Notice of Privacy Practices
CDS Family & Behavioral Health Services, Inc.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. Please understand that if you are in a CDS substance abuse prevention, intervention, or treatment program, your records are additionally protected under the Federal regulations governing confidentially of alcohol and drug abuse participant records (42 CFR, Part 2.) PLEASE REVIEW THIS FORM CAREFULLY.
CDS is required by law to maintain the privacy of certain health care information about our participants. The law also requires health care providers like CDS to give you a Notice like this one and to follow its standards.
CDS and Your Protected Health Care Information
As a part of our day-to-day activities, CDS may need to use and disclose (share) your protected health care information for several purposes without first getting your written approval. Those purposes include:
- Your treatment and/or services. [For example, in situations where safety is compromised, CDS has a responsibility to protect and warn.]
- Payment for your treatment and/or services. [For example, CDS may share information with the funding source that pays for services.]
- CDS operations. [For example, appropriate CDS staff may discuss your situation with other members of our staff to ensure you receive the best treatment and/or services possible.]
- CDS may contact you based upon your protected health care information. [For example, CDS may call you to arrange your appointments, provide you with information about benefits, services, and/or treatment that may be available to you as a participant of CDS.]
- CDS may provide information to entities or agencies that oversee health care or are working on threats to public safety from unsafe products, diseases, abuse, neglect, domestic violence, and other crimes.
- CDS may provide information to licensed researchers who are under strict rules regarding how they use and disclose protected health care information. Those researchers, as an example, may use the information about participants for a study to improve services.
- CDS enters data into the Homeless Management Information System (HMIS) through established Business Associate Agreements with local HMIS Administrative Agencies regarding homeless minors sheltered by CDS Interface Youth Programs to facilitate access to resources and funding for the provision of services to homeless youth. Records entered into this system, can not be viewed by system users at other participating agencies.
No other uses and disclosures of your protected health care information will occur without your written authorization; and, if you sign such an authorization, you have the right to cancel it at any time.
Your Rights Regarding Your Protected Health Care Information
Under the law, you have several rights that CDS is committed to upholding. Those rights include:
- The right to request restrictions on some of the ways CDS uses and discloses your information. These restrictions can go beyond the restrictions already in the law. However, CDS may not always agree to implement these additional restrictions.
- The right to receive confidential communications. While CDS cannot promise to communicate in every possible way participants might request, we will work with you to find a practical way of communicating with you in confidence.
- The right to inspect and get copies of your health care information held by CDS by making a request in writing. CDS, however, may charge a reasonable fee to cover only the cost of providing this information.
- The right to request that CDS amend or correct information about you. To make such a change, CDS will ask you to make the request in writing with a description of the reason you want your record changed. CDS may not always agree to such requests.
- The right to a list of CDS disclosures of your protected health care information that were not authorized by you and the disclosures that were unrelated to treatment, payment and CDS operations.
If you have any questions or complaints about the way CDS handles your protected health care information or if you believe your privacy rights have been violated, contact the CDS Privacy Officer at (352) 244-0628 or in person. You can also contact the Secretary of the U.S. Department of Health and Human Services. Please note that there will be no retaliation against you for filing a complaint or making requests regarding your health care information, or for disagreeing with CDS related decisions.
CDS may need to change its privacy practices from time to time. Before making such changes, however, CDS will modify this Notice and begin distributing it to participants when they are treated by CDS. These new practices will then apply to all information held by CDS. Anyone has a right to get a paper copy of the latest version of this Notice, at any time, by asking the CDS receptionist.
CDS Family & Behavioral Health Services, Inc.
Privacy Officer, Samuel P. Clark
1218 NW 6th Street