Privacy Notice

Your records and personal information are protected under federal regulations governing the privacy, confidentiality and security of personal health information (42 CFR, Part 2, and 45 CFR Parts 160 and 164).  This means that the program may not say to a person outside of the program that you attend the program or receive services.  And we cannot share information about you in any way, except when:

• You consent (agree to allow us to) in writing,
• The disclosure (giving the information) is allowed by a court order;
• The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation,
• The disclosure is made about a crime committed at the program or against any person who works for the program or about any threat to commit such a crime.
• The disclosure is about suspected child abuse or neglect.

When you sign the "Fee Agreement" form, you are asked to consent, or give us permission to provide information for the purposes of billing, payment, treatment, or routine business operations.  Examples of these activities are: providing the date and type of service to your insurance company so we can be paid for the service, or sometimes staff members review client information to be sure that people are receiving services that meet their needs. You must give us permission (or "authorization") to disclose your information for all other reasons, and that permission must be given in writing.  We use special forms for that purpose.  Violation of the Federal law and regulations by the program is a crime.  Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.  You have the following rights to:

• Request a restriction on certain uses or disclosures of your personal information.  We may not agree to your requested restrictions under certain circumstances
• Request how and where we contact you about personal health information (e.g., home, work, email)
• See and copy your client record unless the program director recommends otherwise,
• Request an amendment (to correct information in your records)
• Request a list (or "accounting") of disclosures we have made.  (Exceptions include disclosures prior to April 14, 2003, disclosures for your treatment, billing, and those that you authorize.)

Any requests you wish to make about these rights, or if you want more information on how to exercise these rights, ask to speak to the "rights advisor," or Program Supervisor at this office.

Catholic Human Services is required by federal and state laws to protect the privacy, security and confidentiality of your personal information.  We are also required to provide you with this notice of our legal duties and privacy policies.  We are required to follow the laws and duties outlined in this notice.  We may revise our privacy practices, change the terms of this notice, and to make new notice provisions for all personal information we maintain.  We will provide you with updated information about any changes.

Effective April 3, 2003