If you have any questions about this notice, please contact our Privacy Officer at (563) 583-7357 or toll free at (877) 437-6333

WHO WILL FOLLOW THIS NOTICE

This notice describes our agency's practices and that of:

• Any health care professional authorized to enter or review information into your treatment record.



• All programs of Hillcrest Family Services, except Hillcrest schools, Adoption Program, and Big Brothers Big Sisters of Dubuque County.



• Any member of a volunteer group we allow to help you while you are being helped by Hillcrest staff.



• All employees, staff, students, and other Hillcrest personnel.



• Hillcrest sites and programs follow the terms of this notice except those listed above. In addition, these sites and programs may share health information with each other for treatment, payment or agency operations purposes described in this notice.

• make sure health information that identifies you is kept private;



• give you this notice of our legal responsibilities with respect to your health information and



• follow the terms of the notice that is currently in effect.

• For Treatment. We may use health information about you to provide you with health care, treatment or services. We may give out the minimum necessary health information about you to doctors, nurses, technicians, health care interns or students, clergy, social workers, counselors, direct care staff, pharmacists or others who are involved in your care. For example, clinicians providing you a service need to be aware of those events in your past, which have caused you emotional or psychological harm. Different departments of this agency also may share health information about you in order to coordinate your medical or mental health treatment. Counselors, therapists, mental health technicians may disclose health information about you to their supervisor or the Clinical Director during a case consultation with the intent of improving current services and preparing for aftercare.



• For Payment. We may use and give out health information about you so that the treatment and services you receive from Hillcrest Family Services may be billed to and payment may be collected from you, an insurance company or a third party such as a county. For example, we may need to give your insurance plan information about the services you received at Hillcrest so your health plan will pay us for the service. We may also tell your health plan about a treatment you are going to receive in order to get prior approval or to determine whether your plan will cover the treatment.



• For Health Care Operations. We may use and give out health information about you for agency operations. These uses and disclosures are necessary to run the agency and make sure that all of the individuals being served receive quality care. For example, we may use health information to send satisfaction surveys or gather data to improve our programs here at Hillcrest. Personal health information will be taken out unless it is necessary for state staff or other persons to review our work.
  
  Individual's records will be handled by authorized people and stored in a designated secured area. Only authorized people will have access to both open and closed files.
  
  During a meeting with a supervisor, health information may be shared when discussing your treatment needs. Individuals involved during a supervision meeting may include the Clinical Director, the therapist you work with, referring worker, a nurse, family/support individual, a psychologist or psychiatrist or direct care staff such as a youth care worker.



• Appointment Reminders. We may use and give out health information to contact you as a reminder that you have an appointment for services at Hillcrest, except for the Hillcrest Health Clinic.



• Business Associates. There are some services provided in our organization through contracts with business associates. Examples include financial audits, computer software vendors, etc. We may disclose your health information to our business associates so they can perform the job we've asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.



• Treatment Alternatives. We may use and give out health information to tell you about possible treatment options that may be of interest to you.



• Health-Related Benefits and Services. We may use and give out information to tell you about health-related benefits, health services or health education classes that may be of interest to you.



• Fundraising Activities. We may use information about you in order to help us raise money for Hillcrest. We would only release information such as your picture or first name with your written permission.



• Hillcrest Directory of Persons Served. Hillcrest keeps a list of persons we have served or are serving. The information on the list includes name, program, date of admission, and discharge. This information is used primarily for the receptionist to get phone calls and mail to you in the correct program. We may also give out health information about you to the Red Cross or other agencies, helping with a disaster relief effort (fire, tornado) so that your family can be told about your location and condition.



• Individuals Involved in Your Care or Payment for Your Care. We may release health information about you to a caregiver that may be a friend or family member. We may also give information to someone who helps pay for your care.



• Research. Sometimes, with your written permission, we may use and give out health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all individuals who have received one type of treatment to those who have received another, for the same condition. All research projects, however, are subject to a special approval process. We will ask for your specific permission if the researcher will have access to your name, address or other types of information.



• As Required By Law. We will give out health information about you when required to do so by federal, state or local law.

• Military. If you are a member of the armed forces, we may give out health information about you as required by military authorities. We may also give out health information about foreign military personnel to the appropriate foreign military authority.



• Workers' Compensation. We may give out health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.



• Public Health Risks (Health and Safety to you and/or others). We may give out health information about you for public health activities. We may use and give out health information about you to agencies when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. These activities generally include the following:


• to prevent or control disease, injury or disability;



• to report births and deaths;



• to report child or dependent adult abuse or neglect



• to report reactions to medications, medication errors or problems with products;



• to let people know about recalls of products they may be using;



• to let a person know who may have been exposed to a disease or may be at risk for catching or spreading a disease or condition;



• to let the appropriate government authority know if we believe an individual has been the victim of abuse, neglect or domestic violence. We will only make this known when required or authorized by law.


• Health Oversight Activities. We may give out health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to oversee the healthcare system, government programs and follow civil rights laws.



• Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may give out health information about you in response to a court or administrative order. We may also give out health information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute.



• Law Enforcement. We may give out health information if asked to do so by a law enforcement official:


• In response to a court order, subpoena, warrant, summons or similar process;



• To identify or locate a suspect, fugitive, material witness or missing person;



• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;



• About a death we believe may be the result of a criminal act;



• About criminal conduct in a Hillcrest program, and



• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.



• Coroners, Medical Examiners and Funeral Directors. We may give out health information to a coroner or medical examiner. This may be necessary, for example, to identify the person who died or find the cause of death. We may also give out health information about patients of the agency to funeral directors as necessary to carry out their duties.



• National Security and Intelligence Activities. We may give out health information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.



• Protective Services for the President and Others. We may give out health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations for their protection.



• Inmates. If you are an inmate of a jail or prison or under the custody of a law enforcement official, we may give out health information about you to the jail, prison or law enforcement official. This release would be necessary (1) for the jail or prison to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

• Right to Inspect and Copy. You have the right to look at and copy health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
  
  To look at and copy health information that may be used to make decisions about you, contact the person managing your care. If you ask for a copy of the information, we will charge a fee for the costs of copying, mailing or other supplies in order to give you your copies.
  
  We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may ask that the denial be reviewed. The Clinical Director will review the denial. We will accept the outcome of the review.



• Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to correct the information. You have the right to request a correction for as long as the information is kept by or for Hillcrest.


• To ask for a correction, you must do so in writing and give it to the Privacy Officer. In addition, you must have a reason that supports your request.



• We may deny your request for correction if it is not in writing or does not include a valid reason to support the request. In addition, we may deny your request if you ask us to change information that:


• Was not created by us or the person or entity that created the information is no longer available to make the correction;



• Is not part of the health information kept by or for Hillcrest;



• Is not part of the information which you would be allowed to inspect and copy, or



• Is already accurate and complete.



• Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the times we gave out health information about you to others except for purposes of treatment, payment and operations identified above.
  
  To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should tell us in what form you want the list (for example, on paper or electronically). You may ask for one free list in a 12-month time period. For additional lists, we may charge you for the costs of providing the list. We will tell you the cost and you may choose to change your request at that time before any costs are added.



• Right to Request Restrictions. You have the right to ask for a limitation on the health information we use or give out about you for treatment, payment or health care operations. You also have the right to ask for a limit on the health information we give out about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, if you are a patient of the Hillcrest Clinic, you could ask that we not use or give out information about your care.
  
  We are not required to agree to your request. If we do agree, we will accept your request unless the information is needed to provide you emergency treatment.
  
  To ask for restrictions, you must make your request in writing to the Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit the use or giving out of health information or both or (3) to whom you want the limits to apply, for example, giving out information to your wife or husband.
  
  You may write to us at:
  Privacy Officer
  Hillcrest Family Services
  2005 Asbury Road
  Dubuque, Iowa 52001
  

• Right to Request Confidential Communications. You have the right to ask that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work, home or by mail.
  
  To ask for confidential communications, you must make your request in writing to the Privacy Officer. We will not ask you the reason for your request. We will accept all reasonable requests. Your request must tell us how or where you wish to be contacted.



• Right to a Paper Copy of This Notice. You have the right to a paper copy of this privacy notice. You may ask us to give you a copy of this privacy notice at any time by requesting a copy from any Hillcrest staff member.

• We have the right to change this notice. We have the right to make the changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice at each Hillcrest office. The notice will contain on the first page, at the top of the page, the effective date. In addition, each time you are admitted to Hillcrest for treatment or health care services, we will offer you a copy of the current notice.