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This Notice is effective on April 14, 2003
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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
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WE ARE REQUIRED BY LAW TO PROTECT
MEDICAL INFORMATION ABOUT YOU.
We are required by law to protect the privacy of medical
information that is about you and that identifies you. This medical information may be information about health
care we provide to you or payment for health care provided to you. It may also be information about your past,
present, or future medical condition.
We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and
privacy practices with respect to medical information. We are legally required to follow the terms of this Notice.
We are only allowed to use and disclose medical information in the manner described within this Notice.
We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new
Notice effective for all medical information that we maintain. If we make changes to the Notice, we will:
Post the new Notice in our waiting area and on our website at www.jfcsjax.org.
The rest of this Notice will:
- Discuss how we may use and disclose medical information
about you
- Explain your rights with respect to medical information
about you
- Describe how and where you may file a privacy-related
complaint
If you have questions about information in this Notice
or about our privacy policies, procedures or practices, please contact our PRIVACY OFFICER at 904-394-5726.
WE MAY USE AND DISCLOSE MEDICAL INFORMATION
ABOUT YOU IN SEVERAL CIRCUMSTANCES
We use and disclose medical information about clients
everyday. This section of our Notice explains in some detail how we may use and disclose medical information about
you in order to provide health care, obtain payment for that health care, and operate our business efficiently.
This section then briefly mentions several other circumstances in which we may use or disclose medical information
about you. For more information about any of these uses or disclosures, or about any of our privacy policies, procedures
or practices, contact our Privacy Officer.
1. Treatment
We may use and disclose medical information about
you to provide health care treatment to you. In other words, we may use and disclose medical information about
you to provide, coordinate or manage your health care and related services. This may include communicating with
other health care providers regarding your treatment and coordinating and managing your health care with others.
Example: Jane is a client at a social service agency providing health and mental health services. The receptionist
may use medical information about Jane when setting up an appointment. The therapist will likely use medical information
about Jane when reviewing Jane's history and developing a treatment plan. If the determination is made to refer
Jan to another provider, the agency may disclose medical information about Jane to the new provider to assist them
in providing appropriate care to Jane.
2. Payment
We may use and disclose medical information about
you to obtain payment for health care services that you have received. This means that, within this agency, we
may use medical information about you to arrange for payment (such as preparing bills and managing accounts). We
also may disclose medical information about you to others (such as insurers, collection agencies, and consumer
reporting agencies). In some instances, we may disclose medical information about you to an insurance plan before
you receive certain health care services because, we may need to know whether the insurance plan will pay for a
particular service.
Example: Jane is a client at the social service agency and she has private insurance. The agency billing specialist
will use medical information about Jane when he/she prepares a bill for the services provided at the appointment.
Medical information about Jane will be disclosed to her insurance company when the billing clerk submits the bill.
3. Healthcare Operations
We may use and disclose medical information about
you in performing a variety of business activities that we call "health care operations." These "health care operations"activities
allow us to, for example, improve the quality of care we provide and reduce health care costs. For example, we
may use or disclose medical information about you in performing the following activities:
- Reviewing and evaluating the skills, qualifications,
and performance of health care providers taking care of you.
- Providing training programs for students, interns, health
care providers or non-health care professionals to help them practice or improve their skills.
- Cooperating with outside organizations that evaluate,
certify or license health care providers, staff or facilities in a particular field or specialty.
- Reviewing and improving the quality, efficiency and
cost of care that we provide to you and our other clients.
- Improving health care and lowering costs for groups
of people who have similar health problems and helping manage and coordinate the care for these groups of people.
- Cooperating with outside organizations that assess the
quality of the care others and we provide, including government agencies and private organizations.
- Planning for our organization's future operations.
- Resolving grievances within our organization.
- Reviewing our activities and using or disclosing medical
information in the event that control of our organization significantly changes.
- Working with others (such as lawyers, accountants and
other providers) who assist us to comply with this Notice and other applicable laws.
Example: Jane was diagnosed with depression. The agency
used Jane's medical information -as well as medical information from all of the other clients diagnosed with depression
- to develop an educational program to help people recognize the early symptoms of depression. (Note: The educational
program would not identify specific clients without their permission).
4. Persons Involved in Your Care
We may disclose medical information about you
to a relative, close personal friend or any other person you identify if that person is involved in your care and
the information is relevant to your care. If the client is a minor, we may disclose medical information about the
minor to a parent, guardian or other person responsible for the minor except in limited circumstances.
We may also use or disclose medical information about you to a relative, another person involved in your care or
possibly a disaster relief organization (such as the Red Cross) if we need to notify someone about your location
or condition.
You may ask us at any time not to disclose medical information about you to persons involved in your care. We will
agree to your request and not disclose the information except in certain circumstances (such as emergencies) or
if the patient is a minor. If the patient is a minor, we may or may not be able to agree to your request.
Example: Jane's husband regularly comes to the agency with Jane for her appointments and attends therapy sessions
from time to time. When the therapist is discussing a new treatment strategy with Jane, Jane invites her husband
to come into the private room. The therapist discusses treatment with Jane and Jane's husband.
5. Required by Law
We will use and disclose medical information
about you whenever we are required by law to do so. There are many state and federal laws that require us to use
and disclose medical information. For example, state law requires us to report known or suspected child abuse or
neglect to the Abuse Hotline. We will comply with those state laws and with all other applicable laws.
6. National Priority Uses and Disclosures
When permitted by law, we may use or disclose
medical information about you without your permission for various activities recognized as "national priorities."The
government has determined that under certain circumstances, it is so important to disclose medical information
that it is acceptable to disclose medical information without the individual's permission. We will only disclose
medical information about you in the following circumstances when we are permitted to do so by law. Below are brief
descriptions of "national priority"activities recognized by law.
- Threat to health or safety: We may use or disclose
medical information about you if we believe it is necessary to prevent or lessen a serious threat to health or
safety.
- Public health activities: We may use or disclose
medical information about you for public health activities. Public health activities require the use of medical
information for various activities, including, but not limited to, activities related to investigating diseases,
reporting child abuse and neglect, monitoring drugs or devices regulated by the Food and Drug Administration, and
monitoring work-related illnesses or injuries. For example, if you have been exposed to a communicable disease
(such as a sexually transmitted disease), we may report it to the State and take other actions to prevent the spread
of the disease.
- Abuse, neglect or domestic violence: We may disclose
medical information about you to a government authority (such as the Abuse Hotline) if you are an adult and we
reasonably believe that you may be a victim of abuse, neglect or domestic violence.
- Health oversight activities: We may disclose
medical information about you to a health oversight agency -an agency responsible for overseeing the health care
system or certain government programs. For example, a government agency may request information from us while investigating
possible insurance fraud.
- Court proceedings: We may disclose medical information
about you to a court or officer of the court (such as an attorney). For example, we would disclose medical information
about you to a court if a judge orders us to do so.
- Law enforcement: We may disclose medical information
about you to a law enforcement official for specific law enforcement purposes. For example, we may disclose limited
medical information about you to a police officer if the officer needs the information to help find or identify
a missing person.
- Coroners and others: We may disclose medical
information about you to a coroner, medical examiner, or funeral director or to organizations that help with organ,
eye and tissue transplants.
- Workers'compensation: We may disclose medical information
about you in order to comply with workers'compensation laws.
- Research organizations: We may use or disclose
medical information about you to research organizations if the organization has satisfied certain conditions about
protecting the privacy of medical information.
- Certain government functions: We may use or disclose
medical information about you for certain government functions, including, but not limited to, military and veterans'activities,
national security and intelligence activities. We may use or disclose medical information about you to a correctional
institution in certain circumstances.
7. Authorization
Other than the uses and disclosures described
above in Section #1-6, we will not use or disclose medical information about you without the "authorization"-or
signed permission -of you or your personal representative. In some instances, we may wish to use or disclose medical
information about you and we may contact you to ask you to sign an authorization form. In other instances, you
may contact us to ask us to disclose medical information and we will ask you to sign an authorization form.
If you sign a written authorization allowing us to disclose medical information about you, you may later revoke
(or cancel) your authorization in writing (except in very limited circumstances related to obtaining insurance
coverage). If you would like to revoke your authorization, you may write us a letter revoking your authorization
or fill out an Authorization Revocation Form, available from our Privacy Officer. If you revoke your authorization,
we will follow your instructions except to the extent that we have already relied upon your authorization and taken
action.
_________________________________________________________
YOU HAVE RIGHTS WITH RESPECT TO
MEDICAL INFORMATION ABOUT YOU
This section of the Notice will discuss these rights.
For more information, please contact our Privacy Officer.
1. Right to a Copy of This Notice
You have a right to have a paper copy of our
Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be posted in our waiting
area. If you would like to have a copy of our Notice, ask the receptionist for a copy or contact our Privacy Officer.
2. Right of Access to Inspect and Copy
You have the right to inspect (see or review)
and receive a copy of medical information about you that we maintain in certain limited groups of records (designated
record set). If you would like to inspect or receive a copy of medical information about you, you must provide
us with a request in writing. You may write us a letter requesting access or fill out an Access Request Form, available
from our Privacy Officer.
We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing
so in writing. We will inform you in writing if you have the right to have our decision reviewed by another person.
If you would like a copy of the information, we will charge you a fee to cover the costs of the copy. Due to the
overhead costs (labor, review of records, cost of equipment and supplies) involved in reproducing and/or sending
copies of records to outside parties, a fee of $5.00 will be charged for this service. This fee will be waived
in circumstances involving a court order or request from a Guardian Ad Litem.
We may be able to provide you with a summary or explanation of the information. Contact our Privacy Officer for
more information on these services and any possible additional fees.
3. Right to Have Medical Information Amended
You have the right to have us amend (which means
correct or supplement) medical information about you that we maintain in certain groups of records. If you believe
that we have information that is either inaccurate or incomplete, we may amend the information to indicate the
problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to
amend information, you must provide us with a request in writing and explain why you would like us to amend the
information. You may either write us a letter requesting an amendment or fill out an Amendment Request Form, available
from our Privacy Officer.
We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing
so in writing. You will have the opportunity to send us a statement explaining why you disagree with our decision
to deny your amendment request and we will share your statement when we disclose the information in the future.
4. Right to an Accounting of Disclosures We Have
Made
You have the right to receive an accounting (which means
a detailed listing) of disclosures that we have made for the previous six (6) years. If you would like to receive
an accounting, you may send us a letter requesting an accounting or fill out an Accounting Request Form, available
from our Privacy Officer.
The accounting will not include several types of disclosures, including disclosures for treatment, payment or health
care operations. It will also not include disclosures made prior to April 14, 2003. If you request an accounting
more than once every twelve (12) months, we will charge you a fee of $5.00 to cover preparation costs.
5. Right to Request Restrictions on Uses and Disclosures
You have the right to request that we limit the
use and disclosure of medical information about you for treatment, payment and health care operations. We are not
required to agree to your request.
If we agree to your request, we must follow your restrictions (except if the information is necessary for emergency
treatment). You may cancel the restrictions at any time. We may cancel a restriction at any time as long as we
notify you of the cancellation and continue to apply the restriction to information collected before the cancellation.
6. Right to Request an Alternative Method of Contact
You have the right to request to be contacted
at a different location or by a different method. For example, you may prefer to have all written information mailed
to your work address rather than to your home address.
We will agree to any reasonable request for alternative methods of contact. If you would like to request an alternative
method of contact, you must provide us with a request in writing. You may write us a letter or fill out an Alternative
Contact Request Form, available from our Privacy Officer.
YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY
PRACTICES
If you believe that your privacy rights have been violated
or if you are dissatisfied with our privacy policies or procedures, you may file a complaint either with us or
with the federal government. We will not take any action against you or change our treatment of you in any way
if you file a complaint.
To file a written complaint with Jewish Family &
Community Services, bring your complaint to our office or mail it to:
Jewish Family & Community Services
Attention: Privacy Officer
6261 Dupont Station Court, East
Jacksonville, FL 32217
To file a written complaint with the federal government,
send your complaint to:
Region IV, Office for Civil Rights
U.S. Dept. of Health & Human Services
Atlanta Federal Center, Suite 3B70
61 Forsyth Street, S.W.
Atlanta, GA30303-8909
Contact us now
Explore our many services. Then call us at 904-448-1933
or visit JFCS for a confidential, no-obligation consultation.
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Contact Robin Peters at
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