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COMPREHENSIVE YOUTH
SERVICES
En
Español
In Hmong
Notice of Privacy
Practices
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
PRIVACY
AND YOU
Your health
information is personal and private. Comprehensive Youth Services must keep your
health information private. We get information about you when you apply for
services with Comprehensive Youth Services. Our social workers and clinicians
may keep health care information about you in their file. We must give you this
Notice of the law and how we keep your health information private.
CHANGES
TO NOTICE OF PRIVACY PRACTICES
Comprehensive Youth
Services must follow the rules in this Notice. We have the right to change this
Notice in the future and to make any new Notice effective for all health
information that we maintain. If we do make changes, we will post the new Notice
at our service sites and send you a copy within 60 days if there are any
important changes.
HOW
WE MAY USE AND SHARE YOUR INFORMATION
Comprehensive Youth
Services (CYS) must obey laws on how we use and share your information, such as
your name, address, personal facts, the health care you had and your medical
records. CYS may use and share your health information to provide health care,
to obtain payment for health care and to respond to administrative healthcare
operations (such as mandated reporting or auditing). CYS may use and share your
health information for such reasons as:
-
To
coordinate mental health care services
-
To
substantiate program eligibility and/or health benefits
-
To
establish ways to pay for health care
-
To
report negligence or abuse
-
To
report healthcare fraud
WHY WE MAY USE OR SHARE YOUR HEALTH
INFORMATION:
1. For Treatment: Comprehensive Youth Services (CYS) may use and share
health information with health care providers who are involved in your health
care. We will share information with necessary providers to make sure you get
the care you need. For example, CYS may use and share your health information
with your Primary Physician to coordinate your care and to decide what treatment
you need.
2. For Payment: When a third party payor such as a county or state or
federal health plan pays your health care bills, we share health information
with your third party payor who pay for your health care. Additionally, we may
send some bills to other health plans or groups who pay the bills. For example,
CYS may provide your health information with the bill. This health information
may include your health condition(s), your clinician’s name and the types of
services you are receiving.
3. For Health Care Operations: We may use your health records to check
the quality of the health care you get. We may be required to use them in
audits, fraud and abuse programs, planning, and managing other healthcare
operations.
4. For Health Notices: We may send you notices about free health exams
and other topics. For example, before school starts, we may send a notice of
places where your children can get free shots for school or educational and
seminars that might interest you.
5. For Judicial and Administrative Proceedings: We may use and share
health information about you in response to a court or administrative order, a
subpoena, a discovery request or other lawful process. For example, if a lawyer
gives us a valid subpoena, we may share your medical records.
6. For Appeals: If you or your health care provider appeal CYS’s health
program decisions made about your health care services, your health information
may be used to decide these appeals. For example, a person thinks that they
should get specialized psychological treatment, but CYS does not approve the
request. If the person appeals the decision, we may use and share that person’s
health information for the appeal.
7. For Eligibility: We may share your information with federal, state and
local agencies when you apply for a county, state or federal health plan to
verify eligibility, and for other purposes related to the administration of that
health plan. For example, the State of California requests to look at your
medical records to see if you are eligible for a new Medi-Cal program. We may
share your health information to determine eligibility.
8. For Abuse Reports and Investigations: We may use and share your health
information with Child Protective Service, Adult Protective Service or law
enforcement when required by state or federal law.
9. To Avoid Harm: We may use and share your health information to law
enforcement to avoid a serious threat to the health and safety of a person or
the public.
10. For Public Health Activities: We may be asked by a governmental
entity to share your health information with the public health agency that keeps
and updates vital records, such as births and death, and track some diseases.
11. For Health Oversight Activities: We may use and share your health
information to inspect, monitor or investigate health care providers. For
example, we may use and share your health information to investigate the quality
of services you are receiving.
12. For Government Programs: We may use and share your health information
with public benefits government programs. For example, we may share your
information for the determination of Supplemental Security Income (SSI)
benefits.
13. Family, Friends and Others: We may share your health information with
persons involved in your health care, unless you tell us not to share the
information. For example, you want a family member to pick up your Client
Treatment Plan at CYS; we will give that person your Client Treatment Plan
unless you tell us not to.
14. For Research Purposes: We may use and share your health information
for research purposes regarding your treatment or to create studies that do not
identify you.
15. Appointment Reminders: We may call you or send you a letter to remind
you that you have an appointment for services, unless you tell us not to contact
you with a reminder. For example, we may pull all client information for
appointments and send you a post card reminding you of your appointment.
16. Treatment Alternatives: We may use and share your health information
to tell you about alternative treatments that may interest you. We may use and
share your health information with other providers or plans in order to find
alternative treatment options for you.
17. Law Enforcement. We may disclose health information about you to law
enforcement when required by federal or state law. For example, law enforcement
is asking about your health when investigating a criminal situation.
18. Required by Law. We may use or disclose health information about you
when required or permitted by federal or state law.
WRITTEN PERMISSION
Comprehensive Youth Services may use or share your information in limited ways.
If we want to use your health information in a way not listed above, we must get
your permission in writing. If you give permission, you may cancel your
permission. If you cancel your permission, we will follow your instructions
unless we have already relied on your consent and taken some action.
Other Laws Protecting your health information: Other laws may require your
written permission to share certain mental health, alcohol and drug treatment,
HIV/AIDS testing or treatment.
WHAT ARE YOUR PRIVACY RIGHTS?
You have the right to:
* Ask us to contact you in writing only, at a different address, post office
box, or by telephone only. We will agree to any reasonable requests.
* Look at and get a copy of your Comprehensive Youth Services (CYS) health
information that the CYS maintains. A personal representative who has the legal
right to act for you may look at and get it for you. We have information about
your health plan eligibility, your health care bills, your care and some medical
records. If you want to look at or get a copy of your health care information,
you must make your request in writing. You will need to pay a fee for us to copy
and mail the records. We may deny your request in certain circumstances. If we
deny your request, we will explain our reason for doing so and will notify you
in writing. If we deny your request, you may have a right to have our decision
reviewed by another person. We may request that records be reviewed with a CYS
staff person prior to releasing.
* Ask CYS to change information in your records if it is not correct or
complete. If CYS makes the change, we will try to notify others who have copies
of the inaccurate or incomplete information. We may deny your request to change
the information in certain circumstances. If we deny your request, we will
explain our reason for doing so and will notify you in writing. You may send a
letter to disagree with the denial.
* Receive a list of the people with whom CYS has shared your health information
for reasons other than treatment, payment or the the healthcare operations. The
list may also include when the information was shared, why it was shared and
what information was shared. This list will start after April 14, 2003. The
first list that you request within a 12-month period will be given to you
without a charge. CYS may charge you for the cost of providing additional lists
within a 12-month period. If we deny your request, we will explain our reason
for doing so and will notify you in writing.
* Request that Comprehensive Youth Services limit the way we use or share your
health information for treatment, payment, and health operations. We are not
required to agree to your request. If we deny your request, we will explain our
reason for doing so and will notify you in writing. If we agree to your request,
we must follow your restrictions, except if the information is needed for
emergency treatment. You may cancel the restrictions at any time. In addition,
we may cancel a restriction at any time if we notify you.
* Ask for a paper copy of this Notice of Privacy Practices. You can ask your
counselor or our receptionist for a copy.
**** IMPORTANT ****
COMPREHENSIVE YOUTH SERVICES DOES NOT HAVE FULL COPIES OF YOUR MEDICAL
RECORDS. IF YOU WANT TO LOOK AT, GET A COPY OF, OR CHANGE YOUR MEDICAL RECORDS,
PLEASE CONTACT YOUR DOCTOR, DENTIST, OR THE APPROPRIATE CLINIC.
HOW DO I GET INFORMATION ABOUT MY PRIVACY RIGHTS OR FILE A COMPLAINT?
Contact us
*If you would like to ask questions about this Notice.
*If you want to use any of the privacy rights explained in this Notice.
*If you think that your privacy rights have been violated by CYS.
*If you are not happy with CYS privacy policies and procedures.
Also, you may file a complaint either with the CYS or the federal government
(Secretary). Contact us by phone or in writing:
CYS Privacy & Information Security Officer
3755 E. Shields Avenue
Fresno, CA 93726-7029
(559) 229-3561 ext. 30
To file a complaint with the federal government, contact the CYS Privacy &
Information Security Officer who will provide you with the address for the U.S.
Department of Health and Human Services, Office for Civil Rights.
NO RETALIATION: Comprehensive Youth Services cannot take away your health
care benefits or retaliate in any way if you file a complaint or use any of the
privacy rights of the Notice.
To get a copy of this notice in other languages, alternative format in
compliance with the Americans With Disabilities Act, please call or write to the
CYS Privacy & Information Security Officer above.
July 20, 2005
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