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Family & Children's Service of Ithaca is dedicated to providing affordable, professional services that support children, families, and organizations in finding solutions to the challenges of life today.

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PLEASE REVIEW IT CAREFULLY

OUR COMMITMENT TO YOUR PRIVACY

The privacy of your medical information is important to us. Family & Children's Service is required by law to maintain the privacy of your health information. We believe that maintaining the confidentiality of your records is an important duty, and every staff member in every department of the agency signs an agreement to protect this information from unauthorized disclosures. It is our policy to make every effort to get your written consent before we disclose any of your health information.

We are also required by law to give you information of our legal duties and privacy practices related to your health information. This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights to access and control your protected health information. "Protected health information" or PHI, is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

This notice takes effect April 14, 2003.

OUR LEGAL DUTY

Family & Children’s Service of Ithaca, Inc. is required by applicable federal and state laws to maintain the privacy of your PHI.  We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning PHI.  We must follow the privacy practices that are described in this notice while it is in effect.

We reserve the right to change our privacy practices and the terms of this notice at any time, provided that applicable law permits such changes. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all PHI that we maintain, including medical information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and give the new notice to our clients at the time of the change.

You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the contact information at the end of this notice.

Uses and Disclosures of Nonpublic Personal Information

Nonpublic Personal Information is information you give us when you become a client of this agency. Examples of this information are your name, social security, number, addresses, type of health care benefits, payment amounts, etc.

We will not give out your nonpublic personal information to anyone unless we are permitted to do so by law or have received a signed authorization form from you.

Uses and Disclosures of Medical Information Based Upon Your Written Consent

Your protected health information may be used and disclosed by our clinical staff, our office staff and others who are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the agency. The following categories describe different purposes for which we use and disclose PHI. For each category of uses of disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed; however, all of the ways we are permitted to use and disclose information will fall within one of the categories.

Treatment: We may disclose PHI to treat you, or to coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your PHI. For example, we may ask you to undergo laboratory tests and to use the results to help us reach a diagnosis. The people who work for our agency may use or disclose your PHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your PHI to others who may assist in your care, such as your physician or others for whom you have given us written authorization.

Payment:  Our agency may use and disclose your PHI in order to bill and collect payment for the services you may receive from us. For example, we will contact your health insurer to certify that you are eligible for benefits, and for what range of benefits, and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We will not disclose PHI to an unauthorized person not involved in your care or treatment, unless we are required or permitted to do so by law. We may use and disclose PHI to collect payments from you or your insurance company or other third party payers, such as family members, who might be responsible for such costs. We may also use your PHI to bill you directly for services.

Healthcare Operations: We may use and disclose PHI for purposes of performing our healthcare operations. Our healthcare operations include using PHI to determine the cost of services we offer, to conduct quality assessment and improvement activities, to engage in care coordination or case management, to determine eligibility for benefits. For example, we may use or disclose PHI when working with accreditation agencies which monitor and evaluate the quality of the services we offer.

To You: We must disclose your PHI to you, as described in the Individual Rights section of this notice below. We may also use and disclose PHI to tell you about recommended possible treatment options or alternatives.

For Appointment Reminders: Our agency may use and disclose your PHI to contact you and remind you of scheduled appointments.

Release of Information To Family/Friends: Our agency may release your PHI to a friend or family member that is helping you pay for your health care, or who assists in taking care of you. In a medical emergency, when you cannot give consent to such disclosure, we will disclose the minimum amount necessary.

To Our Business Associates: A business associate is defined as a person or company who assists us in managing our business, such as a professional who reviews the quality of our services. These business associates are required to sign a confidentiality agreement with us that limits their use or disclosure of the PHHI they receive.

Research: We may use or disclose PHI for research purposes in limited circumstances. For example, a research project may involve comparing the health of all clients who received one treatment to those who received another. All research projects are required to obtain special approval.

Permitted and Required Uses and Disclosures That May Be Made Without Your Consent

It is our policy to receive your consent for any disclosure of protected health information. Under law, however, we are not required to receive your consent to make the following kinds of disclosures:

Required by Law: We may use or disclose PHI when we are required to do so by law. For example, we must disclose PHI to the U.S. Department of Health and Human Services upon request to determine whether we are in compliance with federal privacy laws.

Coroners, Medical Examiners and Funeral Directors:  We may release PHI to a coroner or medical examiner, to identify a deceased person or determine the cause of death. We may also release PHI about deceased clients to funeral directors to carry out their duties.

Public Health and Safety: We may disclose PHI to the extent necessary to avert a serious and imminent threat to your health or safety, or the health or safety of others. We may disclose PHI to a government agency authorized to oversee the healthcare system or government programs or its contractors, and to public health authorities for public health purposes.

Victims of Abuse, Neglect or Domestic Violence: We may disclose PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence or other crimes.

Process and Proceedings: We may disclose PHI in response to a court or administrative order, subpoena, discovery request or other lawful process. Under limited circumstances, such as a court order, warrant or grand jury subpoena, we may disclose PHI to law enforcement officials.

Military and National Security: We may disclose to the military the PHI of U.S. and foreign armed forces personnel (including veterans) under certain circumstances. We may disclose to authorized federal officials medical information required for lawful intelligence, counterintelligence and other national security activities. We may disclose your PHI to federal officials in order to protect the President, other officials, or foreign heads or state.

Workers’ Compensation: We my release your PHI for workers’ compensation and similar programs.

Your Individual Rights

Access: you have the right to inspect and/or copy your PHI, with limited exceptions such as information a licensed health care professional, exercising professional judgment, determines that providing access is reasonably likely to endanger the life, or physical safety or cause someone substantial harm. In certain circumstances, a decision to deny access may be reviewable. On or after 4/14/03, you may make a written request to us to inspect or copy your PHI. If you request copies, we reserve the right to charge you a reasonable fee for each copy, plus postage if the copies are mailed to you.

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your PHI. The list will not include disclosures we made for the purpose of treatment, payment, healthcare operations, disclosures made with your authorization, or certain other disclosures. You may request a list of disclosures made on or after April 14, 2003, and the request may not exceed a six-year time period. We will provide you with the date on which we made the disclosure, the name of the person of entity to whom we disclosed your PHI, a description of the PHI we disclosed, and the reason for the disclosure.  If you request this list more than once in a 10-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. Your request must be in writing, and must specify the form you want the list (for example, on paper, or electronically).

Restriction Requests: You have the right to request that we place additional restrictions on our use or disclosure of your PHI. You also have the right to request a limit on the medical information we disclose bout you to someone who is involved in your care or payment for your care, such as a spouse, or for notification purpose as described in this notice.

Our agency is not required to agree to your request, but if we do agree, we will comply with your request only until receive written notice from you that you no longer want the restriction to apply (except as required by law or in emergency situations).

Any request for a restriction on our use and disclosure of your PHI must be made in writing. You request must describe in a clear and concise manner (a) the information you wish restricted; (b) whether you are requesting to limit the agency use or disclosure, or both; and (c) to whom you want the restrictions to apply.

Confidential Communication: You have the right to request that the agency communicate with you about your health and related issues in a particular manner or at a certain location. For example, you may ask that we contact you at work rather than at home. We will accommodate all reasonable requests made in writing. Requests must include your statement that you believe you would be endangered if we do not communicate to the alternative location or by alternative means.

Amendment: You have the right to request to amend your PHI. Your request must be in writing, and it must explain why the information should be amended. We may deny your request if we did not create the information you want amended, or if we determine the information is accurate. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment, and to include the changes in any future disclosures of that information. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be attached to the information you wanted amended. You may make your request for amendment on or after April 14, 2003.

Right to a Paper Copy of this Notice: You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time.

Right to Provide an authorization for Other Uses and Disclosures: Our agency will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. You should make your request to the agency’s Privacy Officer at the address below. After you revoke your authorization, we will no longer use or disclose your PHI for the purposes described in the authorization, except under the following circumstances:

• We have taken action in reliance upon your authorization before we received your written revocation
• You were required to give us your authorization as a condition of obtaining treatment.
• We are required to retain records of your care.

This notice describes privacy practices required by law. Our agency holds to a standard of even more strict safeguards of your privacy. You may contact us if you want further information about our Release of Client Records Protocol.

Questions and Complaints

If you want more information about our privacy practices, or have questions or concerns, please contact us using the contact information at the end of this notice.

On or after 4/13/03, if you are concerned that we may have violated your privacy rights as described above, of if you disagree with a decision we have made about access to your PHI or with our response to a request you made to amend or restrict the use or disclosure of your PHI or to have us communicate confidentially with you at an alternative location, you may complain to us using the contact information at the end of this notice. All complaints must be submitted in writing. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.

For privacy complaints and other questions related to this notice, please contact:
Privacy Officer
Family & Children’s Service of Ithaca, Inc.
127 West State Street
Ithaca, NY 14850
Phone: (607) 273-7494
email: privacyofficer@fcsith.org