| Notice of Privacy Practices
Effective date: May 1, 2003
THIS NOTICE DESCRIBES HOW CONFIDENTIAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact:
Richard Hughes, MFT
ChildNet Youth and Family Services
Head
of Behavioral Health Services
(562)490-7600
or
The ChildNet Privacy Officer and Director of
Quality Assurance:
Kelly Loven
(562) 498-5528
By Mail:
P.O. Box 4550
5150 E. Pacific Coast Highway Suite 365
Long
Beach, CA 90804
OUR DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION KNOWN
TO CHILDNET AS CLIENT CONFIDENTIAL INFORMATION (CCI)
We understand that individually identifiable information about
you and/or your family is personal. We are committed to protecting
this private and confidential information. All information,
whether it is past, present, future or payment information,
is considered client confidential information (CCI). As a result
we have developed this manual called a “Notice of Privacy” and
by law are required to extend certain protections to your CCI.
This Notice of Privacy explains how, when and why we may use
or disclose your CCI. We also describe your rights and certain
obligations we have regarding the use and disclosure of CCI.
We will follow the practices described in this manual, though
we reserve the right to change our privacy practices and the
terms of the Notice at any time. If we do so, we will post
a new Notice (see addresses to the specified ChildNet LOCATIONS
at the end of this notice).
WHO WILL FOLLOW THIS NOTICE
This notice describes our agency’s practices and that
of:
- All ChildNet departments under the Behavioral Health
Services (BHS).
- All ChildNet employees and volunteers who
may have contact with you and/or who deal directly with
your CCI in
regards to payment, treatment and overall Agency operations.
HOW WE MAY USE AND DISCLOSE YOUR CCI
The following categories describe different ways that we use
and disclose confidential information. For each category of
uses or disclosures we will explain what we mean and try to
give some examples. Not every use or disclosure in a category
will be listed. However, all of the ways we are permitted to
use and disclose information will fall within one of the following
categories.
For Treatment
We may use your CCI to provide you with proper case
management, clinical, psychiatric and treatment services. ChildNet
uses
teams and takes an inter-disciplinary approach when providing
services. Your CCI will be shared among members of your treatment
team and/or any individuals involved in the coordination of
your care. Therefore, a psychiatrist, nurse, clinician, administrative
staff members, etc. will need to know your CCI as all are responsible
for some aspect of your treatment. For example, your assigned
clinician may have to discuss any health issues with the youth
home nurse or discuss treatment goals and progress with your
assigned case manager. In addition, your assigned clinician
may have to inform your psychiatrist that you are having trouble
sleeping in order for the doctor to properly assess the effects
of your psychotropic medication.
For Overall Operations
We may use or disclose your CCI for overall operations. These
uses and disclosures are necessary to run the agency and make
sure all clients receive quality services. For example, CCI
may be shared in order to review our treatment and services
and to evaluate the performance of our staff in caring for
you. We may disclose information to staff members for review
and learning purposes.
For Payment
We may use and disclose CCI about you so that the services
you receive may be billed and collected by ChildNet. Information,
may need to be passed on to a third party, such as MediCal,
Los Angeles County Probation and Department of Children and
Family Services (DCFS), Department of Mental health (DMH) and
other county or state organizations in order to collect payment
of services. Therefore office support staff and appointed accounting
staff members may disclose your CCI. In addition, your CCI
may be shared with county or state agencies in order to determine
you eligibility for publicly funded services. For example,
your diagnosis will be given to MediCal to verify payment of
therapy and possible medication support services. In addition,
dates such as your birth date, and admission dates to LBYH
(if applicable) will be provided by the accounting department
to a county agency in order for ChildNet to receive payment
for services rendered.
Other specific treatment, payment and operation examples are
as follows:
Agency Quality Assurance Audits and Program Reviews
Many of the ChildNet programs are accountable to state and
county agencies, in order to maintain licenses, certifications,
etc. As a result, these agencies may conduct investigations,
audits, inspections, etc. and your CCI may be disclosed.
For example, LA DCFS reviews random files at the residential
facility to ensure LBYH is providing quality care. In addition,
DMH will review BHS treatment files in order to ensure that
the therapy provided to you is suitable regarding the diagnosis
documented. These activities are necessary in order for the
government agencies to monitor our overall operations and
to ensure that ChildNet is in compliance with required standards,
laws and regulations. ChildNet also conducts internal audits
where treatment files are reviewed on a regular basis.
Appointment Reminders & Transportation Services
We may disclose your CCI in order to contact you as a reminder
that you have an appointment. For example, ChildNet does have
transportation services and the ChildNet employee, the van
driver, may be provided your telephone number and address.
Referral
and Resources
ChildNet is committed to ensure that all clients receive the
best quality of care and therefore referrals to outside recourses
are often necessary. For instance, many clients ask that ChildNet
staff members (case managers) act as their advocate and request
the staff call various agencies regarding housing, legal, medical,
family issues, etc.
Directories or Identification Cards
It is crucial in some ChildNet programs, as with the residential
home, that daily activities are structured on a consistent
basis. As a result, client names are posted in order to maintain
organization. In addition, client names are posted on the residential “status
board” for identification, safety and accountability
purposes. The ChildNet vans also regularly carry a copy of
client medical cards for emergency purposes, therefore CCI
may be disclosed in order to ensure safety as a priority. In
addition, the BHS day treatment program also posts a daily
structure, which may include your CCI, such as your name, assigned
sub-specialty group, and status level as some examples.
Staff Supervision and/or Training
We may use or disclose your CCI for supervision and training
purposes. These situations occur in all program areas in order
to ensure that ChildNet employees receive the necessary training
and supervision. For instance, a ChildNet therapist may discuss
your CCI with a licensed ChildNet professional in order to
review treatment interventions, progress, areas of concern,
etc. There may be therapy or group sessions that are video
taped for the purposes of training staff members on various
treatment issues and interventions.
Research
ChildNet is always interested in how treatment services can
be improved and at times will mail satisfaction surveys to
previous clients. All of the data is collected and analyzed
by ChildNet employees.
Fundraising Activities
ChildNet may use your CCI in order to contact you for fundraising
purposes. We may contact you and inquire if you are interested
in speaking at a fundraising event and discuss your experiences
with ChildNet.
As Required by Law
An interdisciplinary team approach forms the basis of the
ChildNet philosophy. Communication between the employees in
different programs regarding services provided to you and other
clients is essential to the therapeutic approach utilized by
the ChildNet programs. Therefore, issues discussed for example
during a therapy session will likely be made available to all
treatment members serving your best treatment interests. However
it is required by law that ChildNet employees obtain an authorization
signed by you in order to use or disclose any CCI otherwise
described in this notice. Lastly, state and federal law mandates
that treatment ChildNet employees report to the proper authorities
information related to the following:
- Reasonable suspicion of
sexual abuse, physical abuse, and neglect of children (under
the age of 18).
- Reasonable suspicion of an imminent danger
to self (suicidality).
- Reasonable suspicion of an imminent
danger to others (Tarasoff).
- Reasonable suspicion of the
abuse of elderly persons.
- Legal Disputes/Subpoenas
YOUR RIGHTS REGARDING YOUR CCI
Right to Inspect and Copy
You have a right to inspect and copy some of your CCI. However,
most of your CCI may be mental health related which may not
always be accessible to you.
Right to Amend
If you feel that your CCI is incorrect or incomplete, you
have a right to amend the information.
Right to an Accounting of Disclosures
You have a right to request an “accounting of disclosures.” This
is a list of the disclosures we made of CCI other than our
own uses for treatment, payment and overall agency operations,
as those functions are described above.
Right to Request Restrictions
You have the right to request restrictions or limitations
on the CCI we use or disclose about you for treatment, payment,
or operations. You also have the right to request a limit on
the CCI we disclose about you to someone who is involved in
your care or the payments of your care. We are not required
to agree to your request. If we do agree, we will comply with
your request unless the information is needed to provide you
emergency treatment.
Right to a Paper copy of this Notice
You have the right to a paper copy of this notice and may
request a copy at anytime. Please contact the ChildNet Privacy
Officer, in writing, and request a copy.
Please note that you MUST submit all requests regarding your
above mentioned “Rights” in writing to the ChildNet
Privacy Officer. If you submit a request, we will respond and
provide you with the details regarding each Right within 30
days.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the
right to make the revised or changed notice effective for CCI
we already have about you as well as any information we receive
in the future. We will post all new and revised Notice of Privacy
at all agency sites and the website. We will ask that you acknowledge
that you received a copy of this notice at the time of your
admission to the agency.
COMPLAINTS
If you believe your privacy has been violated, you may file
a complaint with the agency. Please contact the ChildNet privacy
Officer and note that all complaints must be in writing. You
will not be penalized for filing a complaint.
LOCATIONS
ChildNet Youth and Family Services
Long Beach Youth Home
4151 Fountain Street
Long Beach, CA 90804
(562) 961-6350
Zinsmeyer Academy
4223 Anaheim Street
Long Beach, CA 90804
(562) 961-6350
Behavioral Health Services
2931 Redondo Avenue
Long Beach, CA 90806
(562) 490-7600 |
