This notice describes how health and service information about you/your child may be used and disclosed and how you can get access to this information. Please read and review it carefully.

Protected Health Information (PHI) means individually identifiable information about your past, present, or future physical/mental health or condition, the provision of your health care, or payment for your health care services.

Our Privacy Commitment to You

We care about your privacy.  The information we collect about you/your child is private. We are required to give you a notice of our privacy practices.  Only people who have both the need and the legal right may see your information.  Unless you give us permission in writing, we will only disclose information for purposes of treatment, payment, business operations or when we are required to do so by law.

Treatment

We will use/disclose your/your child’s PHI to coordinate and manage your/your child’s treatment services.  For example, to clinicians and other staff, volunteers, and other service delivery personnel who are involved in providing and coordinating your treatment services.

Payment

We may use/disclose your/your child’s PHI, so the care you/your child receives can be properly billed.  For example, to Medicaid or a state or private insurance plan, to determine eligibility or coverage, to ensure appropriateness of your care, or to justify the charges for your care.

Business Operations

We may need to use/disclose information about your/your child’s PHI in the course of operating our agency.  Examples of such releases would be quality assessment and improvement, reviewing the performance or qualification of our clinicians, licensing, accreditation, and general administrative activities.

Your Right to Receive Confidential Communications

Unless you provide us with alternative instructions, we may send appointment reminders, treatment/service information, and other similar materials to your home.

Fundraising

We may contact you to participate in fundraising activities for The Children’s Center.

Exceptions

For certain kinds of records, your permission may be needed even for the release of information for treatment, payment, and business operations.

Your Privacy Rights

You have the following rights regarding the health/treatment information that we have about you/your child:

Your Right to Inspect and Copy

You have the right to inspect and copy your protected health information.  You may be charged a small fee.  We require requests to inspect/copy PHI to be submitted in writing.  We will respond within 30 days of receiving the request.

Your Right to Amend

You have the right to amend or submit corrections to your protected health information.  We will respond within 60 days of receiving the request.

Your Right to Request Restrictions on the Use of Disclosures

You have the right to ask that we limit how we use or disclose your PHI.  We will consider your request, but are not legally bound to agree to the restriction.

Your Right to a List of Disclosures

You have the right to get a list of your PHI that has been released other than instances of disclosures for which you gave consent.

Uses and Disclosures Not Requiring Consent or Authorization>

As required by law we will release information when we are required to do so.  Examples of such releases would be for law enforcement, national security, government purposes, subpoenas or other court orders, communicable disease reporting, suspected abuse and neglect and criminal activity investigations, inspections of unusual incidents, audits, approved research activity, worker’s compensation, and review of our activities by government agencies to avert a serious threat to health or safety.

With Your Permission

If you give us permission in writing, we may use/disclose your/your child’s PHI.  If you give us permission, you have the right to revoke the disclosure at any time in writing.  We cannot take back any uses or disclosures already made with your permission.

Changes to the Notice

We are required by law to comply with changes in HIPAA, therefore we reserve the right to revise this notice as needed.  If we do so, we will post a revised notice at the receptionist desk.

How to Use Your Rights Under This Notice

If you believe your/your child’s privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. 

Office of Civil Rights
Department of Health and Human Services

200 Independence Ave. SW, Washington, D.C. 20201

Phone:  886-627-7748    TTY:  886-788-4989

ocrprivacy@hhs.gov

 

To file a complaint or if you have questions, contact:

Demereal Owens, Privacy Officer

79 W. Alexandrine, Detroit, MI  48201

313-831-5535     dowens@childrensctr.net

 

There will be no retaliation for filing a complaint.