SUMMARY – PLEASE REVIEW THIS NOTICE CAREFULLY
At Wesley Family Services, we are committed to protecting the privacy of our consumer’s mental and physical health information, as the federal and state laws require. This Notice explains how we will satisfy this commitment and your rights about what is in your Wesley Family Services health record. When we use the terms “information”, we are referring to consumer health, treatment, or payment information that identifies you, as a Wesley Family Services consumer. If you have any questions as a Wesley Family Services consumer, please ask a Wesley Family Services staff member for more information.
We must provide you with this Notice about our privacy practices. It explains how, when and why we may use and disclose your health information. With some exceptions, we will avoid using or disclosing any more of your health information than is necessary to accomplish the purpose of the use or disclosure. If this health information concerns mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and/or HIV status, we may be very limited in what we provide and may be required to first obtain from you specific authorization. If you are the parent of a child under 14 years of age, then you have the right to make decisions about the health care information referred to in this Notice. In the state of Pennsylvania a child between the ages of 14-17 generally retains the right to make these decisions.
We reserve the right to change the terms of this Notice and our privacy practices at any time. Any changes will apply to any of your health information that we already have. Before we make an important change to our policies, we will promptly change this Notice, and post a new Notice in our reception areas and on our website. You may also request, at any time, a copy of our Notice of Privacy Practices that is in effect at any given time, from the Wesley Family Services Quality Department/Privacy Officer at 412-342-2300. You may view and obtain an electronic copy of this Notice on our web site at www.wfspa.org
We would like to take this opportunity to answer some common questions concerning our privacy practices:
QUESTION: HOW WILL WESLEY FAMILY SERVICES USE AND DISCLOSE MY PROTECTED HEALTH INFORMATION?
Answer: We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each.
A. Uses and Disclosures Relating to Treatment, Payment or Healthcare Operations. With the possible exception of information concerning mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status ( for which we may need your specific authorization), we may, by federal law, use and disclose your health information for the following reasons:
- For Treatment: We may disclose your general treatment information to other providers who are involved in your care. For example, we may disclose your treatment history to a hospital if you need medical attention while at our facility or to a residential program we are referring you to. Reasons for such a disclosure maybe to get them the historical treatment information they need to coordinate your care, appropriately treat your condition, or schedule needed testing.
- To Obtain Payment for Treatment: We may use and disclose necessary health information in order to bill and collect payment for the treatment that we have provided to you. For example, we may provide certain portions of your health information to your health insurance company, Medicare or Medicaid, or to the County or a county-funded service coordination unit in order to get paid for your treatment.
- For Health Care Operations: We may, at times, need to use and disclose your health information to run our organization. For example, we may use your health information to evaluate the quality of the treatment that our staff has provided to you. We may also need to provide some of your health information to our accountants, attorneys and consultants in order to make sure that we are complying with the law.
B. Certain Other Uses and Disclosures are Permitted by Federal Law. With the possible exception of information concerning mental health disorders and/or treatment, drug and alcohol abuse and/or treatment, and HIV status (for which we may need your specific authorization), we may use and disclose your health information without your authorization for the following reasons:
- When a Disclosure is Required by Law. For example, we may disclose your protected information if we are ordered by a court, or if a law requires that we report that sort of information to a government agency or law enforcement authorities, such as in the case of a dog bite, suspected child abuse or a gunshot wound.
- For Public Health Activities. Under the law, we need to report information about certain diseases, and about any deaths, to government agencies that collect that information. We are also permitted to provide some health information to the coroner or a funeral director, if necessary, after a client’s death.
- For Health Oversight Activities. For example, we will need to provide your health information if requested to do so by the County and/or the State when they oversee the program in which you receive care. We will also need to provide information to government agencies that have the right to inspect our offices and/or investigate healthcare practices.
- For Organ Donation. If one of our clients wished to make an eye, organ or tissue donation after their death, we may disclose certain necessary health information to assist the appropriate organ procurement organization.
- For Research Purposes. In certain limited circumstances for example, approved by an appropriate (Privacy Board or Institutional Review board under federal law), we may be permitted to use or provide protected health information for a research study.
- To Avoid Harm. If one of our service providers, counselors, physicians or nurses believes that it is necessary to protect you, or to protect another person or the public as a whole, we may provide protected health information to the police or others who may be able to prevent or lessen the possible harm. If you are in treatment with our organization for the propensity to commit a particular type of action, we may not report your statements or provide protected health information about that particular propensity for purposes of avoiding harm.
- For Specific Government Functions: We may disclose the health information of military personnel or veterans here required by U.S. military authorizations. Similarly, we may also disclose a client’s health information for national security purposes, such as assisting in the investigation of suspected terrorists who may be a threat to our nation.
- For Workers’ Compensation. We may provide your health information as described under the workers’ compensation law if your condition was the result of a workplace injury for which you are seeking workers’ compensation.
- Appointment Reminders and Health-Related Benefits or Services. Unless you tell us that you would prefer not to receive them, we may use or disclose your information to provide you with appointment reminders or give you information about helpful alternative programs and treatments.
- Fundraising Activities. For example, if our organization chooses to raise funds to support one or more of our programs or facilities, or some other charitable cause or community health education program, we may use the information that we have about you to contact you. If you do not wish to be contacted as part of any fundraising activities, please contact your program director.
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object. (This information may not contain information about mental health disorders and/or treatment, alcohol abuse and/or treatment and HIV status without your specific authorization)
- Disclosures to Family, Friends or Others Involved in Your Care. We may provide a limited amount of your health information to a family member, friend or other person known to be involved in your care or in the payment for your care, unless you tell us not to. For example, if a family member comes with you to your appointment and you allow them to come into the room with you, we may disclose otherwise protected health information to them during the appointment, unless you tell us not to.
- Disclosures to Notify a Family Member, Friend or Other Selected Person. When you first started in our program, we asked that you provide us with an emergency contact person in case something should happen to you while you are at our facilities. Unless you tell us otherwise, we will disclose certain limited health information about you (your general condition, location, etc.) to your emergency contact or another available family member, should you need to be admitted to the hospital, for example.
- Disclosure to Business Associates. We may share your information with business associates who perform services on our behalf. The business associate must agree in writing to protect the confidentiality of the information. For example, we may share information with a contracted Doctor.
- Disaster Relief. We may use or disclose information to a public or private entity by law to assist with and coordinate disaster relief efforts.
D. Other Uses and Disclosures Require Your Prior Written Authorization. In situations other than those categories of uses and disclosures mentioned above, or those disclosures permitted under federal law, we will ask for your written authorization before using or disclosing any of your protected health information. In addition, we need to ask for your specific written authorization to disclose information concerning your mental and physical health, drug and alcohol abuse and or treatment, or to disclose your HIV status. If you choose to sign an authorization to disclose any of your health information, you can later revoke it to stop further uses and disclosures to the extent that we haven’t already taken action relying on the authorization, so long as it is revoked in writing (except for individuals receiving drug and alcohol services, where a verbal revocation is acceptable.)
QUESTION: WHAT RIGHTS DO I HAVE CONCERNING MY PROTECTED HEALTH INFORMATION (PHI)?
Answer: You have the following rights with respect to your protected health information:
A. The Right to Request Limits on Uses and Disclosures of Your Health Information. You have the right to ask us to limit how we use and disclose your health information. We will certainly consider your request, but you should know that we are not required to agree to it. If we do agree to your request, we will put the limits in writing and will abide by them, except in the case of an emergency. Please note that you are not permitted to limit the uses and disclosures that we are required or allowed by law to make. A Wesley Family Services consumer or their representative has the right to request that the PHI not be disclosed to a health plan (i.e. insurance company) for payment or treatment when the service that is to be excluded from the disclosure was paid for out-of-pocket in full by the patient or person on the consumers behalf.
B. The Right to Choose How We Send Health Information to You or How We Contact You. You have the right to ask that we contact you at an alternate address or telephone number (for example, sending information to your work address instead of your home address) or by alternate means – for example, by (e-mail/mail) instead of telephone. We must agree to your request so long as we can easily do so. Your request must be made in writing.
C. The Right to See or to Get a Copy of Your Protected Health Information. In most cases, you have the right to look at or get a copy of your health information that we have and use to make decisions about your care. This includes your right to request a copy of your electronic medical record in electronic form. Your request must be in writing. Request forms are available at the reception desk or ask your Wesley Family Services service provider. We will respond to you within 30 days after receiving your written request. If we do not have the health information that you are requesting, but we know who does, we will tell you how to get it. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial. In certain circumstances, you may have a right to appeal the decision. If you request a copy of any portion of your protected health information, we may charge you for the copy on a per page basis, only as allowed under state law. We may need to require that payment be made in full before we will provide the copy to you. If you agree in advance, we may be able to provide you with a summary or an explanation of your records instead. There may be a charge for the preparation of the summary or explanation.
D. The Right to Receive a List of Certain Disclosures of Your Health Information That We Have Made. You have the right to get a list of certain types of disclosures that we have made of your health information. You also have the right to receive an accounting of disclosure from our business associates. This list would not include uses of disclosures for treatment, payment or healthcare operations, and disclosures to you or with your written authorization, or disclosures to your family for notification purposes or due to their involvement in your care. This list also would not include any disclosures made for national security purposes, disclosures to corrections or law enforcement authorities if you were in custody at the time, or disclosures made prior to July 1, 2017. You may not request an accounting for more than a six- (6) year period. To make such a request, we require that you do so in writing; a request form is available upon asking at our reception desk or from your Wesley Family Services service provider. We will respond to you within 60 days of receiving your request. The list that you may receive will include the date of the disclosure, the person or organization that received the information (with their address, if available), a brief description of the information disclosed, and a brief reason for the disclosure. We will provide such a list to you at no charge; but, if you make more than one request in the same calendar year, you will be charged a reasonable fee for each additional request that year.
E. The Right to Ask to Correct or Update Your Health Information. If you believe that there is a mistake in your health information or that a piece of important information is missing, you have a right to ask that we make an appropriate change to your information, as long as the information is maintained by or for Wesley Family Services. This does not permit you to alter or change the original record created by your health care provider or their staff. You must make the request in writing, with the reason for your request, on a request form that is available at the reception desk or from your Wesley Family Services service provider. We will respond within 60 days of receiving your request. If we approve your request, we will make the change to your health information, tell you when we have done so, and will tell others that need to know about the change. We may deny your request if the protected health information: (1) is correct and complete; (2) was not created by us; (3) is not allowed to be disclosed to you; or (4) is not part of our records. Our written denial will state the reasons that your request was denied and explain your right to file a written statement of disagreement with the denial.
F. The Right to Information that is Maintained Electronically. If Wesley Family Services maintains your health information electronically (in our computer), you have the right to ask for an accounting of disclosures of where Wesley Family Services disclosed your information. In accordance with federal law, you may request an accounting period of three years prior to the date the accounting is requested. You may also have the right to ask our business associates for an accounting of their disclosures.
G. The Right to get a Paper Copy of This Notice. If you have received this Notice electronically, you have the right to a paper copy of this Notice.
QUESTION: HOW DO I COMPLAIN OR ASK QUESTIONS ABOUT WESLEY FAMILY SERVICES’ PRIVACY PRACTICES?
In the event that a breach of your PHI occurs by Wesley Family Services or one of it’s business associates, you will be provided with written notification as required by law.
If you believe your privacy has been violated by us, you may file a confidential complaint directly with us. If you have any questions about anything discussed in this Notice, or about any of our privacy practices, or if you have any concerns please contact the Wesley Family Services Quality Department/Privacy Officer at 412-342-2300. You also have the right to file a written complaint with the Secretary of the U.S. Department of Health and Human Services. We may not take any retaliatory action against you if you lodge any type of complaint.
Wesley Family Services
221 Penn Avenue
Pittsburgh, PA 15221
U.S. Department of Health and Human Services
200 Independence Ave. S.W.
Washington, DC 20201
This Notice took effect on July 1, 2017 and was revised April 18, 2018.