EFFECTIVE APRIL 14, 2003

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.

As part of the federal Health Insurance Portability and Accountability Act of 1996, known as HIPAA, Community Human Services has created this Notice of Privacy Practices (Notice).  This Notice describes Community Human Services’ privacy practices and the rights you, the individual, have as they relate to the privacy of your Protected Health Information (PHI).  Your PHI is information about you, or that could be used to identify you, as it relates to your past and present physical and mental health care services. The HIPAA regulations require that Community Human Services protect the privacy of your PHI that Community Human Services has received or created.

This Covered Entity will abide by the terms presented within this Notice.  For any uses or disclosures that are not listed below, Community Human Services will obtain a written authorization from you for that use or disclosure, which you will have the right to revoke at any time, as explained in more detail below.  Community Human Services reserves the right to change privacy practices and this Notice.  Revisions to the Notice will be posted in Community Human Services and upon your request, provided to you in a paper format.

HOW COMMUNITY HUMAN SERVICES MAY USE AND DISCLOSE YOUR PHI
The following is an accounting of the ways that Community Human Services is permitted, by law, to use and disclose your PHI.

Uses and disclosures of PHI for Treatment: We will use the PHI that we receive from you coordinate or manage your health care.

Uses and disclosures of PHI for Payment: Community Human Services will disclose your PHI to obtain payment or reimbursement from insurers for your health care services.

Uses and disclosures of PHI for Health Care Operations: Community Human Services will use your PHI to conduct quality assessments, improvement activities, and evaluate Community Human Services’ workforce.

The following is an accounting of additional ways in which Community Human Services is permitted or required to use or disclose PHI about you without your written authorization.

Uses and disclosures as required by law: Community Human Services is required to use or disclose PHI about you as required and as limited by law.

Uses and disclosure for Public Health Activities: Community Human Services may use or disclose PHI about you to a public health authority that is authorized by law to collect for the purpose of preventing or controlling disease, injury, or disability.

Uses and disclosure about victims of abuse, neglect or domestic violence: Community Human Services may use or disclose PHI about you to a government authority if it is reasonably believed you are a victim of abuse, neglect or domestic violence.

Uses and disclosures for health oversight activities: Community Human Services may use or disclose PHI about you to a health oversight agency for oversight activities that it is authorized by law to conduct.

Disclosures for judicial and administrative proceedings: Community Human Services may disclose PHI about you in the course of any judicial or administrative proceedings, provided that proper documentation is presented to Community Human Services.

Disclosures for law enforcement purposes: Community Human Services may disclose PHI about you to law enforcement officials for authorized purposes.

Uses and disclosures about the deceased: Community Human Services may disclose PHI about the deceased, or prior to, and in reasonable anticipation of an individual’s death, to coroners, medical examiners, and funeral directors.

Uses and disclosures for cadaveric organ, eye or tissue donation purposes: Community Human Services may use and disclose PHI for the purpose of procurement, banking, or transplantation of cadaveric organs, eyes, or tissues for donation purposes.

Uses and disclosures for research purposes: Community Human Services may use and disclose PHI about you for research purposes with a valid waiver of authorization from the research board.  Otherwise, Community Human Services will request a signed authorization by the individual for all other research purposes.

Uses and disclosures to avert a serious threat to health or safety: Community Human Services may use or disclose PHI about you, if it believed in good faith, and is consistent with any applicable law and standards of ethical conduct, to avert a serious threat to health or safety.

Uses and disclosures for specialized government functions: 
Community Human Services may use or disclose PHI about you for specialized government functions including; military and veterans activities, national security and intelligence, protective services, department of state functions, and correctional institutions and law enforcement custodial situations.

Disclosure for workers’ compensation: Community Human Services may disclose PHI about you as authorized by and to the extent necessary to comply with workers’ compensation laws or programs established by law.

Disclosures for disaster relief purposes: Community Human Services may disclose PHI about you as authorized by law to a public or private entity to assist in disaster relief efforts.

Disclosures to business associates: Community Human Services may disclose PHI about you to Community Human Services’ business associates for services that they may provide to or for the agency.

OTHER USES AND DISCLOSURES
Community Human Services may contact you for the following purposes:

Appointment reminders: Community Human Services may contact you to remind you of your appointment and rescheduling date and time.

Information about treatment alternatives: Community Human Services may contact you to notify you of alternative treatments and/or products.

Health related benefits or services: Community Human Services may use your PHI to notify you of benefits and services the agency provides.

Fundraising:  If Community Human Services participates in a fundraising activity, the agency may use demographic PHI to send you fundraising packet, or Community Human Services may disclose demographic PHI about you to its business associate or an institutionally related foundation to send you a fundraising packet.  No further disclosure will be allowed by the business associates or an institutionally related foundation without your written authorization.

FOR ALL OTHER USES AND DISCLOSURES
Community Human Services will obtain a written authorization from you for all other uses and disclosures of PHI, and the agency will only use or disclose pursuant to such an authorization.  In addition, you may revoke such an authorization in writing at any time. To revoke a previously authorized use or disclosure, please contact Doug Clewett.

YOUR HEALTH INFORMATION RIGHTS  
The following are a list of your rights in respect to your PHI.

Request restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions of Community Human Services’ uses and disclosures of your PHI; however, the covered entity is not required to accommodate a request.  If you wish to request additional restrictions, please obtain the form, Request for Restriction of Uses & Disclosures, from Community Human Services and return the completed form to Doug Clewett.

The right to have your PHI communicated to you by alternate means or locations: You have the right to request that Community Human Services communicate confidentially with you using an address or phone number other than your residence.  However, state and federal laws require Community Human Services to have an accurate address and home phone number in case of emergencies. Community Human Services will consider all reasonable requests.  If you wish to request a change in your communicating address and/or phone number, please obtain a form,Request for Alternative Arrangements for Confidential Communication, from Community Human Services and return the completed form to Doug Clewett.

The right to inspect and/or obtain a copy your PHI: You have the right to request access and/or obtain a copy of your PHI that is contained in Community Human Services for the duration the agency maintains PHI about you.  If you wish to inspect or obtain a copy your PHI, please obtain a form, Request for Access to Records, from the agency and return the completed form to Doug Clewett.  There may be a reasonable cost-based charge for photocopying documents.  You will be notified in advance of incurring such charges, if any.

The right to amend your PHI: You have the right to request an amendment of the PHI Community Human Services maintains about you, if you feel that the PHI the agency has maintained about you is incorrect or otherwise incomplete.  Under certain circumstances we may deny your request for amendment. If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involved in the initial review.  You may also ask the Secretary, United States Department of Health and Human Services, or their appropriate designee, to review such a denial.  If you wish to amend your PHI files, please obtain a form, Request for Amendment to PHI, from Community Human Services and return the completed form to Doug Clewett.

The right to receive an accounting of disclosures of your PHI: You have the right to receive an accounting of certain disclosures of your PHI made by Community Human Services. If you wish to receive an accounting of disclosures of your PHI, please obtain a form, Request for Accounting of Disclosures, from Community Human Services and return the completed to Doug Clewett.  You should be aware, however, that such an accounting excludes uses and disclosures made for treatment, payment, or health care operations purposes.

The right to receive additional copies of Community Human Services’ Notice of Privacy Practices: You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically.  If you wish to receive a paper copy of this request, please ask a Covered Entity workforce member and they will provide you with a copy.

REVISIONS TO THE NOTICE OF PRIVACY PRACTICES
Community Human Services reserves the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. The revised Notice will be available, upon request, to all individuals.  Community Human Services will also post the revised version of the Notice throughout the agency.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Community Human Services and/or to the Secretary of HHS, or their designee.  If you wish to file a complaint with Community Human Services, please contact Doug Clewett.  If you wish to file a complaint with the Secretary, please write to:

The U.S Department of Health and Human Services
200 Independence Ave, S.W.
Washington, D.C. 20201

Community Human Services will not take any adverse action against you as a result of your filing of a complaint.

CONTACT INFORMATION
If you have any questions on Community Human Services’ privacy practices or for clarification on anything contained within the Notice, please contact:

Community Human Services Corporation
Attn:  Doug Clewett
374 Lawn Street
Pittsburgh, PA 15213
412-246-1602

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