Our Responsibilities:
We are required by law to protect the privacy of our client’s health information and will not use or disclose health information without written permission, except as described in this Notice. If we change our practices and this Notice, we will give you a revised Notice.

Throughout this Notice, we use the term “protected health information” or PHI. PHI is information about our client that may identify him or her and relates to their past, present or future physical or mental health condition and related health care services.

You Have A Right To:

• Request that we limit certain uses and disclosures of client information.

You have the right to request that we limit how we use or disclose client’s PHI to carry out the plan of care, get paid for our services or administer the Agency. (This is also referred to as “treatment, payment or health care operations). You also have the right to request a restriction on the PHI we disclose about our client to someone who is involved in their care or payment for their care, such as a family member or payment source. However, we are not required to agree to your request. To request limitations or restrictions, you must send a written request to Schwartz Center for Children – Attn: Privacy Officer.

• See and get a copy of your information.
Clients (Parents / Guardians) have the right to look at and copy PHI contained in our medical and billing records for as long as the Agency maintains the information. To look at or copy your PHI, please send a written request to the attention of the Privacy Officer. If you request a copy of the information, we may charge you a fee for the costs of copying, mailing, or other supplies that are necessary to grant your request. We may deny your request in certain limited circumstances. If you are denied the right to see or copy your PHI, you may request that the denial be reviewed.

• Correct or update of information.

If you feel that PHI we have about our client is incomplete or incorrect, you may request that we correct or update (amend) the information. You may request an amendment for as long as we maintain the health information. To request an amendment, you must send a written request to the attention of the Privacy Officer. In addition, you must include the reasons for your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may prepare a response to your statement, which we will provide to you.

• Receive a list of the disclosures of your information.

You have the right to receive a list (‘accounting’) of the disclosures we have made of your PHI for most purposes other than treatment, payment or health care services. The accounting will not include disclosures we have made directly to you, disclosures to family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other limitations. To request an accounting, you must submit your request in writing to the Schwartz Center for Children’s Privacy Officer. Your request must state the time period, but may not be longer than six years. You may be charged for the cost of providing this information. We will notify you of the cost involved and you may choose to withdraw or modify your request at any time.

• Request communications of your information by alternative means or at alternative locations.

For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of PHI, you must submit your request in writing to the Privacy Officer. Your request must state how or when you would like to be contacted. We will accommodate all reasonable requests.

• Withdraw your consent to use or disclose PHI except to the extent that action has already been taken.

You may withdraw or ‘revoke’ consent in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already take action in reliance on the consent. We may refuse to continue to treat an individual that revokes his or her consent.

• Obtain a paper copy of the Notice of Privacy Practices upon request.
You may request a copy of this Notice at any time. To obtain additional copies of this notice, contact the Privacy Officer.

Using and Disclosing Your Protected Health Information
We will use client information for care and treatment. For example, information obtained by our staff / consultants or other members of the team will be recorded in the record and used to determine the plan of care. Clinicians will document in the record his or her expectations of the members of the team. Members of the healthcare team will then record the actions taken and their observations.

We will use client information for payment. For example, a bill may be sent to you, your insurance company, Department of Public Health or Medicaid. The information on or accompanying the bill may include information that identifies the client, as well as the treatment provided.

We will use client protected health information to operate our Agency. For example, members of our quality assurance team may use information in the record to assess the care and outcomes in client cases.

We may use or disclose your PHI without your consent in the following circumstances:

• When a disclosure is required by federal, state or local law, judicial or administrative proceedings or law enforcement.
For example, we may disclose client PHI for law enforcement purposes as required by law or in response to a valid subpoena. If clients are involved in a lawsuit or a dispute, we may disclose client PHI in response to a court or administrative order. We may also disclose health information about the client in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell the client about the request or to obtain an order protecting the information requested.

• Communication with family involved in client care or payment for client care:
Our staff and consultants, using their professional judgement, may disclose to a family member, or any other person you identify, PHI related to that person’s involvement in your care or payment related to your care, unless you object.

• Food and Drug Administration (FDA):
We may disclose to the FDA PHI relative to adverse events with respect to food, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

• Worker’s Compensation:
We may disclose client PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.

• Public Health and health oversight activities:
As required by law, we may disclose client PHI to public health or legal authorities charged with preventing or controlling disease, injury or disability. We may disclose client PHI to an oversight agency for activities authorized by law, including audits and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

• Specific government functions:
For example we may disclose PHI to authorized federal officials for national security purposes, such as protecting government officials and performing intelligence activities or investigations.

• Business Associates:
There are some services provided by this Agency through contracts with business associates such as billing companies. When these services are contracted for, we may disclose client PHI to our business associates so that they can perform the job we have asked them to do. We require our business associates to appropriately safeguard client information.

• Personal Communication:
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

• Fundraising:
We may contact you as part of a fundraising effort for our Agency.


• To avert a serious threat to health or safety:
We may use and disclose client PHI when necessary to prevent a serious threat to health and safety or the health and safety of the public or another person.

• Victims of abuse or neglect:
We may disclose client PHI to a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary.

Before using or disclosing PHI for any other purpose, we will obtain written authorization. The parent/guardian may withdraw or ‘revoke’ this authorization in writing at any time. After we receive your written revocation, we will stop using or disclosing client PHI, except to the extent that we have already taken action in reliance on the authorization.

For More Information or to Report a Problem
If you have questions or would like additional information about the Agency’s privacy practices, you may contact the Director of Operations at 1 Posa Place, Dartmouth, Ma. 02747, 508-996-3391. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer—at the Schwartz Center or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.