THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE REVIEW IT CAREFULLY.

Cathedral Home for Children (CHC) is required by law to maintain the privacy of protected health information, to provide individuals with notice of its legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We will require you to acknowledge receipt of this notice in writing.

We create records concerning your medical and/or mental health treatment, etc. to maintain a record to comply with certain legal requirements. Protected Health Information (PHI) is defined as individually identifiable information regarding a patient’s health care history; mental or physical condition; or matters related to treatment. Some examples of PHI may include, but are not limited to: date of birth and treatment, treatment records, enrollment and claims records, and other matters as provided by law. CHC is required by law to maintain the confidentiality of your PHI. CHC will receive, use, and disclose your PHI to provide care for you, to obtain payment for services provided to you, and as otherwise permitted or required by law. Any other disclosure of your PHI without your authorization is prohibited. We must follow the privacy practices described in this notice, but also comply with any stricter requirements under federal or state law which may apply.

EFFECTIVE DATE:

This notice became effective on February 28, 2004, and was amended on April 23, 2013, and will remain in effect until amended. We will abide by the most current privacy notice. In the event of an amendment, we will post the updated notice on our website and redistribute it to you within the time provided by law. You may request a copy of this notice anytime by contacting the address or phone number at the end of this notice. You should receive a copy of this notice at the time of enrollment as a CHC resident and upon your request.

Permitted Uses and Disclosures of Your PHI

We are permitted to use or disclose your PHI without your prior authorization under controlling law, including, but not necessarily limited to the purposes described below. Permitted uses and/or disclosures include uses and/or disclosures for purposes of health care treatment, payment of claims, and other health care operations. If your health benefit plan is sponsored by an employer or another party, we may provide PHI to your employer or that sponsor, as provided by law. Such uses and disclosures may include but are not limited to processing your claims, collecting enrollment information and premiums, reviewing the quality of care you received, customer service, resolving grievances, and sharing payment information with insurers.

FOR TREATMENT:

We may use your PHI to provide you with medical/mental health treatment or services. We may disclose your PHI to doctors, nurses, psychotherapists, or other professionals who are involved with or managing your care. Examples: Immunization records will be sent to schools, and other doctors’ offices upon request, and placed on the Wyoming Vaccine Registry. If you are receiving medical/mental health treatment at CHC, the professional providing treatment needs to be informed of therapy progress for medication management. Therapists must be informed of diagnoses and recommendations from the psychiatrist to develop the appropriate therapy plan. We may also share your PHI with other healthcare providers to aid in treating you.

FOR PAYMENT:

We may use and disclose your PHI information for payment purposes. Examples: You are treated at CHC for a medical issue. We need to give your health insurance carrier or other payor the information about the diagnosis and treatment you received so your health plan will pay us or repay you for services paid for. We may also tell your health insurance carrier about the treatment you may receive for approval or to determine if your plan will pay for the treatment.

FOR HEALTH CARE OPERATIONS:

We may also use and disclose your PHI for our healthcare operations. This may include measuring and improving quality, evaluating associate performance, conducting training programs, and obtaining the accreditation, certificates, licenses, and credentials we need to provide you with quality health care. Example: Our facility is being audited by an external agency (i.e. Title XIX). Certain portions of your medical/mental health information may be examined for quality control purposes.

ADDITIONAL USES AND DISCLOSURES:

We may use and disclose your PHI without your authorization for the following additional purposes:

We may disclose PHI to third parties that perform services for CHC regarding your care or related matters. These parties are required by law to sign a contract agreeing to protect the confidentiality of your PHI. These affiliates are required to implement privacy policies and procedures and comply with applicable federal and state law.

We are also permitted to use and/or disclose your PHI to comply with a valid authorization, to a personal representative, and to report victims of abuse, neglect, or domestic violence. You have a right to revoke any authorization you provide to us, but any disclosures made in reliance on the authorization prior to the revocation remain unaffected.

Other permitted uses and/or disclosures are for purposes of health oversight by government agencies, judicial, administrative, or other law enforcement purposes, information about decedents to coroners and medical examiners, certain research purposes, to avert a serious threat to health or safety, specialized government functions such as military and veterans activities, workers’ compensation purposes, and use in creating summary information that can no longer be traced to you. Additionally, with certain restrictions, we may be permitted to disclose your PHI for insurance underwriting purposes.

We are also permitted to incidentally use and/or disclose your PHI during the course of a permitted use and/or disclosure but must be kept to a minimum. We use administrative, technical, and physical safeguards to maintain the privacy of your PHI and must limit the use and/or disclosure of your PHI to the minimum amount necessary to accomplish the purpose of the use and/or disclosure.

As required by law; various state or federal statutes or rules may require us to release PHI.

Family/Friends Involved:

We are allowed to release protected health information to your close friends and/or family members who are directly involved in your care. These persons are allowed to receive protected health information concerning you unless you object. If you object, then you should inform us and we will then coordinate with you to determine what information can be disclosed and what steps are needed to assure your continued effective treatment and care.

Court orders, Judicial and Administrative Proceedings:

Under certain circumstances, we may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process. For example, we may share the PHI of an inmate or other person in lawful custody with a law enforcement official or correctional institution.

Public Health Activities:

We may disclose your PHI to public health or other authorities charged with preventing or controlling disease, injury, or disability, including child abuse or neglect, as required by law. We may disclose your PHI to persons subject to the jurisdiction of the Food and Drug Administration for the purpose of reporting adverse events associated with product defects or problems, to enable product recalls, repairs, or placements, to track products, or to conduct activities required by the Food and Drug Administration. For example, when authorized by law, we may also notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.

Victims of Abuse, Neglect, or Domestic Violence or Threats of Same:

We may disclose PHI to appropriate authorities if we have reason to believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. For example, we may share your PHI if it is necessary to prevent a serious threat to your health or safety or the health or safety of others.

Workers’ Compensation:

When authorized and necessary to comply with laws relating to workers’ compensation or other similar programs, we may disclose your PHI.

Health Oversight Activities:

We may disclose PHI to an agency providing health oversight or oversight activities authorized by law. Examples, are audits, civil, administrative, or criminal investigations or proceedings, inspections, licensure or disciplinary actions, or other authorized activities.

Law Enforcement:

Under certain circumstances, we may disclose your PHI to law enforcement officials. We may share certain PHI concerning a suspect, fugitive, material witness, crime victim, or missing person. Examples include reporting required by certain laws, complying with a legal process (e.g. subpoena or court order), reporting limited information concerning identification and location (e.g. missing person), reports regarding suspected victims of crimes, reporting death, crimes on our premises, or to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Personal Representative:

This is a person who, under applicable law, has the authority to represent you in making decisions related to your care (e.g., parents, guardians, etc.) Under the privacy laws, a personal representative has the same right to obtain protected health information as the person being treated.

Note: The use or disclosure of PHI is governed by state and federal law, and the situations set forth herein are meant to provide you examples of the general instances of where we may use or disclose your PHI without your authorization. Whether PHI will be used and disclosed will be considered under the circumstances at the time, in accordance with state and federal law in effect at the time.

PSYCHOTHERAPY NOTES:

Special rules relate to psychotherapy notes. Psychotherapy notes refer to notes recorded (in any medium) by a mental health professional documenting or analyzing the content of conversation during a private, group, joint, or family counseling session and are separated from the rest of the individual’s medical record. Psychotherapy notes exclude medication prescription and monitoring, session start and stop times, modalities and frequencies of treatment, results of clinical tests, and any summary of the following items: diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date. We create these notes pertaining to you for our personal use. Consequently, these notes may be of limited use to others, including you. You should understand that in certain circumstances we may decline to provide you your psychotherapy notes, as may be provided by law. Moreover, psychotherapy notes may not be disclosed without your written authorization except in certain limited circumstances.

PERMITTED USES OR DISCLOSURES FOR PSYCHOTHERAPY NOTES:

- Supervised mental health training programs for students, trainees, or practitioners;

- By CHC to defend legal action, complaint, investigation, or other proceeding brought by you or involving you;

- For legal and clinical oversight of the psychotherapist who made the notes; and/or

- To prevent or lessen a serious and imminent threat to the health or safety of you or the public.

YOU HAVE THE RIGHT TO:

You have the right to request an inspection of and obtain a copy of your PHI. You may access your PHI by contacting CHC in writing. You must include your name, address, telephone number and the PHI you are requesting. Note: we may charge you for labor costs, a per-page copying fee, and the cost of any media used to give you your PHI (compact discs or flash drives). These charges pertain to paper and microfilmed charts. We may also charge you for postage. Please contact us with questions about our fee structures.

You may not inspect or copy PHI compiled in reasonable anticipation of or use in, civil, criminal, or administrative action or proceeding, or PHI otherwise not subject to disclosure under federal or state law. In some circumstances, you may have a right to have this decision reviewed. Please contact the privacy office as noted below if you have questions about access to your PHI. We may deny your request to inspect and/or to receive a copy in certain limited circumstances. If you are denied access to mental health information, you may have the denial reviewed by another licensed healthcare professional chosen by us. We will comply with the outcome of the review.

You have the right to request a restriction of your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it unless the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law and the PHI pertains solely to a health care item or service for which you, or some person other than the health plan on behalf of you, has paid CHC in full. If we accept your request for a restriction, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.

You have the right to amend, correct, or update your PHI. You may request an amendment of your PHI for as long as we maintain this information. In certain cases we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy. If your PHI was sent to us by another, we may refer you to that person to amend your PHI. Please contact the privacy office as noted below if you have questions about amending your PHI.

You have the right to request or receive confidential communications from us by alternative means or at a different address. We will agree to a reasonable request if you tell us that disclosure of your PHI could endanger you. You may be required to provide us with a statement of possible danger, a different address, and a different method of contact or information as to how payment will be handled. Please make this request in writing to the privacy office as noted below. Reminder calls: We may contact the telephone number or e-mail address you have specified to remind you of an appointment at CHC.

You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI within certain time periods. This right does not apply to disclosures for purposes of treatment, payment, or health care operations or for information we disclosed after we received a valid authorization from you. Additionally, we do not need to account for disclosures made to you or family members or close friends involved in your care, or for notification purposes. We do not need to account for disclosures made for national security or intelligence reasons, for certain law enforcement or correctional purposes, disclosures made as part of a limited data set, incidental to a disclosure or use otherwise permitted by law, disclosures made prior to April 14, 2003, and for other disclosures as provided by law. Please contact us if you would like to receive an accounting of disclosures or if you have questions about this right.

You have the right to get his notice by e-mail. You have the right to get a copy of this notice by e-mail. You also have the right to request a paper copy of this notice.

You have a right to file a complaint. If, in your opinion, we have violated your privacy rights or if you object to a decision we have made about your PHI, you are entitled to file a written complaint with us at the address below or with the Secretary of the United States Department of Health and Human Services, 200 Independence Ave. S.W., Washington, D.C., 20201. We will not retaliate in any way if you choose to file a complaint.

Contact information:

If you have questions, want to request information about your PHI, exercise your rights with your PHI, or to file a complaint, contact the following:

HIPAA Compliance Officer

Cathedral Home

Phone: (307) 745-8997

Fax: (307) 742-6146