Privacy Notice

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice applies to the following programs operated by Family Networks, Inc.:

	Early Intervention and Prevention Services
	Outpatient Services
	Day Treatment Programs

Our Pledge And Legal Duty To Protect Health Information About You

The privacy of your health information is important to us. We are required by federal and state laws to protect the privacy of your health information. We must give you notice of our legal duties and privacy practices concerning your health information:

	We must protect information that we have created or received about your past, present, or future health condition, health care we provide to you, or payment for your health care
	We must notify you about how we protect your health information. We must explain how, when and why we use or disclose your health information.
	We may only use or disclose your health information as we have described in this Notice.
	We will disclose only the minimum and necessary information required for each situation.
	We must abide by the terms of the Notice currently in effect.

We are required to abide by the terms of this Notice. We reserve the right to change the terms of this Notice and to make new Notice provisions effective for all health information that we maintain. We will post a revised Notice in our offices, make copies available to you upon request and post the revised Notice on our website.

Our Uses and Disclosures of Your Health Information

	Family Networks, is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations, as described in the following examples:
	Treatment – For example we may disclose information to a consulting psychiatrist in order to develop a plan of medical treatment. As necessary, we may share information within Family Networks system for treatment payment and health care operations.

Payment – For example we may be required to disclose information about treatment to the insurance company or medical assistance in order to receive authorization for payment.

	Health care operations – An employee of Family Networks may have access to information about you when evaluating treatment effectiveness as part of a quality assurance project.
	Business Associates - Family Networks may disclose information about you to third party “business associates” that perform various activities for Family Networks. Whenever this occurs Family Networks will have a written agreement that the business associates protect the privacy of your health information.
	Appointment Reminders/Information - Family Networks, may contact you to provide appointment reminders or information about treatment alternatives or other heath-related benefits and services that may be of interest to you or your child/family.

Uses and Disclosures Authorized by Law

Family Networks, is permitted or required, under specific circumstances, to use or disclose protected health information without your written authorization. These circumstances include:

A mental health provider shall disclose client information without written consent under the following circumstances:

1. When mandated by federal or state law, including the mandatory reporting requirements under the maltreatment of minors and vulnerable adult laws;

	When the client communicates to the mental health provider a specific, serious threat of physical violence against a clearly identified potential victim or against the client’s self or against society in general. The mental health provider may release only the information that is necessary to avoid the infliction of physical violence. The mental health provider shall release this information to law enforcement or other appropriate authorities and to the potential victim or victim’s legal representative;
	A mental health provider may disclose information to law enforcement officials if a client is a victim of a crime or perpetrates a crime against Family Networks;
	If the mental health provider has reason to believe that a pregnant client has used a controlled substance during pregnancy.

2. For a health oversight activity such as an audit, criminal investigation, investigation by a professional licensing board (i.e. Board of Psychology or Board of Social Work) or investigation by the U.S. Department of Health & Human Services.

3. For judicial or administrative proceedings, such as responding to a county, state or federal court order, legal order, subpoena or other legal documents.

4. To Military Authorities/ National Security. We may give health information to authorized people from the U.S. military, foreign military, and U.S. national security or protective services.

5. To Correctional Facilities. We may give the health information of an inmate or other person in custody to law enforcement or a correctional institution

6. Medical Emergency. We may use or give your health information to help you in a medical emergency.

7. Public Health Risks. We may give health information about you for public health purposes that include the following:

	Reporting and controlling disease (such as tuberculosis), injury or disability;
	Notifying a person who may have been exposed to a disease or be at risk for catching or spreading a disease or condition.

Other uses and disclosures will be made only with your written authorization, and you may revoke such authorization at any time through a written notice to your child’s mental health provider.

Your Individual Rights Regarding Your Protected Health Information

Access - You have the right to access and receive a copy or a summary of your health information contained in clinical, billing and other records that we maintain and use to make decisions about you. We ask that your request be made in writing. We may charge a reasonable fee. There might be limited situations in which we may deny your request. Under these situations, we will respond to you in writing, stating why we cannot grant your request and describing your rights to request a review of our denial.

Amendment – You have the right to amend your protected health information, as provided by federal or state regulation. Requests to amend your protected health information must be in writing. A form is available from your mental health provider. Once you have submitted your request in writing, your mental health provider will consult with the Director of Program Operations regarding your request. Family Networks is not required to agree to the amendment, however. If we deny your request, we will respond to you in writing stating the reasons for the denial. You may file a statement of disagreement with us. You may also ask that any future disclosures of the health information under dispute include your requested amendment and our denial to your request.

Accounting of Disclosures - You have the right to request a listing of certain disclosures we have made of your health information. Requests for an accounting of disclosures must be in writing and addressed to the Director of Program Operations. You may ask for disclosures made up to six (6) years before the date of your request (not including disclosures made prior to April 14, 2003). We will provide you one accounting in any 12-month period free of charge.

Restriction Requests – You have the right to request restrictions on certain uses and disclosures of your protected health information. Requests for restriction on the use and disclosure of your protected health information should be in writing to your mental health provider, indicating what is to be restricted and to whom it is not to be disclosed. Family Networks, is not required to agree to a requested restriction, however.

Confidential Communication - You have the right to request that we communicate with you in a specific way or at a specific location. For example, you may request that we contact you at your work address or phone number or by e-mail. We ask that your request be made in writing. While we are not required to agree with your request, we will make efforts to accommodate reasonable requests.

Copy of this Notice – You have the right to obtain a paper copy of this Notice from Family Networks upon request. You also have the right to request to receive the Notice electronically, and still retain the right to receive a paper copy. Electronic Notices are available on the Family Networks website at www.familynetworks.org and are also available through e-mail.

Questions or Complaints

Individuals may bring their questions or concerns to Family Networks without fear of retaliation by Family Networks, if they believe their privacy rights have been violated. Family Networks, Inc.’s contact person for matters relating to these issues is:

Roger Grusznski, Ph.D.

Clinical Director

5530 Zealand Avenue North

New Hope, MN 55428

763-504-8322

Complaints may also be addressed in writing to the Secretary of Health and Human Services, Office for Civil Rights, U.S. Department of Health and Human Services, 233 N. Michigan Ave., Suite 240, Chicago, Ill. 60601. Complaints must be filed within180 days from when you discovered the action for which you are making a complaint.