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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.
The Coordinating Council for Children in Crisis, Inc.
is federally mandated to maintain the privacy of your information
and wants you to know about our practices for protecting your information.
The Coordinating Council for Children in Crisis, Inc.
is required to abide by the terms of this notice. The information
we maintain may come from any of the providers from whom you have
received services. We will not use or disclose your information
without your permission, except as described in this notice.
We reserve the right to change our practices and to make the new
provisions effective for all information we maintain. Should our
information practices change, we will amend this notice and post
a notice of the changes, which will be made available to anyone
upon request. This notice is effective as of October 1, 2003.
USES AND DISCLOSURES: In general, it is our policy
to obtain written authorization for release of information prior
to making a disclosure. You may revoke an authorization at any time,
except to the extent that we have already acted on it.
We may use
your information without authorization for:
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Treatment, e.g., share information with other providers
involved in your care
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Payment, e.g., to the state Department of Administrative
Services to bill for your healthcare services
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Healthcare operations, e.g., to internal staff for evaluation
of the quality of services provided
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Reminding you of appointments
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Other permitted
disclosure of your information without authorization might
include the following:
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Disclosures required by law, e.g., to the Department
of Children and Families when a law requires that we report
suspected abuse or neglect
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For research, audit or evaluations
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Public Health, e.g., mandated reporting of disease, injury
or vital statistics
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To avert a serious threat to the health or safety of
you or others
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As a response to a court order, e.g., a judge orders
specific portions of your record as a result of a legal
matter
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If deceased, limited information to coroners, examiners
or funeral directors
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WHAT ARE YOUR RIGHTS? YOU HAVE THE RIGHT TO:
- Request restrictions on certain uses and disclosures of your
information
- Receive reasonable confidential communication of information,
e.g., contact you at a place of your choosing
- Inspect and copy your record by written request, with some exceptions.
Coordinating Council for Children In Crisis, Inc. reserves the
right to deny the request, to which you may make a further appeal
- Request an amendment of your record. Coordinating Council for
Children In Crisis, Inc. reserves the right to deny the request,
to which you may make a further appeal
- Receive an accounting of Coordinating Council for Children In
Crisis, Inc. disclosures of your information during the six years
prior to your request. Accountings of disclosures start as of
October 1, 2003 and are unavailable prior to that time.
HOW CAN YOU REPORT A PROBLEM?
If you feel your privacy rights have been violated, you may file
a complaint with: the Coordinating Council for Children
In Crisis, Inc. Privacy Officer, Jacquelyn Farrell,
LCSW, (203) 624-2600 ext. 310, and appeals may be directed
to Executive Director Cheryl Burack, MS, (203) 624-2600
ext. 303. Further appeals may be directed to the Secretary
of the United States Department of Health and Human Services (DHHS),
Office for Civil Rights (OCR) at: U. S. DHHS, OCR, 200 Independence
Avenue, S.W., Room 509F, Washington, DC 20201.
There will be no retaliation for filing a complaint.
WOULD YOU LIKE MORE INFORMATION?
If you have questions and would like more information, you may
contact the Coordinating Council for Children In Crisis,
Inc. at (203) 624-2600.
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