301-459-2121
NOTICE OF PRIVACY PRACTICES
YOUR RIGHTS TO CONFIDENTIALITY
Family Service Foundation takes confidentiality
very
seriously. We follow very strict rules from the Federal and State
governments
about when we can release your medical record – your Protected
Health
Information.
All agencies providing services to people with
developmental
disabilities, mental disorders, and HIV/AIDS are required to abide by
the Code
of Maryland Regulations (COMAR) to protect the confidentiality of your
medical
record and treatment, and to establish guidelines as to when this
information may
be released.
The Federal Health Insurance and Portability and
Accountability Act (HIPAA) Privacy Rule establishes a foundation to
Federal
protection for personal health information, carefully balanced to avoid
creating unnecessary barriers to the delivery of quality health care.
The Rule
generally prohibits this program from using or disclosing your
Protected Health
Information unless authorized by you, except as follows:
We are authorized to disclose your Protected
Health
Information without your consent when we use that information for
treatment,
payment, or the health care operations of the program.
Treatment generally means the provision,
coordination, or
management of health care and related services among health care
providers or
by a health care provider with a third party, consultation between
health care
providers regarding a client, or the referral of a client from one
health care
provider to another. According to COMAR, a signed Release of
Information Form
is required under this category; however, we are required by law to
disclose
your Protected Health Information in certain circumstances, such as to
report
abuse and neglect, and to warn about dangerous behavior.
Payment encompasses the various activities of
health care
providers to obtain payment or be reimbursed for their services. For
example,
we may disclose your Protected Heath Information as part of a claim for
a
payment to a health plan.
Your medical records and any verbal or written
communications between you, your parent/legal guardian (if applicable),
or any
authorized representative are strictly confidential. Further, no
material or
information concerning you or your family will be disclosed to another
party
without your express written consent and/or that of a legally
authorized
representative. This excludes circumstances when there is a clear and
imminent
danger to yourself or others when disclosure is mandated by law.
SECURITY
Your medical record (which includes your Protected
Health
Information) is kept in a secure location and only those employees or
health
professionals who need access to your medical record for treatment,
payment or
health care operations have access to your medical record.
It is our policy to reasonably limit disclosures
of requests
for Protected Health Information for payment and health care operations
to the
minimum necessary. We also limit which members of our workforce may
have access
to your Protected Health Information based on those who need access to
the
information to do their jobs. We may also disclose information in order
to
contact you, for example to make appointments, to check with you about
how you
are doing, and to evaluate the services that we provide to you. We may
also
contact you for fundraising efforts.
YOUR RIGHTS TO SEE YOUR RECORD
You have the right to see your record (with the
exception of
psychotherapy notes) or to receive a summary of your record. To do
this, please
contact the Family Service Foundation Corporate Compliance Officer at
5301 76th
Avenue, Landover Hills, Maryland 20784, or by phone at 301-459-2121.
DISCREPANCIES IN YOUR RECORD
If you disagree with the contents of your medical
record,
you may request an amendment to the record. We will place that
amendment in the
medical record unless we did not create that part of the record or we
believe
the existing record is accurate and complete. If we grant the
amendment, we
will notify your and you may request that we provide the amendment to
other
programs and to programs that you identify to us as having already
received
your medical record. If we deny the amendment, we will give you
specific
reasons for the denial. You may then submit a statement of disagreement
and we
may submit a rebuttal. If you notify us in writing, we will attach your
request
for amendment and our denial to future disclosures of that part of your
medical
record. Also, if you continue to disagree, you may file a complaint
with the
Family Service Foundation Corporate Office Compliance Officer (contact
information above) and the Secretary of Health and Human Services at
the Office
of Civil Rights at:
U.S. Department of Heath and Human Services
Office for Civil Rights, DHHS
150 South Independent Mall – West Room 372
Philadelphia, Pennsylvania 19106-3499
1-866-627-7748
1-866-788-4989 TTY
If you want your Protected Health Information sent
to
someone, you must sign an authorization, which can be obtained from the
Family
Service Foundation Corporate Compliance Officer at 530176th Avenue,
Landover
Hills, Maryland 20784, or by phone at 301-459-2121, or from your
therapist,
doctor, or program staff.
HIPAA PRIVACY PROCEDURE COMPLAINT
If you believe that your Protected Health
Information has
been released in violation of the law, you have the right to file a
complaint.
You may:
File a complaint with our program by contacting or
submitting a letter to the Family Service Foundation Corporate
Compliance
Officer at 5301 76th Avenue, Landover Hills, Maryland 20784, or by
phone at
301-459-2121.
You may also file a complaint with the Health and Human
Services at the Office of Civil Rights at:
U.S. Department of Heath and Human Services
Office for Civil Rights, DHHS
150 South Independent Mall – West Room 372
Philadelphia, Pennsylvania 19106-3499
1-866-627-7748
1-866-788-4989 TTY
You have our promise that we will not retaliate
against you
if you file a complaint.
UPDATES
Over time we may change this Notice of Privacy
Practices. If
we make changes a hard copy will be provided to you at no cost.