JEVS Human Services 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 READ IT CAREFULLY.
JEVS Human Services (JEVS) has adopted the following policies and procedures for protection of the privacy of the people we serve.
Our Obligation to You
We at JEVS Human Services respect your privacy. We are required by law to maintain the privacy of “protected health information” about you, to notify you of our legal duties and your legal rights, and to follow the privacy policies described in this notice. “Protected health information” or “PHI” means any information that we create or receive that identifies you and relates to your health or payment for services to you.
Use and Disclosure of Information About You
Use and disclosure for treatment, payment, and health care operations
We will use your protected health information and disclose it to others as necessary to provide treatment to you. Here are some examples:
- Various members of our staff may see your clinical record in the course of our care for you. This may include, but is not limited to, physicians, nurses, rehabilitation counselors/therapists, activities specialists, admissions counselors, job coaches, residential support staff, support coordinators/case managers, personal care attendants, clerical support, and administrative staff.
- If part of your treatment, we will send blood and urine samples to a laboratory for analysis to help us evaluate your medical condition and substance of abuse.
- We may provide information to your health plan or another treatment provider in order to arrange for a referral or clinical consultation. Examples include: your physician, support coordinators, mental health center, speech therapists, behavior specialists, and other social service agencies.
- We may contact you to remind you of appointments.
- We may contact you to tell you about treatment services that we or others offer that might be of benefit to you.
- During the provision of services to you, it may be necessary for us to make referrals for some of your other family members with whom we come into contact.
If needed by the program you are enrolled in, JEVS Human Services will use or disclose your protected health information as needed to arrange for payment for service to you. For example, information about your diagnosis and the service we render is included in the bills that we submit to your health insurance plan, or other funder of your program. Your funding source may require health information in order to confirm that the service rendered is appropriate and medically necessary. A health care provider that delivers service to you, such as a clinical laboratory, may need information about you in order to arrange for payment for its services.
It may also be necessary to use or disclose protected health information for our health care operations or those of another organization that has a relationship with you. For example, our quality assurance staff reviews records to be sure that we deliver appropriate treatment of high quality. Your health plan may wish to review your records to be sure that we meet national, state, and local standards for quality of care.
We may contact you for marketing or fundraising purposes without your written permission. However, if you object to either of these types of communication, notify the contact person of your program.
Depending upon the type of information requested, JEVS Human Services may or may not ask your written permission to disclose your PHI to others for treatment, payment, healthcare operations, or for other purposes as required by law. You should be aware that some disclosures are required by law, even without your permission. Examples include:
- If you are involved in a medical emergency and the information is needed to prevent your death or risk of bodily harm.
- Reporting that you have symptoms of a communicable disease to public health officials.
- When JEVS Human Services receives a court order directing a release of information.
Disclosures to Health Oversight Agencies
JEVS Human Services is obligated to share our records with agencies that inspect and pay for the services we provide to you, such as the Pennsylvania Department of Public Welfare (PA DPW), Community Behavioral Health (CBH), and the Federal Department of Health and Human Services (DHHS).
Some Information Can Be Released Without Your Permission
We may release some of your information without your permission, depending upon the type of information and who requests it. However, there are conditions which must be met before we release any information that is listed below. If you want a more detailed explanation of these conditions, you can ask the Program Director for a copy of the JEVS Human Services Privacy Policies and Procedures.
Mental Health Treatment Information can be released to:
- Others currently providing treatment to you
- People at treatment programs where you are referred
- The County Office of Mental Health/Mental Retardation
- A judge or court
- Lawyers
- Police or other government officials
- Insurance companies or other companies who pay for your treatment
- Physicians or other medical professionals
- Inspectors of our programs
- Child abuse investigators
- You
Mental Retardation Records/Information can be released to:
- Others currently providing treatment to you
- People at treatment programs where you are referred
- The County Office of Mental Health/Mental Retardation
- A judge or court
- Lawyers
- Police or other government officials
- Insurance companies or other companies who pay for your treatment
- Physicians or other medical professionals
- Inspectors of our programs
- Child abuse investigators
- Your parent or legal guardian
- Your advocate
- You
Child Abuse and Neglect Information can be released to:
- Others currently providing treatment to you
- People at treatment programs where you are referred
- The County Office of Mental Health/Mental Retardation
- A judge or court
- Lawyers
- Police or other government officials
- Insurance companies or other companies who pay for your treatment
- Physicians or other medical professionals
- Inspectors of our programs
- Child abuse investigators
- You
Substance Abuse Treatment Information can be released:
- To others providing treatment to or referring you to another program
- When we take out any information that identifies you
- To other agencies that provide an ongoing service to our program or you, such as laboratories and billing companies
- In medical emergencies
- For research
- To inspectors of our programs
- To government agencies, insurance companies, or others who pay for your program
- To government agencies that write rules for your program
- With a court order
- If a crime is committed at our program or against the staff
- If you threaten to harm or kill someone
- When child abuse or neglect is suspected
Sexually Transmitted Disease Information may be released:
To the court and to those authorities that need this information to prosecute/defend that particular case, if you are a criminal defendant.
HIV and AIDS Related Information may be released:
- To you
- To the physician or health care provider who ordered your HIV test
- To medical staff involved in your medical care
- To inspectors of our programs
- To health care providers of emergency care to you
- To insurance companies that pay for your program
- To the Pennsylvania and local Boards and Departments of Health
- With a court order
- To funeral directors
- To county mental health agencies
- To county child and youth agencies
- To county juvenile probation departments
- To county or state facilities for delinquent youth
- To possible residential providers of services to minors
Disclosures with Your Permission
No other disclosure of protected health information will be made unless you give written authorization for the specific disclosure.
Your Legal Rights
Right to Request Confidential Communications
You may request that communications to you, such as appointment reminders, bills, or explanations of health benefits be made in a confidential manner. We will accommodate any such request, as long as you provide a means for us to process payment transactions.
Right to Request Restrictions on Use and Disclosure of Your Information
You have the right to request restrictions on our use of your protected health information for particular purposes, or our disclosure of that information to certain third parties. We are not obligated to agree to a requested restriction, but we will consider your request.
Right to Revoke a Consent or Authorization
You may revoke a written consent or authorization for us to use or disclose your protected health information. The revocation will not affect any previous use or disclosure of your information.
Right to Access/Review and Copy Record
You have the right to see records used to make decisions about you. We will allow you to review your record unless a clinical professional determines that would create a substantial risk of physical harm to you or someone else, or if the facility medical director determines that would be bad for your mental health treatment. If another person provided information about to our clinical staff in confidence, that information may be removed from the record before it is shared with you. We will also delete any protected health information about other people.
At your request, we will make a copy of your record for you. We will provide 1 copy per calendar year to you for free. After that we will charge 20 cents, per page, per side to be copied, for this service.
Right to “Amend” Record
If you believe your record contains an error, you may ask us to amend it. If there is a mistake, a note will be entered in the record to correct the error. If not, you will be told and allowed the opportunity to add a short statement to the record explaining why you believe the record is inaccurate. This information will be included as part of the total record and shared with others if it might affect decisions they make about you.
Right to an Accounting
You have the right to an accounting of some disclosures of your protected health information to third parties. This does not include disclosures that you authorize, or disclosures that occur in the context of treatment, payment or health care operations. We will provide an accounting of other disclosures made in the preceding six (6) years. If requested by law enforcement authorities that are conducting a criminal investigation, we will suspend accounting of disclosures made to them.
Right to a Paper Copy of This Notice
You have the right to a paper copy of any Notice of Privacy Practices posted on our website.
How to Exercise Your Rights
Questions about our policies and procedures, requests to exercise individual rights, and complaints should be directed to the contact person for your program.
Personal Representatives
A “personal representative” of an individual may act on their behalf in exercising their privacy rights. This includes the parent or legal guardian of a minor. In some cases, adolescents who are “mature minors” may make their own decisions about receiving treatment and disclosure of protected health information about them. An adult can grant another person the right to act as his or her personal representative in an advance directive or living will, or through a health care power of attorney. If an adult is incapable of acting on his/her own behalf, the personal representative would be determined by applicable state law.
Disclosure of protected health information to personal representatives may be limited in cases of neglect or suspected sexual, domestic, child, or elder abuse.
Complaints
If you have any complaints or concerns about our privacy policies or practices, please submit a complaint to the contact person of your program. If you wish, the contact person will give you a form that you can use to submit a complaint.
You can also submit a complaint to the United States Department of Health and Human Services.
Send your complaint to:
Region III, Office of Civil Rights
U.S. Department of Health and Human Services
150 S. Independence Mall West, Suite 372
Public Ledger Building
Philadelphia, PA 19106-9111
TEL: 215-861-4441
TOLL-FREE: 1-800-368-1019
FAX: 215-861-4431
TDD: 215-861-4440
We will never retaliate against you for filing a complaint.
We reserve the right to make changes to our practices and to apply any new practices to all health information that we have in our records, that identifies you. Should we make changes, we will distribute a revised notice to you.
Effective Date
These Privacy Practices were approved by the JEVS Human Services Chief Operating Office of Home Health and Work. They are effective as of April 14, 2003.
