Sinnissippi Centers, Inc
Notice of Privacy Practices
EFFECTIVE DATE April 14, 2003 – as modified September 22, 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.
In the course of your admission and treatment at Sinnissippi Centers, we will be collecting the following information: name; social security number; name of guardian, if appropriate; phone number; address including zip code; birth date; gender; ethnicity; payor source, including insurance companies or Medicaid or Medicare information; admission, discharge and service dates; diagnoses; health history and aspects of your personal history that relate to your condition, including your past and current use of substances; any prescribed medications you are taking, or may be prescribed. When you meet with your case worker, counselor or therapist, that professional will collect the following information: date of the meeting; the time of the meeting; the duration of the meeting; the place of the meeting; as well as the type of service provided you. Your case worker will document the content of your discussions and service as appropriate. Sinnissippi Centers will maintain the privacy of this information as outlined in this notice. You will be notified should any changes to these practices occur.
HOW YOUR INFORMATION IS USED
The information is used to provide appropriate treatment services to you. Financial information is used to set your fees, send bills to insurance or other third party payors, and send bills to you. You have the right to restrict certain Protected Health Information (PHI) from disclosure to health plans where you paid out-of-pocket, in full for that service. You must request such a restriction in writing.
Information may be used to mail you an appointment reminder, or to call you to remind you of appointments. We may leave appointment information on your telephone’s voicemail or we may send an email or text message reminder unless you request that we not do so.
Your PHI may also be included in copies of reports or letters sent to you by your case worker.
Your PHI will not be sold to any organization. It will not be used for fund-raising or marketing purposes unless you sign a specific consent requesting and allowing this.
PRIVACY AND CONFIDENTIALITY
The information you provide to us is confidential and private within the requirements of various state and federal laws. Release of this information for purposes other than conducting business or providing treatment within this agency requires that you sign an authorization for the disclosure/release of specified information. We cannot and will not release any information without such an authorization. Psychotherapy notes will only be used and disclosed with your authorization unless otherwise required or authorized by law. Children over the age of 12 require an authorization signed by the minor for the release of information before a case worker can discuss their case with their parents. In some instances, children over the age of 12 can seek counseling without their parents’ knowledge or consent. You will be notified if we become aware of a breach of your PHI.
WHEN AN AUTHORIZATION IS NOT REQUIRED
Under certain circumstances an authorization is not required. These include but are not necessarily limited to: danger of harm to yourself or others; abuse or neglect of a child; criminal activity committed on our property or against our staff; threats to the President of the United States; and, under certain conditions, subpoenas.
- You have the right to restrict to whom your information is disclosed, as allowed by law (164.512). This request must be in writing and signed and dated by you.
- You have a right to read and to request copies of your personal health information that has been generated by us. A written notice of request is required. Copies may require a copying fee. Copies will be made available to you within 30 days of your written request and subsequent to payment of fees, if applicable. Reading your client service record while onsite at our agency may require the presence of a case worker. Payment may be required for the case worker’s presence.
- You have the right to request and obtain electronic copies of your records that we have kept electronically.
- You have the right to request that information in your record be amended or corrected. This request must be in writing. The request to amend or correct will be considered by our agency, but in certain instances we may deny your request. If it is allowed, the amendment will be placed with the original information, but will not replace the original information. If your request is denied, you have the right to file a statement that you disagree with us. Our response and your statement will be filed in your client service record.
- You have the right to request an accounting of any disclosures we have made related to your confidential information, except for information we used for treatment, payment, or healthcare operations purposes or that we shared with you or your family, or information for which you gave specific consent to release. It also excludes information we were required to release.
- Such a request for accounting of disclosures must be made in writing and will apply to information released following April 14, 2003. Disclosure records will be kept for a period of six years. This accounting will be delivered to you within 60 days of your request.
- You have the right to receive a paper copy of this notice if you have requested and received an electronic copy of the notice.
NOTIFICATION OF BREACH OF INFORMATION:
You have a right to be notified if there is a breach of your unsecured protected health information. This would include information that could lead to identity theft. You will be notified if there is a breach or a violation of the HIPAA Privacy Rule and there is an assessment that your PHI may be compromised.
QUESTIONS AND COMPLAINTS
If you have questions or wish to receive a copy of our Notice of Privacy Practices, or if you have any complaints, you may contact and/or submit your written request to our Privacy Officer. You may also contact our office for further information.
Complaints about any of the above processes will follow the agency’s grievance process. Concerns may initially be addressed to your case worker. If they are not settled with your case worker, they may then be addressed to the supervisor or program director. You may file a formal grievance form in writing at any time.
For your concerns regarding this Notice of Privacy Practices, you may contact: Privacy Officer, Sinnissippi Centers, Inc, 325 IL Rt 2, Dixon, IL 61021; or by telephoning 815-284-6611 or 800-242-7642; or by email at www.sinnissippi.com.
If you believe that our agency has violated your privacy rights, you may also contact the Secretary of U.S. Department of Health and Human Services. Sinnissippi Centers will not retaliate against you for filing a complaint.
Changes in Policies