Children’s Therapy Works, Inc.

         Notice of Privacy Practices                     Effective 10/1/04

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.

We are required by law to:

  1. Make sure that protected health information is kept private.

  1. Provide you with this notice of my legal duties and privacy practices relating to your protected health information.

  1. Follow the terms of this notice that is currently in effect.

Privacy Practices

We are required by law to:

Make sure that protected health information is kept private.

Protected health information is information that identifies you and relates to your past, present or future physical or mental condition and related healthcare services.

Provide you with this notice of my legal duties and privacy practices relating to your protected health information.

The notice also describes your rights with respect to protected health information about you.

Follow the terms of this notice that is currently in effect.

We reserve the right to change our practices and this notice and to make the new notice effective for all protected health information we maintain.  Upon request, we will provide the revised notice to you.  

Uses and disclosures of protected health information

Your protected health information may be used and disclosed by the healthcare professionals who are involved in your care and treatment for the purpose of providing healthcare services to you.  Your protected heath information may also be used and disclosed to obtain payment for the services and to support the operation of the healthcare center.  

  1. In accordance with federal law, we will not disclose your medical information without your authorization, except as described in this notice.

Treatment: We will use and disclose your protected health information to provide you with treatment or services.  Information obtained by a nurse, physician or other member of the healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you.  Members of your healthcare team will record the actions they took and their observations.  That way, the physician and the healthcare team will know how you are responding to treatment.   We will also provide your subsequent healthcare provider with copies of reports to assist him or her in treating you.

Payment: Your protected health information will be used, as needed, to obtain payment for your healthcare services.  We will contact your insurer or third-party payer to determine whether it will pay for the services we provided and to determine the amount of your co-payment.

Healthcare Operations: We may disclose your protected health information in order to support the operations of the healthcare center and monitor the quality of the care provided.  

Other uses and Disclosures

In some limited situations the law allows or requires us to use or disclose your health information for purposes beyond treatment, payment or operations.  Not all of these situations will apply and some may never occur at this healthcare center.

Business Associates: If services are contracted with business associates, we will disclose your health information to them so they can perform the duties we have asked them to do.  We require all business associates to appropriately safeguard the protected health information.  

Notification: We may use or disclose your protected health information to notify, or assist you in notifying a family member, personal representative, or another person responsible for your for your care, about your location and general health condition.

Funeral Director, Coroner and Medical Examiner: We may disclose health information to funeral directors, coroners and medical examiners to help them carry out their duties.

Organ Procurement Organizations: We may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.

Food and Drug Administration: We may disclose to the FDA health information relative to adverse events, product defects, or post marketing surveillance information to enable product recalls, repairs or replacement.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability, including child abuse and neglect.

Victims of Abuse, Neglect or Domestic Violence: We may disclose to appropriate governmental agencies, such as adult protective or social service agencies, your health information.  We will only make this disclosure if you agree or when required or authorized by law.  

Health Oversight: In order to oversee the health care system, government benefits programs, entities subject to governmental regulation and civil right laws for which health information is necessary to determine compliance, we may disclose health information for over sight activities authorized by law, such as audits and civil, administrative or criminal investigations.

Court Proceeding: We may disclose health information in response to requests made during judicial and administrative proceedings, such as court orders or subpoenas.  

Law Enforcement: We may disclose protected health information about you for law enforcement purposes as required by law or in response to a valid subpoena, crimes on premises and other legal process.  

Correctional Institutions: If you are or become an inmate of a correctional institution, we may disclose protected health information to the institution or its agents when necessary for your health or the health and safety of others.  

Threats to Public Health or Safety: We may disclose information when it is in good faith belief, consistent with ethical and legal standards, that it is necessary to prevent or lessen a serious and imminent threat or is necessary to identify or apprehend an individual.

National Security, intelligence activities, and protective services for the president: We may release protected health information about you to authorized federal officials for the intelligence, counterintelligence, protective services to the president and other national security activities authorized by law.

Worker’s Compensation: We may disclose protected health information about you as authorized by law and as necessary to comply with the laws relating to worker’s compensation or similar programs established by law.  

Other Uses

  1. To contact you to remind you of an appointment for treatment

  1. To describe or recommend treatment alternatives to you

  1. To furnish information about health related benefits and services that may be of interest to you

Your Health Information Rights

You have the following rights regarding your protected health information:

You may request a restriction on certain uses and disclosures of your protected health information. You have the right to request additional restrictions on the use or disclosure of your protected health information at the healthcare center.  We are not required to agree with those restrictions.

You may inspect or obtain a copy of your protected health information.  You have the right to inspect or obtain a copy of your protected health information that we maintain.  You must submit your request in writing.  There may be a reasonable fee charged for copies, postage, and supplies that are necessary to fulfill the request.

You may request communications of protected health information by alternative methods. You have the right to request that we communicate confidential information to you by alternative means.  You may request that we contact you at work or by mail. You must submit your request in writing.  

You may request an amendment to your protected health information.  You have the right to request that we change the records we maintain about you if you feel that the information is incomplete or incorrect.  To request an amendment, you must submit it in writing.  You must also give a reason to support your request. In certain circumstances, your request may be denied.  

You may obtain a copy of this notice. You have the right to obtain a copy of this notice at any time and one will be given to you.  Copies may be obtained at the healthcare center.

Legal Duties

We will obtain your written authorization before using or disclosing your protected health information for purposes other than those listed in this notice or as otherwise permitted or required by law.  You may revoke an authorization in writing at any time.  Upon receipt of the written revocation, we will stop using or disclosing protected health information about you, except to the extent that we have already taken action in reliance on the authorization or required by law.  

Complaints

Send to: Children’s Therapy Works, Inc.  316 SW 4th St, Ste 23    Willmar, MN 56201

If you believe that your privacy rights have been violated a complaint may be made; contact, Amy Danielson, our privacy officer.  You may also file a complaint with the Secretary of Health and Human Services.