Our Privacy Practices Notice

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT CRISIS CENTER CLIENTS MAY BE USED AND DISCLOSED AND HOW TO CLIENTS MAY OBTAIN ACCESS TO THEIR INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

Introduction

At the Crisis Center, we are committed to utilizing responsible practices with your confidential information. This Notice of Privacy Practices describes the information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective 11/1/09 and replaces earlier issued notices and applies to all protected health information as defined by federal regulations.

Understanding Your Confidential Record/Information

Each time you visit the Crisis Center, a record of your visit is made. Typically, this record contains information about the services you are requesting and the assistance we gave you. This information, often referred to as your client record, serves as a:

• Basis for the services you receive
• Means of communication among other service providers if applicable.
• Legal document describing the care you received
• A source of information for our funders and contractors.
• A source of data for our planning and marketing
• A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how the information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your information, and make more informed decisions when authorizing disclosure to others.

Your Confidential Information Rights

Although your confidential record is the physical property of the Crisis Center, the information belongs to you. You have the right to:

• Obtain a paper copy of this NOTICE OF CONFIDENTIAL PRACTICES upon request,
• Inspect and copy your client record as provided for in 45 CFR 164.524,
• Amend your client record as provided in 45 CFR 164.528,
• Obtain an accounting of non-routine disclosures of your confidential information as provided in 45 CFR 164.528,
• Request communications of your confidential information by alternative means or at alternative locations,
• Request a restriction on certain uses and disclosures of your confidential information as provided by 45 CFR 164.522, and
• Revoke your authorization to use or disclose confidential information except to the extent that action has already been taken.

Our Responsibilities

The Crisis Center is required to:

• Maintain the privacy of your confidential information
• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• Abide by the terms of this notice
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
• Maintain a list of non-routine disclosures about your health information

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, you may request a copy of the updated notice.

We will not use or disclose your confidential information without your authorization, except as described in this notice. We will also discontinue to use or disclose your confidential information after we have received a written revocation of the authorization according to the procedures included in the authorization.

For More Information or to Report a Problem

If have questions and would like additional information, you may contact the Executive Director, Becci Reedus at 319-351-2726 or becci.reedus@jccrisiscenter.org.

If you believe your privacy rights have been violated, you can file a complaint with the Crisis Center, or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Crisis Center or the Office for Civil Rights. The address for the OCR is listed below:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201

Examples of Disclosures

We will use your confidential information in order to provide crisis intervention services and referrals.

We may use your information for payment of services.

We will use your confidential information for improvement of our operations.

Business associates: There are some services provided in our organization through contacts with business associates. Examples include funding organizations, ambulance companies, billing support services, pharmaceutical services. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Communication with family: Professional staff, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify and authorize, health information relevant to that person’s involvement in services we’ve provided.ted to your care.

Research: We may disclose information to researchers when their research has been approved by the Executive Director that has reviewed the research proposal and established protocols to ensure the privacy of your confidential information.

Funeral directors: We may disclose confidential information to funeral directors consistent with applicable law to carry out their duties.

Marketing: We may periodically contact you to provide you benefits or services that may of interest to you.

Fund raising: We may contact you as part of a fund-raising effort.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

Notice of Privacy Policies Revision Number 060203