314-83-4CARE (2273) [email protected]

Patient Privacy

We are committed to protecting your personal health information in compliance with the law.
The attached Notice of Privacy Practices states:

  • our obligations under the law with respect to your personal health information.
  • how we may use and disclose the health information that we keep about you.
  • your rights relating to your personal health information.
  • our rights to change our Notice of Privacy Practices.
  • how to file a complaint if you believe your privacy rights have been violated.
  • the conditions that apply to uses and disclosures not described in this Notice.
  • the person to contact for further information about our privacy practices.
  • We are required by law to give you a copy of this notice and to obtain your written acknowledgment that you have received a copy of this notice.

FAMILY CARE HEALTH CENTERS
Notice of Privacy Practices
Effective Date: September 18, 2013
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.

For More Information, Please Contact Us:
Privacy Officer
Family Care Health Centers
401 Holly Hills Avenue
St. Louis, MO 63111
314-481-1615

Who We Are:
This Notice describes the privacy practices of Family Care Health Centers and the privacy practices
of:

  • all of our doctors, nurses, and other health care professionals authorized to enter information about you into your medical chart.
  • all of our departments, including, e.g., our medical records and billing departments.
  • all of our health center sites – Carondelet and Forest Park Southeast.
  • all of our employees, staff, volunteers and other personnel who work for us or on our behalf.

Our Pledge:
We understand that health information about you and the health care you receive is personal. We are committed to protecting your personal health information. When you receive treatment and other health care services from us, we create a record of the services that you received. We need this record to provide you with quality care and to comply with legal requirements. This notice applies to all of our records about your care, whether made by our health care professionals or others working in this office, and tells you about the ways in which we may use and disclose your personal health information. This notice also describes your rights with respect to the health information that we keep about you and the obligations that we have when we use and disclose your health information.

We are required by law to:

  • make sure that health information that identifies you is kept private in accordance with relevant law.
  • give you this notice of our legal duties and privacy practices with respect to your personal health information.
  • follow the terms of the notice that is currently in effect for all of your personal health information.
  • notify you if your personal health information has been accessed, acquired, used, or disclosed in a manner not permitted by law if it affects the privacy or security of your information.

How We May Use and Disclose Your Health Information:
We may use and disclose your personal health information for these purposes:
For Treatment. We may use health information about you to provide you with health care treatment or services. We may disclose health information about you to the doctors, nurses, technicians,
medical students and others who are involved in your care. They may work at the Health Center, at the hospital if you are hospitalized under our supervision, or at another doctor’s office, lab, pharmacy or other health care provider to whom we may refer you for treatment, consultation, x-rays, lab tests, prescriptions or other health care service. They may also include doctors and other health care professionals who work at the Health Center, or elsewhere, whom we consult about your care. For example, we may consult with a specialist who lends his/her services to the Health Center about your care or disclose to an emergency room doctor who is treating you for a broken leg that you have diabetes, because diabetes may affect your body’s healing process.
For Payment. We may use and disclose health information about you to bill and collect payment from you, your insurance company, including Medicaid and Medicare, or other third party that may be available to reimburse us for some or all of your health care. We may also disclose health information about you to other health care providers or to your health plan so that they can arrange for payment relating to your care. For example, if you have health insurance, we may need to share information about your office visit with your health plan in order for your health plan to pay us or reimburse you for the visit. We may also tell your health plan about treatment that you need to obtain your health plan’s prior approval or to determine whether your plan will cover the treatment. For Health Care Operations. We may use and disclose health information about you for our day-today operations, and may disclose information about you to other health care providers involved in your care or to your health plan for use in their day-to-day operations. These uses and disclosures are necessary to run the Health Center and to make sure that all of our patients receive quality care, and to assist other providers and health plans in doing so as well. For example, we may use health information to review the services that we provide and to evaluate the performance of our staff in caring for you. We may also combine health information about our patients with health information from other health care providers to decide what additional services the Health Center should offer, what services are not needed, whether new treatments are effective or to compare how we are doing with others and to see where we can make improvements. We may remove information that identifies you from this set of health information so others may use it to study health care delivery without learning who our patients are.
Appointment Reminders. We may use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information on your answering machine
or in a message left with the person answering the phone. Health-Related Services and Treatment Alternatives. We may use and disclose health information to tell you about health-related services or recommend treatment options or alternatives that may be of interest to you. Please let us know if you do not wish us to contact you with this information, or if you wish to have us use a different address when sending this information to you. Proof of Immunization. We will disclose proof of immunization to a school that is required to have it before admitting a student where you have agreed to the disclosure on behalf of yourself or your dependent.

Fundraising Activities. We may use health information about you to contact you in an effort to raise money for our not-for-profit operations. We may disclose health information about you to a
foundation related to the Health Center so that the foundation may contact you in raising money for the Health Center. We will only release contact information, such as your name, address and phone number and the dates you received treatment or services from us. Please let us know if you do not want us to contact you for fundraising efforts. Marketing. Most uses and disclosures of protected health information for marketing purposes will be made only with your authorization. Sale of Health Information. We will not sell your health information without your prior written
authorization. The authorization will disclose that we will receive compensation for your health information if you authorize us to sell it, and we will stop any future sales of your information to the extent that you revoke that authorization. Individuals Involved in Your Care or Payment for Your Care. We may release health information about you to a friend or family member who is involved in your health care or the person who helps pay for your care. Research. We may disclose your health information without your written authorization to researchers if authorized by an Institutional Review Board or privacy board, in compliance with applicable law. Psychotherapy Notes. We will not use or disclose your psychotherapy notes without your prior
written authorization except for the following: 1) use by the originator of the notes for your treatment, 2) for training our staff, students and other trainees, 3) to defend ourselves if you sue us or bring some other legal proceeding, 4) if the law requires us to disclose the information to you or the Secretary of HHS or for some other reason, 5) in response to health oversight activities concerning your psychotherapist, 6) to avert a serious and imminent threat to health or safety, or 7) to the coroner or medical examiner after you die. To the extent you revoke an authorization to use or disclose your psychotherapy notes, we will stop using or disclosing these notes. Organ and Tissue Donation. If you are an organ donor, we may disclose health information about you to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation. As Required By Law. We will disclose health information about you when required to do so by federal, state, or local law. To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. Military and Veterans. If you are a member of the armed forces or separated/ discharged from military services, we may release health information about you as required by military command authorities or the Department of Veterans Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military authorities. Workers’ Compensation. We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness. For example, to the extent your care is covered by workers’ compensation, we will make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.

Public Health Activities. We may disclose health information about you for public health activities.
These activities generally include the following:

  • to prevent or control disease, injury or disability.
  • to report births and deaths.
  • to report child abuse or neglect.
  • to report reactions to medications or problems with products.
  • to notify people of recalls of products.
  • to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
  • to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities. We may disclose health information about you to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Lawsuits and Disputes. We may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request or other lawful process that is not accompanied by a court or administrative order, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement. We may release health information about you if asked to do so by a law
enforcement official:

  • in response to a court order, subpoena, warrant, summons or similar process.
  • to identify or locate a suspect, fugitive, material witness or missing person.
  • under certain limited circumstances, about the victim of a crime.
  • about a death we believe may be the result of criminal conduct.
  • about criminal conduct at the Health Center.
  • in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.

Coroners, Health Examiners and Funeral Directors. We may release health information about our patients to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information to funeral directors as may be necessary for them to carry out their duties. National Security and Intelligence Activities. We may release health information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law. Protective Services for the President and Others. We may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Except as described in this Notice of Privacy Practices, Family Care Health Centers will, consistent with its legal obligations, not use or disclose health information which identifies
you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in
writing at any time. If you revoke your authorization, we will no longer use or disclose your personal health information for the reasons covered by your written authorization. However,
we will be unable to take back any uses and disclosures that we already made with your prior authorization.

Your Rights:
You have certain rights with respect to your personal health information. This section of our notice describes your rights and how to exercise them:
Right to Inspect and Copy: You have the right to inspect and copy the personal health information in your medical and billing records, or in any other group of records that we maintain and use to make health care decisions about you. This right does not include the right to inspect and copy psychotherapy notes, although we may, at your request and on payment of the applicable fee,
provide you with a summary of these notes. To inspect and copy your personal health information, you must submit your request in writing to our privacy contact person identified on the first page of this notice. If you request a copy of the information, we may charge a fee for the copying and mailing costs, and for any other costs associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If your request is denied, you may request that the denial be reviewed. We will designate a licensed health care professional to review our decision to deny your request. The person conducting the review will not be the same person who denied your request. We will comply with the outcome of this review. Certain denials, such as those relating to psychotherapy notes, however, will not be reviewed. Right to Amend: If you feel that the health information we maintain about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for any information that we maintain about you. To request an amendment, your request must be made in writing, submitted to our privacy contact person identified on the first page of this notice, and must be contained on one piece of paper legibly handwritten or typed. In addition, you must provide a reason that supports your request for an amendment.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

  • was not created by us, unless the person or organization that created the information is no longer available to make the amendment,
  • is not part of the health information kept by or for Family Care Health Centers,
  • is not part of the information which you would be permitted to inspect and copy, or
  • is accurate and complete.

Any amendment we make to your health information will be disclosed to the health care professionals involved in your care and to others to carry out payment and health care operations, as previously described in this notice.

Right to Receive an Accounting of Disclosures. You have the right to receive an accounting of certain disclosures of your health information that we have made. Any accounting will not include all disclosures that we make. For example, an accounting will not include disclosures:

  • to carry out treatment, payment and health care operations as previously described in this notice.
  • To you or pursuant to your written authorization.
  • to a family member, other relative, or personal friend involved in your care or payment for your care when you have given us permission to do so.
  • to law enforcement officials.

To request an accounting of disclosures, you must submit your request in writing to our privacy contact person identified on the first page of this notice. Your request must state a time period which may not be more than six (6) years prior to the date of the request. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list; this date will not exceed 60 days from the date you made the request.

Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you may request that we not disclose information about you to a certain doctor or other health care professional, or that we not disclose information to your spouse about certain care that you received. We are not required to agree to your request for restrictions if it is not feasible for us to comply with your request or if we believe that it will negatively impact our ability to care for you. If we do agree, however, we will comply with your request unless the information is needed to provide emergency treatment. To request a restriction, you must make your request in writing to our privacy contact person identified on the first page of this notice. In your request, you must tell us what information you want to limit and to whom you want the limits to apply. Right to Restrict Disclosure to a Health Plan. You have the right to request that we not disclose health information about you to a health plan. We will agree to your request if the protected health information involved pertains solely to a health care item or service for which you or someone acting on your behalf has paid us in full, and if the disclosure is not required by law. Right to Receive Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way. For example, you can ask that we only contact you at work or by mail to a specified address. To request that we communicate with you in a certain way, you must make your request in writing to
our privacy contact person identified on the first page of this notice. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.

Right to a Paper Copy of this Notice. You have the right to receive a paper copy of this notice at any time. To receive a copy, please request it from our privacy contact person identified on the first page of this notice.

Changes to this Notice:
We reserve the right to change this notice and to make the changed notice effective for all of the health information that we maintain about you, whether it is information that we previously received about you or information we may receive about you in the future. Until a change is made, we are required by law to comply with the terms of this notice. Our notice will indicate the effective date on the first page, in the top right-hand corner. We will post a copy of our current notice in our facility and make it available on our website. We will also give you a copy of our current notice upon request.

Complaints:
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You may file a complaint by mailing us a written description of your complaint or by telling us about your complaint in person or over the telephone:

Privacy Officer
Family Care Health Centers
401 Holly Hills Avenue
314-481-1615

Please describe what happened and give us the dates and names of anyone involved. Please also let us know how to contact you so that we can respond to your complaint. You will not be penalized
for filing a complaint.

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to the U.S. Department of Health and Human Services Office of Civil Rights on this website: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. You will not be penalized in any way for filing a complaint.