PRIVACY NOTICE

Effective April 14, 2003

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

Our Privacy Commitment To You.
 We care about your privacy. The information we collect about you is private. We are required to give you a notice of our privacy practices. Only people who have both the need and the legal right may see your information. Unless you give us permission in writing, we will only disclose your information for purposes of treatment, payment, business operations or when we are required by law to do so.

Understanding the Type of Information We Have.
 When we receive your health information it includes your date of birth, sex, ID number and other personal information In addition your record contains service goals, assessment results, service plans and other information. This information, often referred to as your health or medical record, serves as a basis for planning your care and services.

Service Delivery: 
We may use your health and service information to provide you with services. We may disclose health and service information about you to other staff members who are involved in providing services to you. For example, a staff member providing family counseling services to you may need to know if you are receiving other services in order to make the counseling more effective. In addition, different departments of JFS also may share health and service information about you in order to coordinate the different things you need, such as prescriptions, assessments and other services.

Payment.
 We may use and disclose information so the care you get can be properly billed and paid for. For example, we may inform the insurance company of the type of treatment you received.

Business Operations.
 We may use and disclose information for our business operations. For example, we may use information to review the quality of care you get In addition, some services in our organization are provided through contracts with business associates, for example, service consultants, our psychiatrist, and CARF (our accrediting body). To protect your information, we require the business associate to appropriately safeguard your information.

As Required By Law. 
We will release information when we are required by law to do so. Examples of such releases would be for law enforcement or national security purposes, subpoenas or other court orders, communicable disease reporting, disaster relief, review of our activities by government agencies, to avert a serious threat to health or safety or in other kinds of emergencies.

With Your Permission. 
If you give us permission in writing, we may use and disclose your personal information. If you give us permission, you have the right to change your mind and revoke it. This must be in writing, too. We cannot take back any uses or disclosures already made with your permission.

Your Privacy Rights

You have the following rights regarding the health information that we have about you. Your requests must be made in writing to Jewish Family Service.

Your Right to Inspect and Copy.
 In most cases, you have the right to look at or get copies of your records. You may be charged a fee for the cost of copying your records.

Your Right to Amend. 
You may ask us to change your records if you feel that there is a mistake. We can deny your request for certain reasons, but we must give you a written reason for our denial.

Your Right to a List of Disclosures.
 You have the right to ask for a list of disclosures made after April 14, 2003. This list will not include the times that information was disclosed for treatment, payment, or health care operations. The list will not include information provided directly to you or your family, or information that was sent with your authorization.

Your Right to Request Restrictions on Our Use or Disclosure of Information.
 You have the right to ask for limits on how your information is used or disclosed. We are not required to agree to such requests.

Your Right to Request Confidential Communications. 
You have the right to ask that we share information with you in a certain way or in a certain place. For example, you may ask us to send information to your work address instead of your home address. You do not have to explain the basis for your request.

Changes to this Notice

We reserve the right to revise this notice. A revised notice will be effective for information we already have about you as well as any information we may receive in the future. We are required by law to comply with whatever notice is currently in effect. Any changes to our notice will be published on our web site. Go to www.jfsdetroit.org website. If the changes are material, a new notice will be given to you before it takes effect.

How to Use Your Rights Under This Notice

If you want to use your rights under this notice, you may call us or write to us. If your request to us must be in writing, we will help you prepare your written request, if you wish.

Complaints to the Federal Government. 
If you believe that your privacy rights have been violated, you have the right to file a complaint with the federal government. You may write to:

Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 866-627-7748
TTY: 886-788-4989
E-mail: ocrprivacy@hhs.gov

You will not be penalized for filing a complaint with the federal government

Complaints and Communications to Us.
 If you want to exercise your rights under this notice or if you wish to communicate with us about privacy issues or if you wish to file a complaint, you can write to:

Privacy Officer
Jewish Family Service
24123 Greenfield Road
Southfield, MI 48075
(248) 559-1500
www.jfsdetroit.org
You will not be penalized for filing a complaint.

Copies of this Notice

You have the right to receive an additional copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. Please call or write to us to request a copy

This notice is available in other languages and alternate formats that meet the guidelines for the Americans with Disabilities Act (ADA).