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HIPAA FORMS Service Privacy 

Effective: 04/03

Revised: 10/18/21

Under the Health Insurance Portability and Accountability Act of 1996 [HIPAA], the Center for Family and Child Enrichment is required to maintain the privacy of your protected health information and provide you with notice of our legal duties and privacy practices with respect to such protected health information.

HOW CENTER FOR FAMILY AND CHILD ENRICHMENT MAY USE OR DISCLOSE YOUR HEALTH INFORMATION

The following describes the purposes for which the Center for Family and Child Enrichment is permitted or required by law to use or disclose your health information without your consent or authorization. Any other uses or disclosures will be made only with your written authorization and you may revoke such authorization in writing at any time.

 

TREATMENT

The Center for Family and Child Enrichment may use client health information for the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party.

PAYMENT

The Center for Family and Child Enrichment may use client health information to obtain reimbursement for the provision of health care. An example or payment would include, but is not limited to, obtaining third-party reimbursement, the determination or eligibility or coverage (including coordination or benefits or the determination or cost-sharing documents amounts), and adjudication or subrogation of health benefit claims.

BEHAVIORAL HEALTH OPERATIONS

The Center for Family and Child Enrichment may use client behavioral health information for the following operations 1) conducting quality assessment and improvement activities, including outcome evaluation and development of clinical guidelines, 2) case management and care coordination, and 3) business related matters such as administrative services.

SPECIAL SITUATIONS

As Required by Law.  We will disclose health information when required to do so by international, federal, state or local law.

To Avert a Serious Threat to Health or Safety.  We may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Disclosures, however, will be made only to someone who may be able to help prevent the threat.

Business Associates. There may be instances where services are provided to the Center for Family and Child Enrichment through contacts with third party business associates. Whenever a business associate arrangement involves the use or disclosure of your health information, the Center for Family and Child Enrichment will have a written contract that requires the business associate to maintain the highest standards of safeguarding your privacy that we require of all our employees and affiliates.

 

Organ and Tissue Donation.  If you are an organ donor, we may use or release health information to organizations that handle organ procurement or other entities engaged in procurement, banking or transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and transplantation.

 

Military and Veterans.  If you are a member of the armed forces, we may release health information as required by military command authorities.  We also may release health information to the appropriate foreign military authority if you are a member of a foreign military.

 

Workers’ Compensation.  We may release health information for workers’ compensation or similar programs.  These programs provided benefits for work-related injuries or illness.

Public Health Risks.  We may disclose health information for public health activities.  These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.  We will only make this disclosure if you agree or when required or authorized by law.

 

Health Oversight Activities.  We may disclose health information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

 

Data Breach Notification Purposes.  We may use or disclose your protected health information to provide legally required notices of unauthorized access to or disclosure of your health information.

 

Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose health information in response to a court or administrative order.  We also may disclose health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement.  We may release health information if asked by a law enforcement official if the information is: (1) in response to a court order,  subpoena, warrant, summons or similar process; (2) limited information to identity or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors.  We may release health information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We also may release health information to funeral directors as necessary for their duties.

 

National Security and Intelligence Activities.  We may release health information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.

 

Protective Services for the President and Others.  We may disclose health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or to conduct special investigations.


Inmates or Individuals in Custody.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information to the correctional institution or law enforcement official.  This release would be if necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) the safety and security of the correctional institution.

BUSINESS ASSOCIATES

There may be instances where services are provided to the Center for Family and Child Enrichment through contacts with third party business associates. Whenever a business associate arrangement involves the use or disclosure of client health information, the Center for Family and Child Enrichment will have a written contract that requires the business associate to maintain the highest standards of safeguarding client privacy that Center for Family and Child Enrichment requires of all its employees and affiliates. Business Associates will implement reasonable and appropriate safeguards to protect the confidentiality, integrity, and availability of the PHI that the provider creates, receives, maintains or transmits. Business Associates are required to timely report improper use of disclosures and data breaches.

 

CLIENT RIGHTS REGARDING CLIENT HEALTH INFORMATION 

The following describes client rights under HIPAA regarding the health information we maintain about you.

RIGHT TO INSPECT AND COPY

You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes.  To inspect and copy this Health Information, you must make your request, in writing to CFCE’s Records Custodian.  We have up to thirty (30) days to make your PHI available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request.  We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program.  We may deny your request in certain limited circumstances.  If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.

RIGHT TO AN ELECTRONIC COPY OF ELECTRONIC MEDICAL RECORDS

If your PHI is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity.  We will make every effort to provide access to your PHI in the form or format you request, if it is readily producible in such form or format.  If the PHI is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form.  We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.

RIGHT TO REQUEST RESTRICTIONS

Clients have the right to request that the Center for Family and Child Enrichment restrict uses of disclosures of client health information to carry out treatment, payment, health care operations and business associates. Center for Family and Child Enrichment is not required to agree to a restriction.

RIGHT TO AMEND

Clients have the right to request an amendment to their health information for as long as the Center for Family and Child Enrichment maintains such information. Client written request must include the reason or reasons that support their request. The Center for Family and Child Enrichment may deny any request for an amendment if the Center for Family and Child Enrichment determines that the record that is the subject of the request was not created by the Center for Family and Child Enrichment and is not available for inspection as specified by law, or is accurate and complete.

RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATIONS

Clients have the right to receive confidential communications of protected healthcare information including the right to request it be provided through alternative mean.  Clients must contact the Executive Director in writing at 1825 NW 167th Street, Suite 102, Miami, FL  33056 with their request to receive their protected health care information in an alternate form than paper copies.

RIGHT TO RECEIVE AN ACCOUNTING OF DISCLOSURES

Clients may have the right to receive an accounting of disclosures of your health information made by the Center for Family and Child Enrichment in the six years prior to the date the accounting is requested. This does not include disclosures made to carry out treatment, payment and health care options. A reasonable, cost-fee shall be imposed for each request.

CLIENTS WHO BELIEVE THEIR PRIVACY RIGHTS HAVE BEEN VIOLATED MAY FILE A WRITTEN COMPLAINT WITH:

Center for Family and Child Enrichment, 1825 N.W. 167th Street, Suite 102, Miami, FL 33056,

Attn: Executive Director, Secretary of Health and Human Services, Washington, D.C.

 

RIGHT TO BE PROTECTED AGAINST RETALIATION UNDER WHISTLEBLOWER ACT

Clients and employees are free to file a complaint without fear of retaliation of any kind. In accordance with subsection 112.3187(2), F.S., CFCE, its contractors and subcontractors may not retaliate against an employee for reporting violations of law, rule, or regulation that create substantial and specific danger to the public’s health, safety, or welfare to an appropriate agency, nor against any person who discloses information to an appropriate agency alleging improper use of governmental office, gross waste of funds, or any other abuse or gross neglect of duty on the part of an agency, public officer, or employee.  Complaints alleging violations of the Whistleblower Act may be filed with the following offices:

 

Office of the Chief Inspector General

Agency Inspector General

Florida Commission on Human Relations

Whistleblower’s Hotline Number: 1-800-543-5353

CFCE reserves the right to change its privacy practices and make the changes effective for all existing PHI.  Any changes will be posted on the organization’s website. 

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