HIPAA Privacy Notice

THIS NOTICE DESCRIBES HOW PERSONAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

 

Your Personal Information – Protecting Your Privacy

It is your right as a client to be informed of the privacy practices of Family & Children’s Center as well as to be informed of your privacy rights with respect to your personal information. This notice of privacy practices is intended to provide you with this information.

 

Family & Children’s Center’s Responsibilities:

 It is your right as a client to be informed of Family & Children’s Center’s legal duties with respect to protection of the privacy of your personal information.

Family & Children’s Center is required to:

  • Maintain the privacy of your personal information;
  • Provide you with a notice of the legal duties and privacy practices regarding personal information collected and maintained about you; and
  • Abide by the terms of this notice.

Family & Children’s Center reserves the right to change the terms of the notice of privacy practices and make the new notice provisions effective for all personal information that it maintains. Family & Children’s Center also reserves the right to change the terms of its notice with respect to any applicable more limited uses and disclosures.

Family & Children’s Center will promptly revise and distribute its notice whenever Family & Children’s Center makes a substantial change to any of its privacy practices.

Family & Children’s Center will not use or disclose your personal information without your authorization, except as described in this notice.

 

Your Personal Information Rights-

You have the right to:

Request a restriction on certain uses and disclosures of your personal information:

You have the right to request restrictions on certain uses and disclosures of personal information, even if the restriction affects your treatment or Family & Children’s Center’s payment or care operation activities. However, Family & Children’s Center is not required to agree to your requested restriction.

Example: Family & Children’s Center providers will document phone calls, messages, and e-mails and this documentation will become part of the client’s file.

Receive confidential communications:

You have the right to request that Family & Children’s Center communicate your personal information to you by alternative means or at alternative locations. Family & Children’s Center shall accommodate reasonable requests.

Example: You may request to be contacted at a phone number that is different from the phone number listed on your intake paperwork or to have your bill mailed to an alternate address.

Inspect and obtain a copy of your personal record:

You have the right to inspect and obtain a copy of your personal record. This request for access to your personal record must be submitted in writing to program staff or Human Resources.  This right does not apply to certain types of psychotherapy notes and Family & Children’s Center may charge you a reasonable fee for a copy of your personal record.  For example, you may request a copy of your health care records from your provider.

Amend your personal record:

You have the right to request an amendment to your personal record if you believe your personal information is incorrect or incomplete. You may be asked to make this request in writing and state the reason why your personal record should be changed. If Family & Children’s Center did not create the personal information you believe is incorrect or if Family & Children’s Center disagrees with you, Family & Children’s Center may deny your request. For example, if you believe that information in your medical history is incorrect, such as your birth date, you may request that this information be amended.

Obtain an accounting of disclosures of your personal information:

You have the right to an accounting of disclosures of your personal information that Family & Children’s Center has made in compliance with state and federal law. The accounting will describe the dates of each disclosure, a brief description of information disclosed and the reason for disclosure. You will receive one accounting per year at no charge and Family & Children’s Center may charge you a reasonable fee for each subsequent request. For example, you may request an accounting of disclosures made from your personal record in the last year to the State for disease reporting.

Obtain a paper copy of the notice upon request:

You have the right to obtain a paper copy of the notice upon request. For example, if you received the notice electronically, you may request that Family & Children’s Center provide a paper copy of the notice.

 

Uses and Disclosures for Treatment, Payment and Care Operations-

Family & Children’s Center, with your authorization and according to state law, is permitted to use or disclose your personal information for treatment, payment or care operations.

Family & Children’s Center may use or disclose your personal information for treatment:

Family & Children’s Center may use or disclose your personal information in the provision, coordination or management of your care.

Example: Your information may be disclosed from one physician to another if they are consulting each other in relation to your care and treatment.

Example: Family & Children’s Center may send you information about treatment alternatives or other personal related services that may be of interest to you.

Family & Children’s Center may use or disclose your personal information for payment:

Family & Children’s Center may use or disclose your personal information to obtain reimbursement for the provision of care services. The bill may include information that identifies you, your diagnosis and your treatment.

Example: Family & Children’s Center may use or disclose your information to your insurer to obtain payment for the provision of care services.

Family & Children’s Center may use or disclose your personal information for care operations:

Family & Children’s Center may use or disclose your personal information for evaluation of client care services, evaluating the performance of care providers, activities relating to compliance with the law and business planning and development. You have the right to opt out of fundraising communications.

Example: Family & Children’s Center may review your personal record to determine the efficiency of the services provided to you.

Example: Family & Children’s Center may contact you as part of a fundraising activity sponsored by your care provider; you have the right to say no.

Example: Family & Children’s Center may contact you to remind you of an appointment. This includes leaving a voicemail message.

 

Uses or Disclosures of Your Personal Information Permitted Without Your Authorization-

Without your written authorization, Family & Children’s Center may use or disclose your personal information for the following purposes:

As required by law:

Family & Children’s Center may use or disclose personal information to the extent that the use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of the law. Uses or disclosures required by federal privacy rule and limited by the more protective requirements of state law include the following:

  • Disclosures about victims of elderly, vulnerable adult or child abuse;
  • Disclosures for judicial and administrative proceedings; or
  • Disclosures for law enforcement purposes.

Public health:

As required by law, Family & Children’s Center may disclose your personal information to the State of Wisconsin or the State of Minnesota for the purpose of statutory reporting.

Family & Children’s Center may disclose your personal information excluding mental health, alcohol or drug abuse or developmental disabled or HIV test result to a state or federal public health agency for the purpose of preventing or controlling disease, injury or disability.

Family & Children’s Center may disclose your personal information excluding your HIV test result without your authorization to a county agency investigating child abuse.

Family & Children’s Center may disclose your personal information excluding mental health, alcohol or drug abuse or developmental disabled or HIV test result without your authorization to the Food and Drug Administration (FDA).

Family & Children’s Center may disclose your HIV test result without your authorization to a person that may have sustained a contact that carries a potential for transmission of HIV.

Family & Children’s Center may disclose your personal information that is reasonably related to a work related illness or injury if an application for workers’ compensation has been filed.

Victims of abuse, neglect or domestic violence:

Family & Children’s Center may disclose personal information except for an HIV test result if Family & Children’s Center reasonably believes that an individual is a victim of child or elderly abuse.

Health oversight activities:

Family & Children’s Center will not disclose HIV test results to health care oversight agencies without an authorization. Family & Children’s Center may disclose your mental health, alcohol or drug abuse or developmental disability related health information to the Department of Health and Family Services, to the county for coordination of human services and to a representative of the board on aging and long-term care. The remainder of your personal information may be disclosed without your authorization to a state or federal agency.

  • All Family & Children’s Center staff are mandated reporters, and are required by law to make a report if there is any suspicion that a child is being harmed physically, emotionally, or sexually abused or neglected. Only information that is pertinent to the specific incident will be disclosed.

 Judicial and administrative proceedings:

 If Family & Children’s Center is subpoenaed to release client information, unless the client agrees to release personal information, the Program Coordinator will contact the legal professional to determine what information is being requested. If personal information is being requested, and the client wishes not to disclose such information, other options can be explored to object to the subpoena.

Judicial and administrative proceedings continued:

If Family & Children’s Center is court ordered to release personal client information, the client will be contacted and informed of the request. The Program Coordinator will contact the legal professional to determine what information is being requested, and Family & Children’s Center will only release the information that is being requested.

Law enforcement:

Family & Children’s Center may disclose your personal information except for HIV test results to county law enforcement officials for the reporting and investigation of elderly and/or child abuse. Family & Children’s Center may disclose your personal information except for mental health, alcohol or drug abuse or developmental disabled or HIV test results to state and federal law enforcement officials. Family & Children’s Center may disclose mental health, alcohol or drug abuse or developmental disabled protected personal information for limited law enforcement purposes as required by law. Family & Children’s Center may disclose your personal information to a law enforcement official in response to a court order or in relation to your commission of a crime or threat to commit a crime on program premises or against any person who works for the program.

Coroner or medical examiner:

Family & Children’s Center may use or disclose your personal information that is not an HIV test result or related to mental health, alcohol or drug abuse and developmental disabilities to a coroner or medical examiner.

Funeral director:

Family & Children’s Center may use or disclose your HIV test result to a funeral director.

For cadaveric organ, eye or tissue donation purposes:

Family & Children’s Center may use or disclose your HIV test result to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation or cadaveric organs, eyes or tissue for the purpose of facilitating organ, eye or tissue donation and transplantation.

Research:

Family & Children’s Center may use or disclose your personal information for research purposes if the researcher has obtained your permission and fulfilled the stringent privacy requirements of state and federal law.

To avoid a serious threat to health or safety:

Family & Children’s Center may disclose your personal information under limited circumstances to law enforcement officials to avert a serious threat to health or safety.

Disclosures for specialized government functions:

Family & Children’s Center may disclose personal information excluding mental health, alcohol or drug abuse or developmental disabled or HIV test result for national security, for protection of the President and for medical suitability determination of Armed Forces personnel to a state or federal agency.

Family & Children’s Center may disclose personal information to limited staff of a correctional institution or a custodial law enforcement official for the provision of care and the transport of inmates.

Workers compensation:

Family & Children’s Center may disclose personal information reasonably related to a workers’ compensation injury.

Authorization:

Family & Children’s Center has attempted to explain with this notice the circumstances where state law may be more protective than the federal privacy rule and provides greater privacy protection.

Except for the situations listed above and treatment, payment or care operation purposes, the use or disclosure of your personal information requires Family & Children’s Center to obtain your written authorization. You may withdraw your authorization in writing at any time by submitting your written withdrawal to Family & Children’s Center’s program staff or Human Resources.  Violation of the Federal or State law and regulations by the Family & Children’s Center is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal Regulations.

Client Complaint Process:

If you believe your privacy rights have been violated, you may file a complaint with Family & Children’s Center or with the Secretary of the Department of Health and Human Services. There will be no retaliation against you for filing a complaint.

To file a complaint with Family & Children’s Center please contact the Family & Children’s Center’s Director, Human Resources, who will provide you with the necessary assistance.

 

Questions or Concerns:

If you have any questions or concerns regarding your privacy rights or the information in this notice, please contact:

Director of Human Resources

Family & Children’s Center
1707 Main Street
La Crosse, WI 54601
(608) 785-0001 ext. 327
Fax: (608) 785-0002

Effective Date: This Notice of Privacy Practice is effective as of June 29, 2016

Citations: 42 CFR Part II, 45 CFR 164, WI DHS 92, WI Ch. 51.30, WI Ch. 146.81-146.84 & MN Statute 144.291-144.3