESCRIBES HOW YOUR
PROTECTED HEALTH INFORMATION (PHI) MAY BE USED AND DISCLOSED. THIS NOTICE ALSO DETAILS YOUR RIGHT TO
ACCESS YOUR PROTECTED HEALTH INFORMATION.
If you have any questions
regarding this notice and how it pertains to you, please contact Randi Howard
at (314) 731-3969.
Who Must Follow This Notice:
q
Any health care professional authorized to enter information
into your records at Bringing Families Together.
q
All departments of Bringing Families Together
q
All administrative staff and employees of Bringing Families
Together.
q
Any business associates of Bringing Families Together that
may come across PHI in their business with Bringing Families Together.
Bringing Families Together Is
Required By Law To:
q
Keep all health information that identifies you private.
q
Provide you with the opportunity to receive written notice
regarding our legal obligations and privacy practices as they pertain to your
PHI.
q
Follow the terms of this Notice.
How Will Bringing Families
Together Use and Disclose Your PHI?
Listed below are several
categories that describe how your PHI may be used. Not every disclosure can be listed, but each type of permitted
disclosure will fall into one of these categories.
q For
Treatment- Bringing Families Together may use your PHI to provide you
with treatment services. We may
disclose PHI to other professionals involved with your care.
q For
Payment- Bringing Families Together may disclose PHI in order to
receive reimbursement from your insurance company or third party payer for
services rendered.
q For Agency
Operations- Bringing Families Together may use or disclose your PHI to
ensure quality care from our agency.
We may use the information to assess the performance of our
professionals in providing you treatment.
We may also disclose your PHI to other agency personnel for review and
learning purposes.
q Appointment
Reminders- Bringing Families Together may use or disclose PHI to
contact you regarding your appointments with our agency.
q Treatment
Alternatives- Bringing Families Together may use or disclose your
PHI to recommend other treatment options available to you.
q Health-Related
Benefits and Services- Bringing Families Together may use or disclose your
PHI to tell you about health related benefits, services, or health education
classes available to you.
q
Individuals Involved in Your Care or Payment for Your
Care- Bringing Families Together may release your PHI to a
caregiver, who may be a friend or a family member. Your PHI can also be used or disclosed to anyone who helps pay
for your care.
q
Research- Bringing Families Together may
use or disclose your PHI for research purposes. All research projects are subject to a special approval
process. Specific permission will be
asked from you if a researcher needs your name, address, or other specific
identifying information that reveals who you are or if the researcher will be
directly involved in your care.
q
As Required By Law- Bringing
Families Together will disclose PHI when required to do so by Federal, State or
Local law.
Special Situations
q Organ and
Tissue Donation- If you are an organ donor, Bringing Families
Together may release PHI to organizations that handle organ procurement or
transplantation or to organ banks as necessary to facilitate donation and
transplantation.
q Military
and Veterans- If you are a member of the armed forces, Bringing
Families Together may release PHI as required by military command
authorities. PHI for foreign military
personnel can be disclosed to the appropriate foreign military authority.
q Workers’
Compensation- Bringing Families Together may release PHI for
workers’ compensation or similar programs.
q Public
Health Risks (Health and Safety to You or Others)-
Bringing Families Together may release PHI for public health activities. The PHI can be used or disclosed to agencies
when necessary to prevent a serious threat to your safety or the health and
safety of the public or another person.
These situations may include:
o
Preventing or controlling disease,
o
Reporting births or deaths,
o
Reporting child abuse and neglect,
o
Reporting reactions to medications or problems with
products,
o
Providing notification of product recalls,
o
Notifying an individual who may have been exposed to a
disease or may be at risk for contracting or spreading a disease or condition
o
Notifying the appropriate government authorities if it is
suspected that the client has been a victim of abuse, neglect or domestic
violence.
Disclosures
are only made when required by law.
q Health
Oversight Activities- Bringing Families Together may disclose PHI to an
oversight agency when required to do so by law. Examples include: audits, investigations, inspections, and
licensing.
q Lawsuits
and Disputes- If you are involved in a lawsuit or dispute,
Bringing Families Together may disclose PHI as ordered by the court or
administrative order. PHI may also be
disclosed in response to a subpoena, discovery request, or other lawful process
by another individual involved in the dispute.
q Law
Enforcement- Bringing Families Together may release PHI if
requested by a law enforcement official:
o
In response to a
court order, subpoena, warrant, summons, or other process;
o
To identify or locate a suspect, fugitive, material witness,
or missing person;
o
About the victim of a crime if BFT is unable to obtain your
agreement;
o
About a death believed to be the result of criminal conduct;
o
About criminal conduct at the agency
o
In emergency
circumstances to report a crime, the location of the crime or victims, or the
identity, description or location of the person who committed the crime.
q Coroner,
Health Examiner, and Funeral Directors- Bringing Families
Together may release PHI to coroners or health examiners. Bringing Families Together may also release
PHI to funeral directors as necessary for them to carry out their duties.
q National
Security and Intelligence Activities- Bringing Families Together may
release PHI to authorized federal officials for intelligence, counterintelligence,
and other national security activities authorized by law.
q Protective
Services for the President and Others- Bringing Families
Together may disclose PHI to federal officials for provision of protective
services to the President, other authorized persons, or foreign heads of state.
q Inmates- if you
are incarcerated at a correctional institution or under the custody of law
enforcement, Bringing Families Together may release PHI to the correctional
institution or law enforcement official.
This release is necessary to provide you health care, to protect your
health and safety or the health and safety of others, and for the safety and
security of the correctional institution.
q Other uses
of PHI- Any other uses or disclosures of PHI not covered by this
notice or applicable laws will not be made without your express written
permission. If you provide permission,
you may also revoke that permission. If
you choose to revoke your permission, Bringing Families Together will
discontinue disclosing PHI for the reasons expressed in your written
revocation. You understand that prior
disclosures made with your permission before your revocation cannot be taken
back. We are required to retain our
records of the care provided to you.
Your Rights Regarding Protected
Health Information
q Right to
Inspect and Copy- You have the right to inspect and copy health
information used to make decisions about your care. To inspect and copy your information, the request must be
submitted in writing to:
Executive
Director
Bringing
Families Together
7151 N.
Lindbergh Blvd.
Hazelwood,
MO 63042
If you
request a copy of your information, Bringing Families Together will charge a
fee to cover the cost of copying, postage, and any other supplies related to
processing your request.
Your
request to inspect and copy may be denied in certain limited
circumstances. If your request is
denied, you may request that the decision be reviewed. A licensed health care professional chosen
by Bringing Families Together will review the request and denial. The professional conducting the review will
not be the individual who denied your request.
Bringing Families Together will comply with the review.
q Right to
Amend- If you believe that the health information Bringing
Families Together contains in your file is incorrect or incomplete, you may
request that your file be amended. You
maintain this right as long as the information is retained by Bringing Families
Together. To request an amendment, the
request, along with reasoning that supports your request, must be forwarded in
writing to:
Executive
Director
Bringing
Families Together
7151 N.
Lindbergh Blvd.
Hazelwood,
MO 63042
Bringing
Families Together may deny your request if it:
o
Is not in writing or does not include a reason to support
the request;
o
Was not created by
Bringing Families Together (unless the entity who created the file is no longer
available to grant the request);
o
Is not part of PHI maintained by Bringing Families
Together;
o
Is not part of the information that is available to inspect
and copy; accurate and complete.
Even if
Bringing Families Together finds the information to be accurate and complete,
your disagreement will still be noted in your file.
q Right to
Accounting of Disclosures- Under certain circumstances, you
have a right to an accounting of disclosures of PHI. To make this request, please forward your request in writing to:
Executive
Director
Bringing
Families Together
7151 N.
Lindbergh Blvd.
Hazelwood,
MO 63042
The
request must indicate a time period, which may not be any longer than six years
and may not include dates prior to April 14, 2003. Your request should indicate how you would like the information
received (i.e. electronically or paper).
The first request made within a 12-month period will be at no cost to
you. However, you will be charged for
each additional list requested within the same 12-month period. The cost will be calculated and forwarded to
you prior to completing your request.
You may choose to withdraw or modify your request before any costs are
assessed.
q Right to
request restrictions- you have the right to request restrictions or
limitations on PHI that Bringing Families Together uses or discloses for your
treatment, payment, or health care operations.
You also have the right to request a limit to the PHI disclosed about
you to someone who is involved in your care or payment of your care.
o
Bringing Families Together is not required to agree to your
request. If agreed, Bringing Families
Together will comply with your request unless the information is needed to
provide emergency treatment.
o
To request restrictions or limitations, the request must be
forwarded in writing to:
Executive
Director
Bringing
Families Together
7151 N.
Lindbergh Blvd.
Hazelwood,
MO 63042
The
request must include what information you would like to limit, if the
limitation pertains to use, disclosure, or both, and to whom you would like to
apply the limits.
q Right to
Request Confidential Communications- You have the right to request
that Bringing Families Together communicate with you regarding your PHI in a
specific way or in a particular location.
To request
confidential communications, forward your request, specifying in what manner
you would like to be contacted, in writing to:
Executive
Director
Bringing
Families Together
7151 N.
Lindbergh Blvd.
Hazelwood,
MO 63042
q Right to a
Paper Copy of This Notice- You have the right to a paper
copy of Bringing Families Together’s Notice of Privacy Practices. You may request a copy at any time from any
staff member of Bringing Families Together.
Changes to This Notice-
Bringing Families Together
reserves the right to change this Notice at any time. The revised change can apply to PHI that Bringing Families
Together already maintains in your file and any PHI that may be obtained in the
future. A copy of the current Privacy
Notice will be posted on site. The
Notice will contain the effective date of the Notice on the first page next to
the title. You are entitled to a copy
of the Notice at any time in paper form.
Complaints-
If you believe Bringing Families
Together has violated your privacy rights, you may contact or submit your
complaint in writing to:
Privacy
Officer
Bringing
Families Together
7151 N.
Lindbergh Blvd.
Hazelwood,
MO 63042
(314)
731-3969
If Bringing Families Together
cannot resolve your concern, you have the right to file a written complaint
with the Secretary of the Department of Health and Human Services. The care you receive from Bringing Families
Together will not be jeopardized and you will not be penalized for filing a
complaint.