THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

Children’s Aid and Family Services, Inc. (hereinafter, “the agency”) considers personal information to be confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as our own agency privacy policies.

We may use or disclose medical information about you as required for purposes of treatment, payment or healthcare operations, such as reviewing and paying claims and utilization review. Some of these functions may be handled directly by our employees, while other functions are performed by other business associates under contract with us. Regardless of who handles your protected health information (PHI), the agency has established policies and entered into formal agreements with our business associates that are designed to prevent the misuse or unnecessary disclosure of such information.

As required by Federal law, this Notice is being provided to you to describe the agency’s health information privacy procedures and policies. It also provides details regarding certain rights you may have under Federal law regarding medical information about you maintained by the agency.

You should review this Notice carefully. The agency is required to abide by the terms of this Notice while it is in effect. This Notice is effective September 1, 2010, and will remain in effect until it is revised.

If the agency’s health information privacy policies and procedures are changed so that this Notice is no longer accurate, the agency will provide a new updated Privacy Notice. The agency reserves the right to apply any changes in its health information policies retroactively to all health information maintained by the agency, including information received or created before the policies were revised.

Protected Health Information
This Notice applies to health information held by the agency that includes identifying information about you (or your spouse or dependents). Such information, regardless of the form in which it is kept, is referred to in this Notice as Protected Health Information, or “PHI”. For example, any health information that includes details such as your name, street address, dates of birth, or social security number is PHI. However, information that does not include such identifying details may be considered PHI if that information could reasonably be expected to allow the person reviewing that information to identify you as the subject of the information. Information that the agency possesses that is not PHI is not covered by this Notice and such information may be used for any purpose that is consistent with applicable law and with the agency’s policies and requirements.

How the Agency Uses or Discloses Protected Health Information
PHI may be used or disclosed by the agency as necessary for treatment, payment or operational purposes. Specifically, PHI may be used or disclosed for the following purposes:

Treatment. With some exceptions where your specific authorization may be necessary, we may disclose your health information to other health care providers who are involved in your care. For example, we may disclose your medical history to a hospital or treating doctor if you need medical attention while at our facility, or to a residential care program. where you will be referred. Reasons for such disclosures may include: getting them the medical history information they need to appropriately treat your condition, coordinating your care or scheduling necessary testing.

Payment. If the agency needs PHI to bill for services provided to you, the agency may use or disclose PHI in a number of ways – in conducting utilization and medical necessity reviews; coordinating care; determining eligibility; reviewing claims or for similar payment-related purposes. The agency may use that information or request that information, and review the information for payment purposes.

Other Health Care Operations. The agency may also use PHI as needed for various purposes that are related to its operation. These purposes include quality assessment and review programs, utilization review programs, contacting providers or other health care providers regarding treatment alternatives, and other functions that are appropriate for purposes of operation.

In addition to the typical purposes described above, PHI may also be used or disclosed as permitted or required under applicable law for the following purposes:

Use Or Disclosure Required By Law. If the agency is legally required to provide PHI to a government agency or anyone else, it will do so. In such cases, the agency will make reasonable efforts to avoid disclosing more information than required by applicable law.

Disclosure For Public Welfare. The agency may disclose PHI to address matters of public interest as required or permitted by law (for example, child abuse and neglect, threats to public health and safety, and matters of national security).

Health Oversight Activities. The agency may disclose PHI to health oversight agencies, including state insurance departments, boards of pharmacy, U.S. Food and Drug Administration, U.S. Department of Labor and other Federal, State, or local agencies that are responsible for overseeing the health care system or particular government program for which health information is needed, for oversight activities authorized by law.

Disclosures for Judicial and Administrative Proceedings. The agency may disclose PHI in response to a court order or other lawful process.

Disclosures for Law Enforcement Purposes. The agency may disclose PHI for a law enforcement purpose to a federal, state or local law enforcement official if certain detailed restrictive conditions are met.

Disclosures for Research Purposes. If certain detailed restrictions are met, the agency may disclose PHI for research purposes.

Uses and Disclosures Not Mentioned Above: Authorization Required
The agency will not use or disclose PHI for any purpose that is not mentioned above except as specifically required or permitted by law or authorized by you. If the agency needs to use or disclose PHI for a reason not listed above or required or permitted by law, it will request your permission for that specific use and will not use PHI for that purpose except according to the specific terms of your authorization. You may complete an Authorization for Release of Information Form if you want the agency to disclose health information to someone else at your request, for any reason. Any authorization you provide will be limited to specific information, and the intended use or disclosure as well as any person or organization that is permitted to use, disclose or receive the information must be specified in the authorization.

Also, an authorization is limited to a specific limited time period and it expires at the end of that period. You always have the right to revoke a previous authorization by making a written request to the agency. The agency will honor your request to revoke an authorization but the revocation will not apply to any action that the agency took in accord with the authorization before you informed the agency that you were revoking the authorization.

Your Health Information Rights
Under Federal law, you have the following rights:

You may request restrictions with regard to certain types of uses and disclosures. This includes the uses and disclosures described above for treatment, payment and other health plan operations purposes. We may consider but may not agree to such requests. If the agency agrees to a restriction you request, it will abide by the terms of that restriction. However, under the law, the agency is not required to accept any restriction. (Some exceptions may apply if payment is paid fully out of pocket at the time of service).

If PHI is being provided to you, you may request that the information be provided to you in a confidential manner. This right applies only if you inform the agency in writing that the ordinary disclosure of part or all of the information might endanger you. For example, an individual may request that information about certain types of treatment be sent to a different address than the home address. The agency will honor such requests as long as they are reasonable.

You may request access to certain medical records possessed by the agency and you may inspect or copy those records. We may ask you to make your request in writing and, in certain cases, may deny the request.

You may request that Protected Health Information maintained by the agency be amended. If you feel that certain information maintained by the agency is inaccurate or incomplete, you may request that the information be amended. The agency may deny your request if it finds that the information is accurate and complete. If the agency denies your request, you may file a written statement of disagreement. The agency will normally respond to a request for an amendment within 30 days after it receives your request. In certain cases, the agency may take up to 30 additional days to respond to your request.

You have the right to receive details about certain non-routine disclosures of health information made by the agency. You may request an accounting of all disclosures of health information made by the agency about you, such as disclosures of health information to government agencies, with certain exceptions. The request will not apply to any disclosures made before September 1, 2010 or for any period earlier than 6 years from the date your request is properly submitted to the agency. If you request an accounting of disclosures more than once in a 12-month period, the agency may charge you a reasonable fee.

You have the right to receive a paper copy of this Privacy Notice. If the agency provides this Notice to you in an electronic form, you may request a paper copy and the agency will provide one.

Health Information Complaint Procedures
If you believe your health information privacy rights have been violated, you may file a complaint with the agency. To file a complaint, you should contact:

Silvia G. Gerges, M.A., Esq.
Compliance and Quality Systems Auditor
200 Robin Road
Paramus, NJ 07652
(201) 261-2800

In addition to your right to file a complaint with the agency, if you feel your privacy rights have been violated, you may file a complaint with the U.S. Department of Health & Human Services and we will provide you with an address upon your request. You will never be penalized or retaliated against in any way as a result of any complaint that you file.

Additional Information: After reading this Notice, if you have any questions about the agency’s health information privacy policies and procedures or if you need additional information, you should contact:

Silvia G. Gerges, M.A., Esq.
Compliance and Quality Systems Auditor
200 Robin Road
Paramus, NJ 07652
(201) 261-2800