THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.
SCOPE OF THIS NOTICE
This Notice of Privacy Practices does not apply to information related to the following: adoption services or adoption records; foster parent information; or educational records, including educational information received or created by DePelchin during the course of treatment.
WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI).
DePelchin Children’s Center and its affiliated companies (collectively, “DePelchin”, “we” or “us”) are committed to providing services designed to meet your needs. We are equally committed to respecting your privacy and protecting the information about you that we may receive. We have prepared this notice to advise you what information we collect, how we use it and how we protect it. For the purposes of this notice, the term “you” refers to the person receiving services at DePelchin.
We are legally required to protect the privacy of your health information. We call this information “protected health information,” or “PHI” for short, and it includes information that can be used to identify you that we’ve created or received about your past, present or future health or condition, the provision of health care to you, or the payment of this health care. We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. Generally, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice. However, we reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice in DePelchin’s reception areas.
If you have any questions about this Notice, please contact our Privacy Officer at (713)802-3809
4950 Memorial Drive
Houston, Texas 77007
As an essential part of our business, we obtain certain personal information about you in order to provide a service to you. Some of the information we receive comes directly from you or on applications or other forms, and may include information you provide during visits to our web site or while speaking with our staff. We may also receive information from physicians, schools and other health providers or government agencies. The types of information we receive may include addresses, social security number, family information, current and past clinical history and financial information.
We protect your PHI from unauthorized access. Our staff receives training regarding our privacy policies, and access to your PHI is restricted to those individuals that need your PHI in order to provide services to you. Examples of activities requiring access to personal information include: insurance claims processing; scheduling appointments; and coordinating with other care providers. Finally, we employ secure technologies in order to safeguard transmission of your PHI electronically, and we have established and maintain procedures to comply with all state and federal laws and regulations regarding the security of personal information. Please note: If you participate in virtual visits, your PHI may be inadvertently shared if you are in an area where others can hear your visits. DePelchin maintains the same level of privacy as if you were in our office during virtual visits.
OUR PLEDGE REGARDING PHI:
We understand that your PHI is personal. We are committed to protecting your PHI. We create a record when services are delivered by our professional staff. We need this record to provide you with quality care and to comply with certain legal requirements licensing and accreditation. This notice applies to all of the records of your care generated by the staff.
This notice will tell you about the ways in which we may use and disclose PHI about you. We also describe your rights and certain obligations we have regarding the use and disclosure of PHI.
We are required by law to:
HOW WE MAY USE AND DISCLOSE YOUR INFORMATION.
The following categories describe different ways that we use and disclose PHI. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose your PHI will fall within one of the categories. We may use and disclose your PHI without your authorization for the following reasons.
For Treatment. We may use your PHI to provide you with clinical treatment or services. We may disclose your PHI to doctors, nurses, clinical students, or other persons who are involved in providing services to you, including family members or government agencies involved in your continued care. Your PHI may be shared internally in order to coordinate services across programs or for prescriptions.
For Payment. We may use and disclose your PHI so that the treatment and services you receive at DePelchin may be billed to and payment may be collected from you, an insurance company, or a third-party resource. For example, we may need to provide information about past or planned treatment to your health plan to obtain authorization or payment for expected and served services.
For DePelchin Operations. We may use and disclose your PHI for our operations. These uses and disclosures are necessary to run DePelchin and make sure that all of our clients receive quality care. For example, we may use client information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine client information about many clients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, school professions, and other similar personnel for review and learning purposes. We may remove information that identifies you and other clients in order to determine how we are doing compared to similar companies in order to make improvements in the care and services we offer.
Appointment Reminders. We may use and disclose your PHI to contact you as a reminder that you have an appointment.
Treatment Alternatives or Related Benefits. We may use and disclose your PHI to tell you about benefits or services that may be of interest to you, or to recommend possible treatment options or alternatives, including appropriate referrals.
Fundraising Activities. We may use your PHI about you to contact you in an effort to raise money for DePelchin and its operations. We only would release contact information, such as your name, address and phone number and the dates you received services. If you do not want to be contacted for fundraising efforts, you must notify Fund Development in writing by sending a letter to Fund Development at 4950 Memorial, Houston, TX 77007.
Individuals Involved in Your Care or Payment for Your Care. We may release your PHI to a friend or family member who is involved in your care or who helps pay for your care, unless you object in whole or in part. In addition, we may disclose your PHI to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research. Under certain circumstances, we may use and disclose your PHI for research purposes. For example, a research project may involve comparing the outcome of a class. All research projects, however, are subject to a special approval process that balances the research needs with the need for your privacy. We may disclose your PHI to people preparing to conduct a research project, for example, to help them look for clients with specific characteristics prior to the approval process.
As Required By Law. We will disclose your PHI when required to do so by federal, state or local law. For example, we make disclosures when a law requires that we report information about victims of abuse, neglect, or domestic violence. . We may also disclose your PHI when requested through a subpoena, or ordered in a judicial or administrative proceeding.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent, or lessen the threat.
Military and Veterans. If you are a member of the armed forces, we may release your PHI as required by military command authorities.
Workers’ Compensation. We may release your PHI for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your PHI for public health activities. These activities generally include the following:
Health Oversight Activities. We may disclose your PHI to an oversight agency such as a government agency for activities authorized by law or required pursuant to an agreement and/or contract. These oversight activities include: audits, investigations, inspections, and licensure. These activities are necessary for oversight agencies to monitor our compliance with the law. .
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. We will inform you of the request in advance of the disclosure when possible or required.
Law Enforcement. We may release your PHI if asked to do so by a law enforcement official:
National Security Activities. We may release your PHI to authorized federal officials for national security activities authorized by law.
YOUR RIGHTS REGARDING INFORMATION ABOUT YOU
You have the following rights regarding your PHI:
Right to Inspect and Copy. In most cases, you have the right to inspect and copy your PHI that we have, but you must make the request in writing. To inspect and copy PHI that we have, you must submit your request in writing to the Custodian of Records. If you request a copy of your PHI, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. If we don’t have your PHI, we will inform you.
In certain situations, we may deny your request to inspect and copy your PHI. If you are denied access to your PHI, you may request that the denial be reviewed. A professional chosen by us will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Please note: PHI that is contained in psychotherapy notes or created for legal proceedings will not be provided and a denial of such a request may not be appealed.
Right to Amend. If you believe that PHI we have about you is incorrect or incomplete, you may ask us to correct or add to the missing information. You have the right to request an amendment for as long as the information is kept by us. To request an amendment, your request must be made in writing and submitted to Custodian of Records, with information as to why the record needs to be amended, or the request may be denied.
We will respond within 60 days of receiving your request. We may deny your request if you ask us to amend information that:
Our written request will state the reasons for the denial and explain your rights to file a written statement of disagreement with the denial, as well as other rights you have, such as your right to request that your amendment request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, and inform you as well as others who need to know about the change to your PHI.
Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or our operations. You also have the right to request a limit on the information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. Note to parents: A minor child may request that certain information not be disclosed to any person, including parents, which is within their right and consistent with the acceptable standards of clinical practice DePelchin providers.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to Custodian of Records. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.
Right to Request Confidential Communications. You have the right to request that we communicate with you about clinical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work rather than at home or by e-mail instead of regular mail.
To request confidential communications, you must make your request, in writing, to the Custodian of Records. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. We must agree to your request so long as we can easily provide it in the format you requested.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. You may obtain a copy of this notice at our website, depelchin.org.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Office of Civil Rights. To file a complaint with us, contact Privacy Officer at (713)802-3809. You may also send a written complaint to the Office of Civil Rights either online or via mail at:.
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
OTHER USES OF YOUR PHI
Other uses and disclosures of your PHI not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose your PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose iyour PHI for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
Please note: While the information belongs to you, the record belongs to DePelchin Children’s Center. The information will be protected as stated in our Notice of Privacy Practices. We will retain the record under our possession for at least the number of years determined by State and Federal regulatory guidelines. Copies or transfer of the documentation within the record may be subject to fee.