LAUGHLIN CHILDREN’S CENTER NOTICE OF PRIVACY PRACTICES
This Notice describes how mental, behavioral, and other health care information about you and your child may be used and disclosed and how you can get access to this information. Please review it carefully.
Parents or guardians are automatically authorized to discuss the health information of their minor children.
Throughout this Notice, use of the term “we” refers to Laughlin Children’s Center. Use of the terms “you” or “your” refers to the parent or guardian reviewing and signing this Notice, and the minor child or children receiving treatment at Laughlin Children’s Center.
Laughlin Children’s Center is required by law (Health Insurance Portability and Accountability Act – HIPAA) to maintain the confidentiality and privacy of your protected health information and to give you this Notice of our legal duties and privacy practices regarding your protected health information (PHI). This Notice describes how we may use or disclose your PHI to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI.
We are required to abide by the terms of this Notice, which is effective March 18, 2011. We reserve the right to change the terms of our Notice at any time. A new Notice will be effective for all PHI that we maintain at that time and for information we receive in the future. We will post a current copy of the Notice and will have copies of our current Notice available each time you are here for health care services. We will also provide you with any revised Notice of Privacy Practices upon a request made by you by phone or in person.
Protected health information (PHI) is information about you, that may identify you or your child and that relates to your child’s past, present, or future physical or mental health or condition and related health care services.
Use is sharing, employing, applying, utilizing, examining, and analyzing information that identifies you or your child within the office.
Disclosure is releasing, transferring, or providing access to information about you or your child to other parties outside the office.
II. Uses and Disclosures for Treatment, Payment, and Health Care Operations
We are permitted by law to use and disclose to our staff and professionals your PHI for treatment, payment, and mental, behavioral, or other health care operations of the Center. Relevant portions or summaries of your PHI may be used or disclosed to those actively engaged in treating your child or to persons at other licensed facilities when your child is referred to that facility and a summary or portion of the record is necessary to provide for continuity of proper care and treatment. Your PHI may also be used or disclosed to third party payers to pay the mental, behavioral, or other health care bills. We may also use your PHI to assist in the operation of Laughlin Children’s Center.
Described below are examples of types of uses or disclosures of your PHI that we are permitted to make. Please be aware that not every use or disclosure is listed.
A. Treatment: We will use or disclose your PHI to provide, coordinate, or manage your child’s mental, behavioral, and other health care and any related services. For example, we may disclose your PHI to:
1. Clinical staff or other personnel who are helping to provide your child with health care services.
2. Consult with another provider or your child’s referral to another provider.
B. Payment: Your PHI will be used to obtain approval for and payment of mental, behavioral, and other health care services. This may include claims submission to applicable 3rd party payers and certain activities that your health insurance plan or government agency may undertake before it approves or pays for the mental, behavioral, or other health care services recommended for your child, such as making a determination of eligibility or coverage for benefits, reviewing services provided for the client for medical necessity, and undertaking utilization review activities. For example, obtaining approval for behavioral health rehabilitation services for children requires that your relevant PHI may be disclosed to state and county officials in order to obtain prior approval for services.
C. Health Care Operations: We may use or disclose PHI as needed in order to support our operations. These activities include, but are not limited to, quality assessment activities, employee review activities, personnel training programs, licensing, case management and care coordination, auditing, and other Laughlin Children’s Center business functions. For example, we may disclose your PHI to:
1. State licensure and other reviewers and inspectors, including the Department of Public Welfare, and other accreditation organizations.
2. Parents or guardians and others when necessary to obtain consent for medical treatment.
3. Call you by name in the waiting room.
4. Contact you to remind you of your child’s appointment.
5. Business and clinical development such as conducting cost management and planning as well as related analyses.
6. A court when a court orders production of the documents.
7. Parents, guardians or others may be asked to sign-in when they arrive.
III. Uses and Disclosures of PHI Requiring Written Authorization
Other uses or disclosures of your PHI not covered by this Notice or by laws that apply to us will be made only with your written authorization. You may revoke this authorization, at any time, in writing. If you revoke this authorization, we will no longer use or disclose your PHI for the reasons covered by the authorization. However, we cannot undo any disclosures we have already made with the authorization and are required to retain our records of the care we provided to your child.
IV. Uses and Disclosures of PHI That May Be Made Without Your Consent or Authorization
In certain circumstances, we may use or disclose your PHI without your consent or authorization. These situations include, but are not limited to, the following:
A. Abuse or Neglect: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. The disclosure will be made consistent with the requirements of applicable Pennsylvania laws.
B. Serious Threat to Health or Safety: We may disclose your PHI in order to take reasonable measures to prevent harm. If a client expresses a serious threat, or intent to kill or seriously injure an identified or readily available person or group of people and the therapist determines that the client is likely to carry out the threat, the therapist must take reasonable measures to prevent harm. Reasonable measures may include directly advising the potential victim of the threat or intent.
C. Health Oversight: We may disclose your PHI to the Department of Public Welfare for overseeing health care activities through audits, investigations, inspections, and licensure. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
D. Legal Proceedings: We may disclose your PHI in the course of any judicial proceeding, in response to an order of a court, or administrative tribunal (but only the PHI expressly authorized by such order).
E. Required Uses or Disclosures: Under the law, we must disclose your PHI when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of HIPAA.
V. Your Rights Regarding Protected Health Information
You have the following rights with respect to your PHI:
A. The Right to Request Restrictions: You have the right to request a limitation or a restriction on the PHI we use or disclose about you or your child for treatment, payment, or mental, behavioral, or other health care operations. You may also request that we limit the PHI we disclose to family members or friends who may be involved in your child’s care or for the payment for your child’s case.
However, we are not required to agree to a restriction that you may request. If we agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your child’s therapist. You may request a restriction by making your request in writing, including (a) what PHI you want to limit; (b) whether you want us to limit our use, disclosure or both; and (c) to whom you want the limits to apply.
B. The Right to Request Confidential Communication: You have the right to request to receive confidential communications from us in a certain way or at an alternative location. For example, you can ask that we only contact you at home or by mail. We will accommodate reasonable requests. We may also condition this accommodation by asking you for specification of an alternative address or another method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer specifying how or where you wish to be contacted.
C. The Right to Inspect and Copy: You have the right to inspect and obtain a copy of PHI about your child that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains clinical and billing records and any other records that we use for making decisions about your child’s care. To inspect and copy your child’s designated record set, submit your request in writing to our Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other related costs.
We may deny your request to inspect and copy in certain limited circumstances. Under federal law, for example, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; information obtained from someone under a promise of confidentiality. Finally, the State law permits us to deny access upon documentation by the therapist that disclosure of specific information will constitute a substantial detriment to the client’s treatment. Depending on the circumstances, a decision to deny access may be reviewed. Please contact the Privacy Officer if you have questions about access to your child’s clinical record.
D. The Right to Amend: If you believe that your child’s designated record set contains information that is incorrect or misleading, you may prepare a statement for inclusion as an amendment to your child’s record. Your statement shall accompany all released records. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your child’s clinical record.
E. The Right to Receive an Accounting of Disclosures: You have the right to an accounting of disclosures for purposes other than treatment, payment, or mental, behavioral, or other health care operations as described in this Notice. It excludes disclosures we may have made to you, to family members, or friends involved in your child’s care, or for notification purposes. You have the right to receive information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restriction, and limitations.
F. The Right to a Paper Copy of this Notice: You have the right to a paper copy of this Notice, upon request, even if you have agreed to accept this notice electronically. To obtain a paper copy, contact our Privacy Officer at 412-741-4087.
If you believe we have violated your child’s privacy rights, you may complain to us or to the Secretary of the U.S. Department of Health and Human Services or the Department of Public Welfare. You may file a complaint with us by notifying our Privacy Officer of your complaint.
You (parent or guardian) may contact our Privacy Officer, Douglas Florey, by phone at 412-741-4087 or by mail at Laughlin Children’s Center, 424 Frederick Avenue, Sewickley, PA 15143 for further information about the complaint process. We are required by law to inform you that we will not retaliate against you for filing a complaint.
The Laughlin Children’s Center is an equal opportunity non-profit agency and will not discriminate on the basis of race, color, national origin, ancestry, religion, sex, sexual orientation, age, handicap, or limited English proficiency in its educational programs, services, facilities, activities, or employment practices as required by Title IX of the 1972 Educational Amendments, Title VI and Title VII of the Civil Rights Act of 1964, as amended, Section 504 Regulations of the Rehabilitation Act of 1973, the Age Discrimination in Employment Act of 1975, Section 204 Regulations of the 1984 Carl D. Perkins Act, the Americans with Disabilities Act, or any other applicable federal or state statute. Any person who believes that s/he has been subjected to discrimination shall report all incidents of such conduct to Doug Florey, Privacy Officer, Laughlin Children’s Center, 424 Frederick Avenue, Sewickley, PA 15143
EFFECTIVE DATE: This Notice is effective as of March 18, 2011
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.
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
•You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
•We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
•You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
•We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
•You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
•We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
•You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
•If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
•You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
•We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
•You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
•If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
•We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
•You can complain if you feel we have violated your rights by contacting us using the information on page 1.
•You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
•We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes
In the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
•We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
•We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
•We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
• We can use or share your information for health research.
Comply with the law
•We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Address workers’ compensation, law enforcement, and other government requests
• We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
Respond to lawsuits and legal actions
• We can share health information about you in response to a court or administrative order, or in response to a subpoena
We may call you by name in the waiting room
We may ask you to sign-in upon arrival
We may contact you or leave a voice mail message at your contact phone number to remind you of your child’s appointment
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.