CHILDREN’S
SUPPORTIVE SERVICES, INC.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES
HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT
CAREFULLY.
If you have any questions about this Notice, please
contact Children’s Supportive Services Inc.'s
Privacy Officer at 208-524-8996.
You may request a copy of this notice at any time.
Copies of this notice are available at all
Children’s Supportive Services offices.
PURPOSE OF THIS
NOTICE
This Notice of Privacy Practices describes how
Children’s Supportive Services Inc. (CSS) may use
and disclose your protected health information. It
also describes your rights to access and control
over your protected health information. “Protected
health information” is information about you that
relates to your past, present or future physical or
mental health and related health care services
We are required to abide by the terms of this
Notice of Privacy Practices. We may; however; change
the terms of our notice at any time. The new notice
will be effective for all protected health
information that we maintain at that time. We will
provide you with any revised Notice of Privacy
Practices upon your request.
We are required to:
- Use and disclose confidential information as
required by law;
- Maintain the privacy of your information;
- Give you this notice of our legal duties and
privacy practices for your information; and
- Follow the terms of the notice that is
currently in effect.
This
Notice of Privacy Practices does not affect your
eligibility for benefits or services.
YOUR RIGHTS ABOUT YOUR CONFIDENTIAL INFORMATION
1. Right to Review and Copy
You have the right to ask to review and copy your
information as allowed by law.
If you would like to ask to review and copy your
information, a "Records Request" form is
available at Children’s Supportive Services offices.
You must complete this form and return it to a CSS
office for processing. CSS will respond to your
request within 30 working days of receipt of your
request. Children’s Supportive Services may extend
the response time 7 additional working days if the
information you have requested cannot be located or
retrieved within the original 30 days. You will be
sent a notification of an extension and the reason
for the extension.
If you ask to receive a copy of the information,
we may charge a fee. The fee will be 10¢ per page.
You will be told if there is information we are
legally prevented from disclosing to you.
2. Right to Amend
You have the right to ask us to make changes to
your information if you feel that the information we
have about you is wrong or not complete.
If you would like to ask Children’s Supportive
Services to change your information, a "Request
to Amend Records" form is available at CSS
offices. You must complete this form and return it
to a CSS office for processing. Children’s
Supportive Services will respond to your request
within 30 days.
We may deny your request if you ask us to change
information that:
- Was not created by CSS;
- Is not part of the information kept by or
for CSS;
- Is not part of the information which you
would be allowed to review and copy; or
- We determine is correct and complete.
3. Right to Restrict Health Information
Disclosures
You have the right to ask us not to share your
health information for your treatment or services,
or normal business purposes. You must tell us what
information you do not want us to share and whom we
should not share it with.
If you would like to ask Children’s Supportive
Services to not share your information, a
"Request to Restrict Health Information Disclosures"
form is available at CSS offices. You must complete
this form and return it to a Children’s Supportive
Services office for processing. CSS will respond to
your request within 30 days.
If we agree to your request, we will comply
unless the information is needed to give you
emergency treatment, or until you end the
restriction.
4. Right to an Alternate Means of Delivery
You have the right to ask that we deliver your
information to you at a different mailing address.
For example, you can ask that we send your
information from one program to a different mailing
address from other programs that you receive
services or benefits from.
If you would like to ask for an alternate means
of delivery for your information, a "Request for
Alternate Means of Delivery" form is available
at Children’s Supportive Services offices. You must
complete this form and return it to a CSS office for
processing. CSS will respond to your request within
30 days.
We will not ask you the reason for your request.
Reasonable requests will be approved.
5. Right to a Report of Health Information
Disclosures
You have the right to ask for a report of the
disclosures of your health information. This report
of disclosures will not include when we have shared
your health information for treatment, payment for
your treatment or normal business purposes, or the
times you authorized us to share your information.
If you would like to ask for a report of your
health information disclosures, a "Request to
Receive a Report of Health Information Disclosures"
form is available at Children’s Supportive Services
offices. You must complete this form and return it
to a CSS office for processing. CSS will respond to
your request within 30 days.
The first report you ask for and receive within a
calendar year will be free of charge. For additional
reports within the same calendar year, we may charge
you for the costs of providing the report. We will
tell you the cost and you may choose to remove or
change your request at that time before any costs
are charged to you.
HOW CHILDREN’S
SUPPORTIVE SERVICES MAY USE AND DISCLOSE YOUR
PROTECTED HEALTH INFORMATION
The following are examples of the types, uses or
disclosures of your protected health care
information this agency is permitted to make once
you have signed CSS’s “Consent for Treatment and
Coordination of Services” form.
Times when your permission is not
needed
TREATMENT. We will use and disclose your
protected health information to provide, 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 also
obtained your permission to have access to your
protected health care information. We will also
disclose protected health information to other
physicians/providers who may be treating you when we
have the necessary permission from you to disclose
your protected health information.
PAYMENT.
Your protected health information will be used and
shared, as needed, so that the treatment and
services you receive through Children’s Supportive
Services can be paid. For example, we may need to
give your medical insurance company information
about the treatment or services that you received so
that your medical insurance can pay for the
treatment or services.
HEALTH CARE OPERATIONS.
We may use or disclose, as needed, your protected
health information in order to support the business
activities of your provider’s practice. This is
necessary for the daily operation of Children’s
Supportive Services and to make sure that all of our
clients receive quality care. For example, we may
use your information to review our provision of
treatment and services and to evaluate the
performance of our staff in providing services for
you.
Times when your permission is
needed
For reasons other than Treatment, Payment or
Healthcare Operations.
There may be times when Children’s Supportive
Services may need to use and share your information
for reasons other than for treatment, payment and
business operations as explained above. For example,
if CSS is asked for information from your employer
or school that is not part of treatment, payment or
business operations, CSS will ask you for a written
authorization permitting us to share that
information. If you give us permission to use or
share your information, you may stop that permission
at any time, if it is in writing. If you stop your
permission, we will no longer use or share that
information. You must understand that we are unable
to take back any information already shared with
your permission.
Individuals that are part of your care or
payment for your care.
We may give your information to a family member,
legal representative, or someone you designate who
is part of your care. We may also give your
information to someone who helps pay for your care.
If you are unable to say yes or no to such a
release, we may share such information as needed if
we determine that it is in your best interest based
on our professional opinion. Also, we may share your
information in a disaster so that your family or
legal representative can be told about your
condition, status and location.
Other uses and sharing of your
information that may be made without your permission
- For Appointment Reminders
- For Treatment Alternatives
- As Required by Law
- For Public Health Risks
- To Law Enforcement
- For Lawsuits and Disputes
- To Coroners, Medical Examiners, Funeral
Directors
- For Organ and Tissue Donation
- For Emergency Treatment
- To Prevent a Serious Threat to Health or
Safety
- To Military and Veterans organizations
- For Health Oversight Activities
- For National Security and Intelligence
Activities
- To Correctional Institutions
SPECIAL
REQUIREMENTS
Information that has been received from a
federally funded substance abuse treatment program
or through the infant and toddler program will not
be released without specific authorization from the
individual or legal representative.
CHANGES TO THIS
NOTICE
Children’s Supportive Services has the right to
change this notice. A copy of this notice is posted
at our CSS offices. The effective date of this
notice is shown in the top right-hand corner of each
page. If Children’s Supportive Services makes any
changes to this Notice of Privacy Practices, CSS
will follow the terms of the notice that is
currently in effect.
COMPLAINTS
If you believe your information privacy rights
have been violated, you may file a written complaint
with Children’s Supportive Services Inc. All
complaints turned in to CSS must be in writing on
the "Privacy Complaint" form that is
available at CSS offices. To file a complaint with
CSS, send your completed Privacy Complaint form to:
Children’s Supportive Services Inc.
Privacy Officer
1322 East Lincold Road
Idaho Falls, ID 83404
If you believe your health information privacy
rights have been violated, you may also file a
complaint with the Secretary of Health and Human
Services. Your complaint must be in writing and you
must name the organization that is the subject of
your complaint and describe what you believe was
violated. Send your written complaint to:
Secretary of Health and Human
Services
200 Independence Avenue Southwest
Washington, D.C. 20201
A complaint filed with either Children’s
Supportive Services Inc. or the Secretary of Health
and Human Services must be filed within 180 days of
when you believe the privacy violation occurred.
This time limit for filing complaints may be waived
for good cause.
You will not be punished or retaliated against for
filing a complaint.
This notice was published and becomes effective
April 14, 2003.
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