Community Services Board

Chesterfield Community Services Board Privacy Notice

This notice describes how medical and service information about you may be used and disclosed and how you can get acces to this information. Please review it carefully

YOUR PRIVACY IS IMPORTANT

Chesterfield Community Services Board understands your privacy is important. We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this notice. We will handle this information only as allowed by federal/state law and agency policy, adhering to the most stringent law that protects your health information.

If at any time you believe your privacy rights have been violated, you may verbally or in writing contact:

• Agency’s Privacy Officer
• State Advocate
• Secretary of Health and Human Services of the Federal government

An address and phone number to use is listed at the end of this notice. You will not suffer any change in services or retaliation for filing a complaint.

Each time you receive services from us, the provider makes a record of the visit. Typically, this record contains your assessment, service plan, progress notes, diagnoses, treatment and plan for future care or treatment.

Your rights are defined under Federal laws (sustance abuse is 42 CFR and HIPPA Privacy Standards 45 CFR Parts 160 and 164) as well as under The Commonwealth of Virginia's Administrative Code, Title 12, sections 35-155-80 and 35-115-90 (Human Rights).

There are several rights concerning your protected health information that we want you to be aware of:

• You have the right to inspect or to request copies of your medical records (a fee may be charged). This process will be kept confidential. This right is not absolute. In certain situations, such as if access would cause harm, we can deny access. You must make this request in writing to your Primary Service Coordinator or Medical Records Supervisor. If denied access, you will receive a timely, written notice of the decision and reason, and a copy of this notice becomes a part of your record, you will be given an opportunity to appeal a decision to deny your access.
• You have the right to request amendment of your medical records if you believe information in the records is inaccurate or incomplete. You must make this request in writing to your Primary Service
  Coordinator or Medical Records Supervisor. We may deny the request for proper reasons but you will be provided with a written explanation of the denial.
• You have the right to receive an accounting of the agency’s disclosures of your protected health information that were not for the purpose of treatment, payment, health care operations, or that were not otherwise authorized by you. You also have the right to be given the names of anyone, other than employees of the agency, who received information about you from the agency.
• You have the right to request from your Primary Service Coordinator or Medical Records Supervisor a restriction with regards to the use or disclosure of your protected health information. This request will be given serious consideration by the Privacy Officer and you will be informed promptly whether we will be able to honor the requested restriction and still offer effective services, receive payment and maintain health care operations. Legally we are not required to agree to any restrictions you request, but if we do agree, we are bound by that agreement except under certain emergency circumstances.
• You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. You also have the right to request with whom we communicate about your bill. Such requests must be made in writing to your Primary Service Coordinator or Accounts Receivable staff. We will agree to all reasonable requests.
• You have the right to obtain a paper copy of this Privacy Notice at any time upon request.

Use and Disclosure of Your Information

Upon signing the agency’s Consent to Treatment/Service form, you are allowing us to use and disclose necessary information about you within the agency and with business associates in order to provide treatment/service, receive payment of provided treatment/service, and conduct our day to day health care operations.

Examples:

In order to effectively provide treatment/service, your Primary Service Coordinator may consult with various service providers within the agency. During those consultations health information about you may be shared.

In order to receive payment of services provided, your health information may be sent to those companies or groups responsible for payment coverage, and a monthly bill is sent to the Responsible Party identified by you and noted on the financial form.

In day-to-day health care operations, trained staff may handle your physical medical record in order to have the record assembled, available for review by the Primary Service Coordinator, or for filing of documentation. Certain data elements are entered into our computer system that processes most billing, and for state statistical reporting to The Department of Mental Health, Mental Retardation and Substance Abuse Services (The Department). As a part of our continuous quality improvement efforts to provide the most effective services, your record may be reviewed by professional staff to assure accuracy, completeness and organization. Records may also be reviewed during accreditation surveys by the Commission on Accreditation of Rehabilitation Facilities (CARF) or by the Department.

Enhancing Your Healthcare

Some agency programs provide the following support to enhance your overall health care and may contact you to provide:

• Appointment reminders by call or letter
• Information about treatment alternatives
• Information about health-related benefits and services that may be of interest to you

Individuals Involved in Your Care or Payment for That Care

We may release medical information about you to a friend or family member or other individual who is involved in your medical care if you agree with the release or we give you an opportunity to object and you don’t. We may also give information to someone who helps pay for your care.

Specific Circumstances for Disclosure

This agency is also allowed by federal and state law in certain circumstances to disclose specific health information about you without your written authorization or opportunity to object.

These specific circumstances are:

• As required by law (ex: reports required for public health purposes, such as reporting certain contagious diseases)
• Judicial and Administrative proceedings (ex: Order from a court or administrative tribunal, or response to subpoena, discovery request, or other lawful process
• For health oversight activities
• Law Enforcement purposes (ex: reporting of gun shot wounds; limited information requested about suspects, fugitives, material witnesses, missing persons; criminal conduct on premises)
• To avert a serious threat to the health and safety of another person or the public (ex: in response to a specific threat made by person to hard another)
• Children or incapacitated adults who are victims of abuse, neglect or exploitation
• Specialized Government functions such as: Military Services, National Security and Intelligence activities, State Department, Correctional Facilities
• Worker’s Compensation to facilitate processing payment
• Coroners and Medical Examiners for identification of a deceased person or to determine cause of death
• To the Department of Health and Human Services in connection with an investigation of us for compliance with federal regulations.

Other Uses and Disclosures of Your Information by Authorization Only

We are required to get your authorization to use or disclose your protected health information for any reason other than for treatment/services, payment, or health care operations, and those specific circumstances outlined previously. We use an Authorization to Use/Disclose form that specifically states what information will be given to whom, for what purpose, and is signed by you or your legal representative. You may have the ability to revoke the signed authorization at any time by a written statement except to the extent that we have acted on the authorization.

Changes to Privacy Practices

Community Services reserves the right to change any of its privacy policies and related practices at any time, as allowed by federal and state law and to make the change effective for all protected health information that we maintain.

If at any time you believe your privacy rights have been violated, you may verbally or in writing contact:

Privacy Officer’s contact
Chesterfield CSB
P.O. Box 92
Chesterfield, VA 23832
(804) 768-7201
(804) 768-7247

Effective Date: April 14, 2003