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NOTICE OF CHILDREN’S HOME SOCIETY OF FLORIDA PRIVACY PRACTICES

Effective September 23, 2013

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.

This information may be about services or health care given to you or payment for that care. It may be about your past, present, or future medical condition or services. Children’s Home Society of Florida is required by law to give you this “Notice of Privacy Practices” explaining our legal duties about your medical information in the way that Children’s Home Society of Florida describes in this Notice. Children’s Home Society of Florida is required to abide by the terms of this Notice that are currently in effect. If Children’s Home Society of Florida changes this Notice, we will post a new notice in our waiting areas and provide copies to you at your request. Contact your caseworker if you have questions or need any of the forms listed in this information. To protect your privacy, if you are asked to be photographed, video/audio taped, or to be viewed through a one-way mirror, you must first be told of this and you must agree to it. If you do not agree, the activity cannot be carried out. If you agree, you will:

  • Receive a written description of the request and the reasons for it;
  • Not be encouraged, given payment or other incentives to agree to the request; and
  • Be asked to sign a form giving your informed consent.

CHILDREN’S HOME SOCIETY OF FLORIDA MAY USE AND SHARE YOUR MEDICAL INFORMATION IN A FEW SITUATIONS:

1. Treatment: To provide or coordinate your health care and related services by talking with other health care givers.

2. Payment: To obtain payment from your insurers, collection agencies and consumer reporting agencies either for services that

you received or before you receive certain services to know whether the insurance plan will pay for a service.

3. Business Operations:

  • To evaluate the skills and performance of those taking care of you.
  • To develop training programs for student caregivers.
  • To cooperate with licensing authorities and government agencies.
  • To review the quality of your care.
  • To manage the care of people who have similar problems.
  • To plan for Children’s Home Society of Florida future operations.
  • To resolve grievances.
  • To review Children’s Home Society of Florida performance.
  • To work with this notice and other laws.

4. Persons Involved in Your Care: Children’s Home Society of Florida may share your medical information with a relative, close personalfriend or a person you identify if that person is involved in your care and the information is about your care. If the consumer is a minor, Children’s Home Society of Florida may share medical information about the minor to a parent, guardian or other person responsible for the minor except in some situations.

5. Required by Law: To report known or suspected child abuse or neglect to the Department of Children and Families.

6. National Priority Uses and Sharing: When permitted by law, Children’s Home Society of Florida may use or share your medical information without your permission for various activities that are recognized as “national priorities” such as:

  • When required by law – Statute, regulation or court order.
  • Threat to health or safety – If Children’s Home Society of Florida believes it is necessary to prevent or lessen a serious threat to your health or safety and/or the health and safety of others.
  • Public health activities – For public health activities such as disease or vital statistics.
  • Abuse, neglect or domestic violence – If Children’s Home Society of Florida believes you or others may be a victim of abuse, neglect or domestic violence.
  • Health oversight activities – A review by a health oversight agency.
  • Court proceedings – A review by a court or an officer of the court (such as an attorney) if a judge orders us to do so.
  • Law enforcement – A review by a law enforcement official for specific law enforcement purposes such as criminal investigations.
  • Coroners and others – A review by a coroner, medical examiner, funeral director or to an organ donor or transplant agency.
  • Workers’ compensation – To comply with workers’ compensation laws.
  • Research organizations – To research organizations after they satisfy conditions about protecting the privacy of medical information.
  • Certain government functions – For certain government functions, including but not limited to military and veterans’ activities, national security and intelligence activities, and correctional institutions in some situations.

Authorization: Other than the uses and sharing listed above, Children’s Home Society of Florida will not use or share your medical information without your/a parent/guardian’s signed permission. You may later cancel your permission form by writing us a letter canceling your permission. Certain programs may have more legally required restrictions on disclosure of your medical information.

YOU HAVE RIGHTS WHEN IT COMES TO YOUR MEDICAL INFORMATION

1. You have the right to have a paper copy of your “Notice of Children’s Home Society of Florida Privacy Practices” at any time.

2. You have the right to see and have a copy of your medical information that is kept in certain groups of records. To see or receive a copy of your medical information, you must make a written request or fill out the “Client Request to Inspect, Copy or Amend Records” (CHS1019 form

A). We will respond to your request within a reasonable amount of time. Requests for older records may take longer to retrieve from storage.

Children’s Home Society of Florida may deny your request in certain situations but will explain why in writing and let you know if you have the right to have our decision reviewed by another person.

3. You have the right to have us amend your medical information that Children’s Home Society of Florida keeps if you believe that Children’s

Home Society of Florida has information that is not correct or not complete.

Children’s Home Society of Florida may amend the information to indicate the problem and notify others who have copies of the

incorrect information. If you would like us to amend information, you must make a request in writing and explain why you would like us to amend the information. You may either write us a letter or fill out the “Client Request to Inspect, Copy or Amend Records” (CHS1019 form A).

Children’s Home Society of Florida may deny your request in certain situations. If Children’s Home Society of Florida denies your request, Children’s Home Society of Florida will explain why in writing. You will have the opportunity to send us a statement explaining why you disagree

with our decision, and Children’s Home Society of Florida will share your statement whenever Children’s Home Society of Florida shares your information in the future.

4. You have the right to have a list of who Children’s Home Society of Florida has shared your information with for the previous six

years. If you would like to have a list, you may send us a letter requesting a list or fill out the “Client Request to Inspect, Copy or Amend Records” (CHS1019 form A). The list will not include some types of shared information, including sharing for treatment, payment or health care operations. If you request a list more than once every twelve months, Children’s Home Society of Florida may charge you a fee to cover the cost of preparing the list.

5. You have the right to request that Children’s Home Society of Florida limit the use and sharing of your medical information for treatment, payment and health care operations. Children’s Home Society of Florida is not required to agree to your request. If Children’s Home Society of

Florida does agree to your request, Children’s Home Society of Florida must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restriction at any time in which case Children’s Home Society of Florida will notify you of the cancellation and continue to apply the restriction to information collected before the cancellation.

6. You have the right to request to be contacted at a different location or by a different method such as your work address instead of home address. If you would like to request a different method of contact, you must make a written request by letter to update your record.

7. You have the right to be notified following a breach of your unsecured protected health information.

8. Most uses and disclosures of psychotherapy notes (where appropriate), uses and disclosures of protected health information for marketing purposes, and disclosures that constitute a sale of protected health information require authorization and in addition other uses and disclosures

not specifically described in this Notice of Privacy Practices will be made only with your authorization.

YOU MAY FILE A COMPLAINT ABOUT CHILDREN’S HOME SOCIETY OF FLORIDA PRIVACY PRACTICES

If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy practices, you may file a complaint either with us or with the federal government. Children’s Home Society of Florida will not take any action against you or change our treatment of you if you file a complaint.

To file a written or verbal complaint with the Children’s Home Society of Florida, you may bring your complaint to a Children’s Home Society of Florida office or you may mail it to the following address:

Privacy Officer

482 S. Keller Rd.

Orlando, FL 32810

To file a complaint with the federal government, you may send your complaint to either of the following addresses:

United States Department of Health and Human Services

Attention: Office for Civil Rights
Atlanta Federal Center,
Ste. 3B70, 61 Forsyth Street, SW
Atlanta, GA 30303-8909
Telephone: (404) 562-7886
Fax: (404) 562-7881
TDD: (404) 331-2867

United States Department of Health and Human Services

Attention: Office for Civil Rights
200 Independence Avenue, SW
Room 509F; HHH Building
Washington, D.C. 20201
Telephone: (202) 619-0257
Toll free: 1-877-696-6775

More information is available about complaints at the government’s website, http://www.hhs.gov/ocr/hipaa

For more information on the privacy of minors’ information, or to obtain forms or general information, contact our Privacy Officer at 321-397-3000.

Special accommodations for clients

Children’s Home Society of Florida recognizes, respects, promotes and celebrates the value of cultural diversity. Your ethnic or cultural customs, practices and beliefs, sexual orientation, gender, gender identity, gender expression, disability and community differences will be respected by agency team members.

No clients shall be discriminated against on the basis of race, color, religion, sex, age, national origin, disability, gender identity, gender expression, sexual orientation, or any other characteristic protected by federal, state or local law. Clients needing accommodations for a disability and/or clients with special communications needs should contact their Children’s Home Society of Florida worker or make their request for accommodation at the time of admission into a Children’s Home Society of Florida program.

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