Answer: We use and disclose health information for many different reasons. For most uses or disclosures, we require your specific written permission (Authorization). We describe here different kinds of "uses and disclosures" with some examples of each kind.

1. Uses and Disclosures Relating to Treatment, Payment or Healthcare Operations. By federal law, we may use and disclose your health information for the following reasons:
   
   
   • For Treatment: As noted above, we almost always need your written permission (Authorization) to disclose information about mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status. Otherwise, we may disclose general health information to other health care providers who are involved in your care. For example, we may disclose your medical history to a hospital if you need medical attention while at our facility, or to a residential care program if we are referring you there. Reasons for making such disclosures may be: to get them the medical history information they need to appropriately treat your condition, to coordinate your care, or to schedule necessary testing.
   • To Obtain Payment for Treatment: As noted above, we almost always need your written permission (Authorization) to disclose information about mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status. Otherwise, we may use and disclose necessary health information in order to bill and collect payment for treatment we provided you. For example, we may provide certain portions of health information to those who pay for your services so that we can get paid. Payors of some clients’ services sometimes include health insurance companies, Medicare, Medicaid, the County of Bucks, or other funder(s). If necessary, we may provide your health information to a billing company that handles our health insurance claims.
   • For Health Care Operations: As noted above, we almost always need your written permission (Authorization) to disclose information about mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status. Otherwise, there may be times when we need to use and disclose your health information to run our organization. For example, we may use health information to evaluate the quality of your treatment by our staff. We may also need to provide some limited information to accountants, attorneys, and consultants to make sure that we comply with law. Such persons themselves are bound by professional ethics to maintain confidentiality.
2. Certain Other Uses & Disclosures Permitted by Federal Law. As noted above, we almost always need your written permission (Authorization) to disclose information about mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status. However, in some situations required or permitted by law, we may use and disclose health information without Authorization for the following reasons:
   
   1. When a Disclosure is Required by Federal, State or Local Law, in Judicial or Administrative Proceedings, or by Law Enforcement. For example, we may disclose protected health information if we are ordered by a court, or if a law requires that we report that sort of information to a government agency or law enforcement authorities, such as in the case of suspected child abuse or neglect.
   2. For Public Health Activities. Under law, we need to report information about certain diseases and about any deaths to government agencies that collect that information. We are permitted to provide some health information to a coroner or funeral director, if necessary, after a client's death.
   3. For Health Oversight Activities. For example, we need to provide health information if requested to do so by the County and/or State when they oversee a program in which you receive care. We also need to provide information to government agencies that have the right to inspect our offices and/or investigate healthcare practices.
   4. For Organ Donation. If a client wished to make an eye, organ, or tissue donation after death, we may in some situations disclose certain necessary health information to assist the appropriate organ procurement organization.
   5. For Research Purposes. In certain limited circumstances (for example, where approved by an appropriate Privacy Board or Institutional Review Board under federal law), we may be permitted to use or provide protected health imformation for a research study. Our Agency policy is to inform clients in advance and in writing before they enter any formal research study. In doing so, we routinely obtain a client's written authorization and consent to participate in such a study. Clients always have the right to refuse to participate in research. Clients who refuse to participate in research are not denied Agency services for which they otherwise are eligible.
   6. To Avoid Harm. If a psychiatrist, nurse, counselor, therapist, counselor, marriage and family therapist, or case manager believes it is necessary to protect you, to protect another person, or to protect the public as a whole, we may provide protected health information to police or others who may be able to prevent or lessen the possible harm.
   7. For Specific Government Functions. We may disclose health information of military personnel or veterans where required by U.S. military authorities. Similarly, we may disclose a client's health information for national security purposes, for example, for protection of the President.
   8. For Worker's Compensation. We may provide health information as described under the Workers' Compensation law, if your condition was the result of a workplace injury for which you are seeking workers' compensation.
   9. Appointment Reminders. Unless you tell us that you prefer not to receive them, we may use or disclose information to provide you with appointment reminders, for example, by using your telephone number to contact you with a reminder.
   10. Fundraising Activities. We do not use private information obtained from clients for fundraising purposes. We do not provide clients' private information to any persons or organizations for such purposes.
3. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
   1. Disclosures to Family, Friends, or Others Involved in Your Care. We may provide a limited amount of health information to a family member, friend, or other person known to be involved in your care or payment for your care, unless you tell us not to. For example, if a family member comes with you to your appointment and you allow them into the treatment room with you, we may disclose otherwise protected health information to them during the appointment, unnless you tell us not to. This information may not contain information about drug and alcohol abuse and/or treatment and may nto contain information about HIV status without your specific Authorization.
   2. Disclosures to Notify a Family Member, Friend, or Other Selected Person. We ask clients to provide us with an Emergency Contact person in case something should happen to you while you are at our facilities. Unless you tell us otherwise, we may disclose certain limited health information about you (your general condition, location, etc.) to your Emergency Contact or another available family member if, for example, you need to be admitted to the hospital.
   We may not disclose information about mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status without your specific Authorization UNLESS you voluntarily consent to participate in family or group treatment sessions with others present. Another exception to the requirement for specific Authorization for disclosure of such information is for a parent/guardian of a minor. Under the state Mental Health Procedures Act, a parent/guardian may attend a minor's treatment session without the minor's specific Authorization.
4. Other Uses and Disclosures Require Your Prior Written Authorization. In situations other than categories of uses and disclosures mentioned above, or disclosures permitted under federal law, we ask for your written Authorization before using or disclosing any protected health information. In addition, as we noted above, we need to ask for your specific written Authorization to disclose information concerning your mental health, drug and alcohol abuse and/or treatment, or to disclose your HIV status. If you choose to sign an Authorization to disclose any health information, you can later revoke it to stop further uses and disclosures so long as you revoke it in writing. We will honor your wishes and stop further uses and disclosures to the extent that we have not alreadty taken action while relying on the Authorization before you revoked it in writing.

What Rights Do I Have Concerning My Protected Health Information?

Answer: You have the following rights with respect to your protected health information:

1. The Right to Request Limits on Uses and Disclosures of Your Health Information. You have the right to ask us to limit how we use and disclose your health information. We will certainly consider your request, but you should know that we are not required to agree to it. If we do afree to your request, we will put the limits in writing and will abite by them, except in the case of an emergency. Please note that you are not permitted to limit the uses and disclosures that we are required or allowed by law to make.
2. The Right to Choose How We Send Health Information to You or How We Contact You. You have the right to ask that we contact you at an alternate address or telephone number (for example, sending information to your work address instead of your home address) or by alternate means (for example, by mail instead of telephone). We must agree to your request so long as we can easily do it.
3. The Right to See or to Get a Copy of Your Protected Health Information. In most cases, you have the right to look at or get a copy of your health information that we have in a Designated Record Set, but you must make the request in writing. We have designated record sets for Psychiatry Services, Psychotherapy Services, and Case Management Services. Depending on the Agency Program(s) in which you obtain services, your health information may be contained in one, two, or three distinct record sets. A request form is available at the reception desk. We will respond to you within one month (30 calendar days) after receiving your written request. If we do not have the health information that you are requesting, but we know who does, we will tell you how to get it. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial. In certain circumstances, you may have a right to appeal the decision.
   
   If you request a copy of any portion of your protected health information, we will charge you for reasonable expenses only as allowed by federal and/or state laws, for example, a copying fee on a per page basis and postage costs. We require that payment be made in full before we will provide the information to you. If you agree in advance, we may be able to provide you with a written summary, abstract, or an explanation of your records instead. There will be a charge for preparation of the summary, abstract, or explanation.
4. The Right to Receive a List of Certain Disclosures of Your Health Information That We Have Made. You have the right to get an Accounting (a list) of certain types of disclosures that we may have made of your health information. The Accounting will not include disclosures made more than six (6) years prior to your request.
   
   This list would not include:
   • uses or disclosures for treatment, payment or healthcare operations,
   • disclosures to you or with your written Authorization, or
   • disclosures to your family for notification purposes or due to involvement in your care or payment for your care.
   
   This list also would not include any disclosures made:
   • for national security purposes,
   • to corrections or law enforcement authorities if you were in custody at the time, or
   • prior to April 14, 2003.
   
   To make such a request, we require that you do so in writing. A request form is available at our reception desk. We will respond to you within two months (60 calendar days) after receiving your written request. The list you may receive will include: date of disclosure, person or organization that received the information (with their address, if available), brief description of information disclosed, and brief reason for the disclosure. We will provide such a list to you at no charge; but, if you make more than one request in the same calendar year, we will charge you a reasonable fee for each additional request that year.
5. The Right to Ask to Correct or Update Your Health Information. If you believe that there is a mistake in your health information or that a piece of important information is missing, you have a right to ask us to make an appropriate change to your information. You must make the request in writing, with the reason for your request, on a request form that is available at the reception desk. We will respond within two months (60 calendar days) after receiving your written request.
   
   If we approve your request, we will make the change to your health information, tell you when we have done so, and tell others who need to know about the change.
   
   If we deny your request, we will state in writing the reasons that your request was denied and explain your right to file a written "Statement of Disagreement" with our denial. If you do not wish to do so, you may ask that we include a copy of your request form, and our denial form, with all future disclosures of that health information. We may deny your request if the protected health information:
   1. is correct and complete;
   2. was not created by us;
   3. is not allowed to be disclosed to you; or,
   4. is not part of our records.
6. The Right to Get A Paper Copy of This Notice. If you have agreed to receive this Notice via E-mail, you will always have the right to request a paper copy of this Notice as well.

How Do I Ask Questions or Complain About This Organization's Privacy Practices?

Answer: If you have any questions about anything discussed in this Notice, about any of our privacy practices, or if you have any concerns or complaints, please contact our:

Privacy Officer
Family Service Association of Bucks County
4 Cornerstone Drive
Langhorne, PA 19047
Tel. (215) 757-6916


You also have the right to file a written complaint with the Secretary of the U.S. Department of Health and Human Services. We may not take any retaliatory action against you if you lodge any type of complaint.

When Does This Notice Take Effect?

Answer: This Notice takes effect April 14, 2003.

Board Approval Date: April 1, 2003



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