MBCH Children & Family Ministries

Notice of Privacy Policy

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.

The Health Information Portability and Accountability Act (HIPAA) of 1996 requires that we protect your health information and provide you with notice regarding our legal duties in the protection of health information and in the use/disclosure of such information. In the work of this agency, "protected health information" refers to any information that relates to the past, present or future physical or mental health or condition of you; the provision of health care to you; or the past, present or future payment for the provision of health care to you. This notice will explain the rules around the privacy of your own health information and our duties to protect the privacy of your records that we create or receive. We are required to abide by the terms of our Notice currently in effect. With only some exceptions, we will avoid using or disclosing any more health information than is necessary to accomplish the purpose of this disclosure.

WHO WILL FOLLOW THIS NOTICE:

All staff of MBCH Children and Family Ministries are required to follow the policies and procedures outlined in this notice. This includes all departments of the agency. This also applies to any volunteer who might assist in our work as well as any professional who has a contractual relationship for the purpose of assisting us in providing services to our consumers.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

We use and disclose your health information for many different reasons. For some of these uses and disclosures, we need your specific authorization. Below we want to explain to you ways that we may, by federal law, use and disclose your health information without your express permission. For each category listed below we will explain what we mean and give an example.

1. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations.

Treatment: We may use health information about you to provide you with treatment or services. We would share health information about you with all the staff who are a part of providing services to you including social workers, child care workers, nurses, supervisory and administrative staff, interns and others involved in providing services. For example, all the members of the treatment team need to know about you in order to assist you in reaching your goals. They will share the minimum amount necessary to accomplish this task. We may also disclose health information about you to others outside our agency who are involved in your medical care or treatment.

Payment: We may use/disclose health information about you so that the treatment and services you receive from our agency may be billed to and payment may be collected from the appropriate payor. For example, we may tell your insurance company when you received certain services in order to verify need for payment.

Health Care Operations: We may use/disclose health information about you as a part of agency operations. This would be done to assure the highest possible standards of care are being provided to you. For example, information about you may be shared for purposes of quality improvement activities such as a record review in which staff reviews the work of another staff person in order to critically evaluate the quality of our services.

2. Other Purposes for Which We are Permitted or Required to Use or Disclose Your Protected Health Information Without Your Written Authorization:

We can use or disclose health information about you without your consent or authorization in the following instances:

Appointment Reminders: We may use/disclose health information to contact you as a reminder of an appointment for services.

Treatment Alternatives: We may use/disclose health information in order to tell you about and possibly recommend other treatment options that may be of benefit to you.

Emergencies: We may use or share your information in an emergency treatment situation. If treatment is required by law and the health care provider has attempted to obtain your consent but is unable to, they may still use or share your information for treatment.

De-identified Information: Your information is changed so that it does not identify you or information is removed so your identity is not disclosed (e.g., your name, address).

Personal Representative: To a person who, under law, has the authority to represent you in making health care decisions.

Individuals Involved in Disaster Relief: Should a disaster occur, we may use/disclose health information about you to any agency assisting in disaster relief so that your family can be notified of your condition, status and location.

As Required by Law: We may use/disclose health information about you when required to do so by federal, state or local law.

Public Health Risks: We may use/disclose health information about you for public health activities. These generally include, by not limited to the following: to prevent or control disease, injury or disability or to report child abuse or neglect.

Health Oversight Activities: We may use/disclose health information about you to outside entities who might provide oversight to the agency’s services. This disclosure may be for the purposes of licensing, accreditation, inspection of facilities, or oversight of compliance with contracted work.

Court and Administrative Proceedings: We may use/disclose health information about you in response to a court or administrative order, or in response to a subpoena, discovery request or other lawful process that is not accompanied by an order of court or administrative tribunal.

Law Enforcement: We may release medical information if asked to do so by a law enforcement official:

• In response to a court order, subpoena, warrant, summons or similar process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at our campus; and
• 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.

Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information to funeral directors as necessary to carry out their duties.

Avert a Threat to Health or Safety: We may share your information if we believe that sharing the information is necessary to prevent or lessen a serious and probable threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.

Inmates: We may share your information to a correctional institution or a law enforcement official if you are an inmate of that correctional facility and your information is necessary to provide care and treatment to you or is necessary for the health and safety of other individuals or inmates.

Communication Barriers: We may use and share your information if our staff tries to communicate for treatment purposes but is unable to do so due to a communication barrier and we, using professional judgment, determine that you intend to authorize the use or share under the circumstances (e.g., language barriers where an interpreter is needed or hearing impairment).

National Security and Intelligence Activities: We may use/disclose health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others: We may use/disclose health information about you to authorized federal official so them may conduct special investigations or provide protection to the President and other authorized persons or foreign heads of state.

C. Any other uses/disclosures of information will be made only with your expressed written authorization. If you choose to sign an authorization to disclose any of your health information, you can later revoke it to stop further uses and disclosures to the extent that we haven’t already taken action relying on the authorization. Any revocation by you must be in writing to be effective.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION:

Right to Inspect and Copy: You have the right to inspect and copy your health information with the exception of psychotherapy notes and information compiled in anticipation of litigation. To inspect you health information, you must submit your request in writing using a form provided by the agency. We will respond to your request in a timely manner. If you request a copy of your health information, you may be charged a fee for the cost of copying, mailing, or other costs incurred with your request.

Your request to inspect you health information may be denied under certain limited circumstances. The most likely reasons for denial would be that seeing the materials would likely endanger the life or physical safety of you or someone else or the materials requested make reference to another person. If your request is denied, you may request that the denial be reviewed. The person conducting the review will not be the person who denied your request.

Right to Request an Amendment: You have the right to request that the health information we have in our records be amended if you believe the information is incorrect or incomplete. You must provide a reason(s) that supports your request. Requests for such amendments must be made in writing to the Privacy Officer. We may deny your request if it is not in writing or if it does not include a reason supporting the request. In addition, we may deny your request if you ask us to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• Is not part of the medical information kept by or for the facility;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.

Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures", a list of the disclosures made by the facility of your health information. To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer of the agency. Your request must state a time period which may not go back more than six years and cannot include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve-month period will be free. For additional lists in a twelve-month period, we may charge you for the cost of providing the list. We will notify you what that cost will be and give you an opportunity to withdraw or modify your request before you are charged. There are some disclosures that we do not have to track. For example, when you give us an authorization to disclose some information, we do not have to track that disclosure.

Right to Request Restrictions: You have the right to request restrictions or limitations on the health information we use or disclose about you for treatment, payment or health care operations. We are not required to agree with the restriction you request. We will try to abide by your request for restriction. If we decide that your requested restriction would limit our ability to provide services in a professionally responsible manner, we may decide not to provide services to you. Requests for restrictions should be submitted in writing to the agency Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want limits to apply (e.g. disclosures to relatives).

Right to Request Confidential Communications: You have the right to request that we communicate with you about your care in a certain way or at a certain location. You do not have to explain to us the reason for the request. The agency will make every effort to accommodate your request but recognizes that the request must be reasonable. The request for special communications must be made in writing to the agency Privacy Officer.

Right to Obtain a Paper Copy: You have the right to request a paper copy of this Notice, even if you have agreed to receive the notice electronically. You may ask for a copy of this Notice at any time.

CHANGES TO THE NOTICE:

We must provide you with a copy of this Notice; however, we reserve the right to change the terms of this Notice and our privacy practices at any time. If we change the Notice, we will post the revised Notice in public areas.

COMPLAINTS:

If you believe your privacy rights have been violated,

1. You may file a complaint with the agency by contacting the agency’s privacy officer: Performance Improvement Director, MBCH Children and Family Ministries, 11300 St. Charles Rock Road, Bridgeton, MO 63044-2793 (phone number 314-739-6811).
2. You may file a complaint with the Secretary of the Department of Health and Human Services by calling 877-696-6775 or writing at 200 Independence Ave. SW., Washington, D.C. 20201.
3. You may file a grievance with the Office of Civil Rights by calling 866-OCR-PRIV (866-627-7748) or 886-788-4989 TTY.

We will not retaliate against you or penalize you for filing a complaint.

QUESTIONS:

Any questions regarding this notice should be directed to the agency privacy officer: Performance Improvement Director, MBCH Children and Family Ministries, 11300 St. Charles Rock Road, Bridgeton, MO 63044-2793 (phone number: 314-739-6811).

EFFECTIVE DATE:

This Notice of Privacy Practices becomes effective April, 14, 2003.