Notice of Privacy Practices

EffectiveDate11/01/02

This notice describes how information about your child may be used/disclosed, and how to get access to it.


Understanding your Child’s Health Record/Information.
Each time your child visits a hospital, physician, or other healthcare provider, a record of his/her visit is made. Typically, this record contains his/her symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, often referred to as the health or medical record, serves as a:

  • Basis for planning his/her care and treatment;
  • Means of communication among the many health professionals who contribute to his/her care;
  • Legal document describing the care he/she received;
  • Means by which you or a third-party payer can verify that services billed were actually provided;
  • Tool in educating health professionals;
  • Source of data for medical research;
  • Source of information for public health officials charged with improving the health of the nation;
  • Source of data for program planning and marketing tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your child’s record and ho w your child’s health information is used helps you to:

  • Ensure its accuracy;
  • Better understand who, what, when, where and why others may access your child’s health information;
  • Make more informed decisions when authorizing disclosure to others.

Your Child’s Health Information Rights.
Although your child’s health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:

  • Request a restriction on certain uses and disclosures of your child’s information as provided
  • by45 CFR164.522;
  • Obtain a paper copy of the notice of information practices upon request;
  • Inspect and copy your child’s health record as provided for in 45 CFR 164.524;
  • Amend your child’s health record as provided in 45 CFR 164.528;
  • Obtain an accounting of disclosures of your child’s health information as provided in 45 CFR 164.528;
  • Request communications of your child’s health information by alternative means or at alternative locations;
  • Revoke your authorization to use or disclose your child’s health information except to the extent that action has already been taken.
    Our Responsibilities.


Our Responsibilities.
This organization is required to:

  • Maintain the privacy of your child’s health information;
  • Let you know promptly if a breach occurs that may have compromised the privacy or security of your information;
  • Provide you with notice as to our legal duties and privacy practices with respect to information we collect/maintain about your child;
  • Abide by the terms of this notice;
  • Notify you if we are unable to agree to a requested restriction;
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the latest address you’ve supplied us.

We will not use or disclose your health information without your authorization, except as described in this notice.

Examples of Disclosures for Treatment, Payment, and Health Operations.
We will use your child’s health information for treatment.

For example: Information obtained by a nurse, physician, counselor or other member of your child’s healthcare team will be recorded in his/her record and used to determine the course of treatment that should work best. Your child’s clinician(s) will document in the record actions they took and their observations. In that way, other healthcare professionals will know who your child is responding to treatment. We will also provide your child’s physician or aftercare health provider with copies of various reports that should assist him or her in treating your child once he/she is discharged from this program.

We will use your child’s health information for payment.

For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies your child, as well as his/her diagnosis, procedures and supplies used.

We will use your child’s health information for regular health operations.

For example: Members of the treatment staff, the risk, Outcome Evaluation or Performance Improvement Manager/staff may use information in your child’s health record to assess the care and outcomes in his/her case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

Business Associates: There are some services provided in our organization through contacts with business associates. Examples include psychiatric services from consulting physicians, certain laboratory tests and a shredding service used to appropriately destroy confidential documentation. When the services are contracted, we may disclose your child’s health information to our business associate in the course of their business actions and bill you or your third-party payer for services rendered. To protect your child’s information, however we require the business to safeguard your health information.

Directory: Unless notified of your objection, we will use your child’s name and general condition for directory purposes. Usage will be restricted to you, your representative or others designated by you as appropriate contacts for your child.


Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative or another person responsible for your child’s care about his or her location and general condition.

Communication with Family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your child’s care or in the payment related to your child’s care.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your child’s information.

Funeral Directors: We may disclose health information to Funeral Directors consistent with law to carry out their duties.

Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or others engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.

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

Fund Raising: We may contact you as part of fund-raising effort.

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

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

Correctional Institution: Should your child become an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for his/her health and the health and safety of other individuals.

Law Enforcement: We may disclose health information to law enforcement as required by law or in response to a subpoena.

Federal law makes provision for your child’s health information to be released to a health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional/clinical standards and are potentially endangering one or more patients, workers or the public.

For More Information or to Report a Problem.
The examples listed are not meant to cover every possible way in which your child’s health information may be used. If you have questions or would like additional information, you may contact the Director of Health Information Management at 901-252-4940. If you believe your child’s privacy rights have been violated, you can file a complaint with the Director of Health Information Management or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.