EFFECTIVE: 4/14/2003

REVISION DATE: 9/16/2020

THIS NOTICE DESCRIBES HOW CLIENT CARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Understanding Your Client Care Information – How it is Used and How it May Be Shared With Others: There are laws that require you be given this Notice about what Saint Francis Ministries, Incorporated (hereafter known as “Saint Francis”) does with your care information. This Notice is about the information kept here while you are receiving services.

If you have any questions about this notice, please contact:

Corporate Privacy Officer
Saint Francis Ministries
110 W Otis Ave.
Salina, KS 67401

WHAT IS YOUR CLIENT CARE RECORD OR CARE INFORMATION?

When you receive services through Saint Francis, a record is made that tells about care services provided. This record will have information about your background, diagnosis, assessments, treatment/care given to you, and notes about what might need to be done at a later date. Saint Francis keeps this information and can use this information in many different ways. What we do with your information and how we can use and share this information is what the rest of this Notice describes.

SAINT FRANCIS PLEDGE REGARDING CARE INFORMATION:

Saint Francis understands that information about you and your care is personal. Saint Francis is committed to protecting information about you. A record of care and services you receive at Saint Francis is created. This record is needed to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by any Saint Francis program, whether made by staff or by consultants who may record in the record.

This notice will tell you about the ways in which Saint Francis may use and disclose care information about you. It will also describe your rights and certain obligations Saint Francis has regarding the use and disclosure of care information.

SAINT FRANCIS IS REQUIRED BY LAW TO:

• Keep your information private, only giving it out when allowed by law to do so;
• Explain our legal duty and our rules about keeping your information private to you;
• Follow the rules given in this Notice;
• Let you know when Saint Francis cannot agree with a request or demand you may make to restrict the sharing of information with others;
• Help you when you want your information sent in a different way than it usually is sent or to a different place than it usually is sent;
• Inform you if there has been a breach of your unsecured protected health information.

Saint Francis will not give out your information without your permission except in certain cases explained in this Notice. There are laws that say your information can be given to others without your permission. Saint Francis will follow these laws. Your care information can be given out electronically (over computer networks, for example) or by facsimile (fax).

KNOWLEDGE BY OTHERS OF YOUR PLACEMENT:

Residential and Foster Homes:

Information of your physical placement in this program may be disclosed to others in several ways:

• When posting information about your status, your group assignments, and account status, only first names will be used.
• Other clients’ family members, case managers, lawyers, etc. may see you and hear your name spoken by staff/foster parents or other clients while visiting with their identified client.
• Staff/foster parents may acknowledge your presence if someone calls asking for you by name. If this person is not on the designated list to call, they may be informed of this fact. If an unidentified, unauthorized person calls asking if you are placed here, they will be informed that this information cannot be provided.

Non-Residential:

Information of your participation in this program may be disclosed to others in several ways:

• By visual sight while waiting in the reception area waiting for an appointment.
• Having your name called for an appointment.

YOUR RIGHTS REGARDING CARE INFORMATION ABOUT YOU:

You and your involved family have the following rights regarding care information maintained about you at Saint Francis:

RIGHT TO AMEND:

If you/legal guardian feel that care information Saint Francis has about you is incorrect or incomplete, you may ask for this information to be amended. You have the right to request an amendment for as long as the information is kept by or for Saint Francis.

RIGHT TO AN ACCOUNTING OF DISCLOSURES:

You/legal guardian have the right to know any time information is disclosed about you. If, after you are discharged and you want an accounting of non-routine disclosures, you must request this list in writing to the Corporate Privacy Officer.

RIGHT TO INSPECT AND COPY:

You have the right to have knowledge regarding information that may be used to make decisions about your care. You have the right to access billing records.

To inspect and copy information that may be used to make decisions about you, must submit your requests in writing to the Corporate Privacy Officer.

RIGHT TO REQUEST RESTRICTIONS:

You/legal guardian have the right to request a restriction or limitation on the care information used or disclosed about you for treatment, payment, or health care operations. You also have the right to request a limit on the care information disclosed about you to someone who is involved in your care or the payment of your care, like a family member or friend.

Saint Francis is not required to agree to your request. If it is agreed upon, the reqest will be complied with unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to the Corporate Privacy Officer.

RIGHT TO A PAPER COPY OF THIS NOTICE:

You/legal guardian have the right to a paper copy of this notice. This is a condensed version of our full paper copy of the Notice of Privacy Practices. You may ask to receive a copy of the full notice at any time. You can request from Saint Francis or you can go to our website, www.SaintFrancisMinistries.org, and obtain the full notice of privacy practices there.

GIVING PERMISSION AND REVOKING PREVIOUS PERMISSION TO USE OR DISCLOSE YOUR HEALTH INFORMATION:

Except as stated in this Notice, in order for us to give out your information, you have to complete a written authorization form. If you want, you can later choose not to let us give out your health information. You can do this at any time. Your request to later stop permission to give out your health information must be in writing and sent to Saint Francis, Corporate Privacy Officer. It is not possible for us to take back any information we have already given out about you that we made with your permission.

As Required by law:

Any information will be disclosed about you when required to do so by federal, state, or local law.

Complaints:

If you believe your privacy rights have been violated, you may file a complaint with Saint Francis or with the Secretary of the Department of Health and Human Services. To file a complaint with Saint Francis, contact the Corporate Privacy Officer. All complaints must be submitted in writing.

You will NOT be penalized for filing a complaint.

Changes to This Notice:

Saint Francis reserves the right to change this notice. A copy of this notice will be posted in the building and will contain the effective and revision date. In addition, each time you are admitted or registered at any Saint Francis program for treatment services as an inpatient
or outpatient, that program will offer you a copy of the current notice in effect.

Case Management ONLY:

When a child is in the custody of the State, the State or their authorized agency (i.e. Saint Francis Ministries) can generally sign for the release of confidential information to other parties who need the information to properly care for the needs of the child when parents are unwilling or unable to provide consents for such.

For more information about HIPAA, visit www.hhs.gov