Your privacy is our ongoing concern. Our agency adheres to the most strict privacy procedures in the profession. Confidentiality and discretion are priorities here at Gulf Coast Social Services.

NOTICE OF PRIVACY PRACTICES

This notice describes how health and service information about you may be used and disclosed with others, and how you can receive this information about yourself. Please review it carefully.

We realize this Notice can be very confusing and we have tried to make it as easy to read as we possibly can. Health Information is any information that relates to you and can be used to identify who you are. Use & Disclose means to allow any person to see, hear or read information about you, to anyone outside Gulf Coast Social Services.

You should read this Notice before signing any Consent to Release Information for treatment, payment, and health care operations of Gulf Coast Social Services.

OUR PROMISE AND OBLIGATION REGARDING YOUR HEALTH INFORMATION

We create a record of the care you receive. This record is needed to provide you with good care and to meet with certain legal requirements. The information in this record is personal and private and is the physical property of Gulf Coast Social Services. It contains your health information that we are obligated to protect.

We are required by law to:

• give you this notice of our legal responsibilities and privacy practices about your health information and;
• to comply with the terms of this notice;
• notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
• make sure that the medical information that identifies you is kept private;
• make sure that we share only the information that we are required to share. We can not give anyone more information than what they actually need;
• accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and obtain your written authorization to use or disclose your health information for reasons other than those listed below and permitted by law.

HOW WE USE AND SHARE YOUR HEALTH INFORMATION

Gulf Coast Social Services uses health information about you for services we render to you, to obtain payment for these services, for administrative purposes, and to evaluate the quality of care that you receive. The categories below describe the ways we use and disclose health information. For each category, we explain what is meant and give an example. Not every use or disclosure can possibly fit in each category. However, all of the ways that we are allowed to use and disclose information will fall within one of these categories. We must have your Consent for Service/Treatment upon admission to Gulf Coast Social Services.

For services: We may disclose your health information with Agency staff members, volunteers, and other providers who are involved in providing services for you. For example, your health information will be shared among members of your Interdisciplinary (ID) Team to ensure you receive the services that you have requested. Our agency staff members, volunteers and other providers will also record actions taken by them in the course of the services provided to you and note how you respond to these services.

To obtain payment: We create bills for services provided to you and we may disclose your health information to different agencies such as, Medicaid, insurance companies, or third parties that pay for your health needs. We may use or disclose your health information in order to bill and collect payment for your services that we provide to you. The information on the bill may contain information that identifies you, your diagnosis, and services or supplies used the course of the services provided to you.

For service operations: We may use or disclose your health information in order to operate our agency and to make sure all of our clients receive quality care. For example, we may use your health information to evaluate whether we are doing a good job providing your care and to ensure we are providing all the services that we can in order to meet your needs. We have to disclose your health information to local Parish, State, or Federal Offices and the Medicaid agency to determine your eligibility for publicly funded services

We may ask if we can disclose your information without getting you to sign a release form. You will have the choice to answer yes or no. If the situation is an emergency and you are not able to make a choice, we will make the choice for you. We will decide whether you would give your permission if you were able.

Business Associates: We may disclose health information to other persons or organizations, known as Business Associates, who provide services on our behalf through a contract. For example, a copying company is making copies of your health information for us. They are only allowed to have the information necessary for them to do their job. We require that they ensure your information is protected.

Research: We may ask you if we can use or disclose health information about you for research purposes. For example, a research project may involve comparing the services provided to some consumers. All research projects have to be specially approved by the Chief Executive Officer of the Agency who has reviewed the research proposal and established guidelines to ensure the privacy of your health information. We will ask for your approval if the researcher needs to know your name, address or other information that tells who you are, or if the researcher will be involved in providing services to you.

Family, Friends, or Others Involved in Your Care: We may ask if we can disclose information about you to your family, friends, other people involved in your life. We may need to tell them where you are, or how you are doing. For example, if you get sick we may need to tell your family that you are ill, or at the hospital.

The law allows us to use or disclose your health information without your permission in certain emergency situations.

Emergency Medical Care: We can disclose your health information for emergency medical care if it is not reasonably possible to get your permission and we think that you would approve if you were able. For example if you are badly injured and need immediate medical care we can instruct the doctors to do whatever is necessary to help you.

As required by law: We have to disclose your health information when required to do so by federal, state, and local law. If required to report to the court concerning your condition, we will include health information about you. For example, we may disclose your health information when required by a licensing agency or other public agency.

Law Enforcement activity: We will disclose your health information when required to do so by a law enforcement official:

• in response to a court order, subpoena, warrant, summons, or similar legal 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 your agreement;
• about a death we believe may be the result of criminal conduct;
• about criminal conduct at an Agency facility or function; 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.

Lawsuits and Disputes:  If you are involved in a lawsuit or a dispute, we have to disclose health information about you in response to a court or administrative order.  We may also disclose health information about you in response to a subpoena, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request, or if we ask the court to protect your information that someone else has requested.

Inmates:   If you are an inmate in a jail or prison or under the custody of a law enforcement official, we must disclose your health information with the correctional institution or law enforcement official.  We have to do this so they can provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

For public health risks:  We have to disclose health information with the public health agencies as required by law.  This public health information may be needed for the following reasons:

• to prevent or control disease, injury or disability;
• to report births and deaths;
• to report child abuse or neglect;
• to report reactions to medications or problems with products;
• to notify people of recalls of products that they may be using;
• to notify a person who may have been exposed to a communicable disease or may be at risk for
• contracting or spreading a disease or condition;

Victims of Abuse, Neglect, or Domestic Violence:  We will notify the appropriate government authority if we believe a client has been the victim or perpetrator of abuse, neglect, or domestic violence.  We will make this report only to a government agency which is authorized by law to receive this kind of report and only what is required by law.  We will inform you of our disclosure unless informing you will place you at risk of serious harm.

For health oversight activities:  We may disclose your health information to a government health agency for activities authorized by law.  These activities include, for example, audits, investigations, inspections, and licensing reviews.  These activities are necessary for the government to monitor the health care system, government programs, and to comply with civil rights laws.

Coroners, Medical Examiners and Funeral Director:  We may disclose your health information to a coroner or medical examiner.  This may be necessary, for example, to identify someone who has died or to determine the cause of death.  We may also disclose information about individuals to funeral directors as they need to carry out their duties.

Organ and Tissue Donation:  If you have agreed to donate organs or tissue, we may disclose your health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to carry out your wishes.

Workers’ compensation:  We may disclose health information about you for Workers’ Compensation claim purposes, or to similar insurance programs in order to comply with laws and regulations related to Worker’s Compensation.  These programs provide benefits for work related injuries or illness.

To avert threat to health or safety:  In order to avoid a serious threat to health or safety, we may disclose your health information, as necessary, to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.  For example, if you are being threatened or have threatened someone else with harm, we will disclose information about you in order to protect you from harm.

For specific government functions:  We may disclose your health information in certain situations, to military personnel and veterans programs, to correctional facilities or government programs relating to eligibility and enrollment, and for national security reasons, such as protection of the President.

OTHER USES AND RELEASE OF HEALTH INFORMATION

If there are other reasons that we need to use or disclose your health information that have not been covered in this Notice, we will get your written permission before we use or disclose your information.  If you give us permission, you may revoke or take away your permission, in writing, to our office, at any time.  If you revoke your permission, we will not use or disclose your health information for the reasons covered by your written permission.  We can not take back any information that we have already shared with your permission.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

To request restrictions on uses/disclosures:  You have the right to ask that we limit how we use or disclose your health information for treatment, payment for services or for service operations.  You also have the right to request a limit on how much health information we share about you with someone who is involved in your care or for payment for your care.  For example, you could request that we do not disclose information about a surgery that you may have had.  We are not required to agree with your request.  If we do agree, we will immediately comply with your request, unless the information is needed to provide you with emergency treatment.  If we do not agree with your request, we will notify you in writing of our decision.

To request a restriction, you must make your request in writing to the Regional Privacy Officer with Gulf Coast Social Services.

In your request you must tell us:

1. what information you want to limit and whether you wish to limit use, disclosure, or both; and
2. to whom you want the limits to apply; for example, you may not want us to tell your family member.

To choose how we contact you:  You have the right to request that we communicate with you about your health information in a certain way, or at a certain location.  For example, you can request that we only talk with you about your health information at home or by telephone.

To look at and/or get a copy your health information:  You have the right to look at your health information.  You also have the right to receive a copy of your health information.  If you would like to look at, or receive a copy of your health information, you must give the Regional Privacy Officer your request, in writing.  If you request a copy of your information, we may charge a fee for the cost of copying your information.

We may deny your request to look at or receive a copy of your information in certain circumstances, such as psychological evaluations.  If we deny your request, you may request that we change our mind and let you have or look at your information.  We will ask another licensed health care professional to review your request.  That person will decide if we should give you your information or not.  We have to comply with their decision.

To request changes to your health information:  If you believe that there is a mistake or missing information in our record of your health information, you may request, in writing, to the Regional Privacy Officer that we correct or add to the record.  We will respond within 60 days of receiving your request.  We may deny the request if we determine that the health information is: (i) correct and complete; (ii) not created by us and/or not part of our records, or; (iii) not permitted to be used or disclosed.  The denial will state the reasons for denial and explain your rights to have the request and denial, along with any statement in response that you provide, added to your health information.  If we approve the request for amendment, we will change the health information and so inform you, and tell others that need to know about the change in the health information.  However, under no circumstances will an entry in your information be erased, or made unreadable.

To find out who we have disclosed your information to:  You have a right to get a list of when, to whom, for what purpose, and what content of your health information has been disclosed other than instances of disclosure for which you gave consent (i.e. for treatment, payment, operations).  To request this list you must submit your request in writing to the Regional Privacy Officer.  Your request must state a time period, which may not be longer than six years and not include dates before April 13, 2003.  You may be charged for the cost of copying the list.

To get a copy of this notice:  You have a right to receive a paper copy of this Notice.  You have the right to request a copy of this Notice at any time.  A copy of this Notice is provided to all consumers at the time of admission.  To get another copy of this Notice, you may ask your case manager.

Revocation:  You have the right to revoke your authorization to use or disclose health information except to the extent that action has already been take.

Gulf Coast Social Services reserves the right to change its information practices and to make new provisions effective for all protected health information it maintains.  Revised notices will be made available to you by contacting the Regional Privacy Officer or by asking your Program Director.

If you think we may have violated your privacy rights, or you disagree with a decision we have made about access to your medical information, you may file a complaint with the Regional Privacy Officer at the address listed below.  Please remember to include your name and address.  If you still are not satisfied you may file a complaint with the Department of Health and Human Services.

If you have any questions or complaints, please contact:

Risk Manager – Pat Landry
Gulf Coast Social Services
5850 Florida Blvd.
Baton Rouge, La., 70806
Telephone: 225-935-9906
Toll free: 800-766-2291
Fax: 225-201-1793

We will not be angry or retaliate if you make a complaint.