CHILDREN’S SUPPORTIVE SERVICES, INC.
NOTICE OF PRIVACY PRACTICES

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

PLEASE REVIEW IT CAREFULLY.

If you have any questions about this Notice, please contact Children’s Supportive Services Inc.'s Privacy Officer at 208-524-8974.

You may request a copy of this notice at any time. Copies of this notice are available at all Children’s Supportive Services offices.

PURPOSE OF THIS NOTICE

This Notice of Privacy Practices describes how Children’s Supportive Services Inc. (CSS) may use and disclose your protected health information. It also describes your rights to access and control over your protected health information. “Protected health information” is information about you that relates to your past, present or future physical or mental health and related health care services

We are required to abide by the terms of this Notice of Privacy Practices. We may; however; change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. We will provide you with any revised Notice of Privacy Practices upon your request.

We are required to:

Use and disclose confidential information as required by law;
Maintain the privacy of your information;
Give you this notice of our legal duties and privacy practices for your information; and
Follow the terms of the notice that is currently in effect.

This Notice of Privacy Practices does not affect your eligibility for benefits or services.

YOUR RIGHTS ABOUT YOUR CONFIDENTIAL INFORMATION

1. Right to Review and Copy

You have the right to ask to review and copy your information as allowed by law.

If you would like to ask to review and copy your information, a "Records Request" form is available at Children’s Supportive Services offices. You must complete this form and return it to a CSS office for processing. CSS will respond to your request within 30 working days of receipt of your request. Children’s Supportive Services may extend the response time 7 additional working days if the information you have requested cannot be located or retrieved within the original 30 days. You will be sent a notification of an extension and the reason for the extension.

If you ask to receive a copy of the information, we may charge a fee. The fee will be 10¢ per page.

You will be told if there is information we are legally prevented from disclosing to you.

2. Right to Amend

You have the right to ask us to make changes to your information if you feel that the information we have about you is wrong or not complete.

If you would like to ask Children’s Supportive Services to change your information, a "Request to Amend Records" form is available at CSS offices. You must complete this form and return it to a CSS office for processing. Children’s Supportive Services will respond to your request within 30 days.

We may deny your request if you ask us to change information that:

Was not created by CSS;
Is not part of the information kept by or for CSS;
Is not part of the information which you would be allowed to review and copy; or
We determine is correct and complete.

3. Right to Restrict Health Information Disclosures

You have the right to ask us not to share your health information for your treatment or services, or normal business purposes. You must tell us what information you do not want us to share and whom we should not share it with.

If you would like to ask Children’s Supportive Services to not share your information, a "Request to Restrict Health Information Disclosures" form is available at CSS offices. You must complete this form and return it to a Children’s Supportive Services office for processing. CSS will respond to your request within 30 days.

If we agree to your request, we will comply unless the information is needed to give you emergency treatment, or until you end the restriction.

4. Right to an Alternate Means of Delivery

You have the right to ask that we deliver your information to you at a different mailing address. For example, you can ask that we send your information from one program to a different mailing address from other programs that you receive services or benefits from.

If you would like to ask for an alternate means of delivery for your information, a "Request for Alternate Means of Delivery" form is available at Children’s Supportive Services offices. You must complete this form and return it to a CSS office for processing. CSS will respond to your request within 30 days.

We will not ask you the reason for your request. Reasonable requests will be approved.

5. Right to a Report of Health Information Disclosures

You have the right to ask for a report of the disclosures of your health information. This report of disclosures will not include when we have shared your health information for treatment, payment for your treatment or normal business purposes, or the times you authorized us to share your information.

If you would like to ask for a report of your health information disclosures, a "Request to Receive a Report of Health Information Disclosures" form is available at Children’s Supportive Services offices. You must complete this form and return it to a CSS office for processing. CSS will respond to your request within 30 days.

The first report you ask for and receive within a calendar year will be free of charge. For additional reports within the same calendar year, we may charge you for the costs of providing the report. We will tell you the cost and you may choose to remove or change your request at that time before any costs are charged to you.

HOW CHILDREN’S SUPPORTIVE SERVICES MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

The following are examples of the types, uses or disclosures of your protected health care information this agency is permitted to make once you have signed CSS’s “Consent for Treatment and Coordination of Services” form.

Times when your permission is not needed

TREATMENT. We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has also obtained your permission to have access to your protected health care information. We will also disclose protected health information to other physicians/providers who may be treating you when we have the necessary permission from you to disclose your protected health information.

PAYMENT.

Your protected health information will be used and shared, as needed, so that the treatment and services you receive through Children’s Supportive Services can be paid. For example, we may need to give your medical insurance company information about the treatment or services that you received so that your medical insurance can pay for the treatment or services.

HEALTH CARE OPERATIONS.

We may use or disclose, as needed, your protected health information in order to support the business activities of your provider’s practice. This is necessary for the daily operation of Children’s Supportive Services and to make sure that all of our clients receive quality care. For example, we may use your information to review our provision of treatment and services and to evaluate the performance of our staff in providing services for you.

Times when your permission is needed

For reasons other than Treatment, Payment or Healthcare Operations.

There may be times when Children’s Supportive Services may need to use and share your information for reasons other than for treatment, payment and business operations as explained above. For example, if CSS is asked for information from your employer or school that is not part of treatment, payment or business operations, CSS will ask you for a written authorization permitting us to share that information. If you give us permission to use or share your information, you may stop that permission at any time, if it is in writing. If you stop your permission, we will no longer use or share that information. You must understand that we are unable to take back any information already shared with your permission.

Individuals that are part of your care or payment for your care.

We may give your information to a family member, legal representative, or someone you designate who is part of your care. We may also give your information to someone who helps pay for your care. If you are unable to say yes or no to such a release, we may share such information as needed if we determine that it is in your best interest based on our professional opinion. Also, we may share your information in a disaster so that your family or legal representative can be told about your condition, status and location.

Other uses and sharing of your information that may be made without your permission

For Appointment Reminders
For Treatment Alternatives
As Required by Law
For Public Health Risks
To Law Enforcement
For Lawsuits and Disputes
To Coroners, Medical Examiners, Funeral Directors
For Organ and Tissue Donation
For Emergency Treatment
To Prevent a Serious Threat to Health or Safety
To Military and Veterans organizations
For Health Oversight Activities
For National Security and Intelligence Activities
To Correctional Institutions

SPECIAL REQUIREMENTS

Information that has been received from a federally funded substance abuse treatment program or through the infant and toddler program will not be released without specific authorization from the individual or legal representative.

CHANGES TO THIS NOTICE

Children’s Supportive Services has the right to change this notice. A copy of this notice is posted at our CSS offices. The effective date of this notice is shown in the top right-hand corner of each page. If Children’s Supportive Services makes any changes to this Notice of Privacy Practices, CSS will follow the terms of the notice that is currently in effect.

COMPLAINTS

If you believe your information privacy rights have been violated, you may file a written complaint with Children’s Supportive Services Inc. All complaints turned in to CSS must be in writing on the "Privacy Complaint" form that is available at CSS offices. To file a complaint with CSS, send your completed Privacy Complaint form to:

              Children’s Supportive Services Inc.
              Privacy Officer
              1322 East Lincold Road
              Idaho Falls, ID 83404

If you believe your health information privacy rights have been violated, you may also file a complaint with the Secretary of Health and Human Services. Your complaint must be in writing and you must name the organization that is the subject of your complaint and describe what you believe was violated. Send your written complaint to:

              Secretary of Health and Human Services
              200 Independence Avenue Southwest
              Washington, D.C. 20201

A complaint filed with either Children’s Supportive Services Inc. or the Secretary of Health and Human Services must be filed within 180 days of when you believe the privacy violation occurred. This time limit for filing complaints may be waived for good cause.

You will not be punished or retaliated against for filing a complaint.

This notice was published and becomes effective April 14, 2003.

Back to Home Page

CHILDREN’S SUPPORTIVE SERVICES, INC. NOTICE OF PRIVACY PRACTICES