FAMILIES FIRST, INC.
NOTICE OF PRIVACY PRACTICES
PROVIDER

FamiliesFirst, Inc.
2100 Fifth St.
Davis, California 95616-6591
Phone: (530) 753-0220

Effective date of this notice: April 14, 2003

If you have questions about this notice, please contact the person listed under "Whom to Contact" at the end of this notice.


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


In the course of receiving services from FamiliesFirst, Inc., you will provide us with personal information about your health, with the understanding that this information will be kept confidential. We may also obtain information about your health from others who have provided you with treatment services. This notice of our privacy practices is intended to inform you of the ways we may use your information and the occasions on which we may disclose this information to others.

We use clients' information when providing treatment, we disclose clients' information to other health care providers to assist them to provide you with treatment, we may disclose information to the financially responsible party as necessary to receive payment, we may use the information within our organization to evaluate quality and improve treatment operations, and we may make other uses and disclosures of clients' information as required by law or as permitted by FamiliesFirst, Inc. policies.

Click on the links below for details about FamiliesFirstInc.'s privacy practices:

* KINDS OF INFORMATION THAT THIS NOTICE APPLIES TO
* WHO MUST ABIDE BY THIS NOTICE
* OUR LEGAL DUTIES
* HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
* YOUR RIGHTS
* OUR RIGHT TO CHANGE THIS NOTICE
* WHOM TO CONTACT

KINDS OF INFORMATION THAT THIS NOTICE APPLIES TO
This notice applies to any information in our possession that would allow someone to identify you and learn something about your health. It does not apply to information that contains nothing that could reasonably be used to identify you.

WHO MUST ABIDE BY THIS NOTICE

* FamiliesFirst, Inc.
* All employees, staff, students, volunteers and other personnel whose work is under the direct control of FamiliesFirst, Inc.

The people and organizations to which this notice applies (referred to as "we," "our," and "us") have agreed to abide by its terms. We may share your information with each other for purposes of treatment, and as necessary for payment and operations activities as described below.

This notice applies to services you receive in FamiliesFirst, Inc.'s facilities. This includes services from physicians who are not employed by FamiliesFirst, Inc. If you also receive services from any of these physicians in their own offices, they may give you a different notice of privacy practices that applies to their offices.

OUR LEGAL DUTIES

* We are required by law to maintain the privacy of your health information.
* We are required to provide this notice of our privacy practices and legal duties regarding health information to anyone who asks for it.
* We are required to abide by the terms of this notice until we officially adopt a new notice.

HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION


A. FOR ALL HEALTH INFORMATION OTHER THAN PSYCHOTHERAPY NOTES


We may use your health information, or disclose it to others, for a number of different reasons. This notice describes these reasons. For each reason, we have written a brief explanation. We also provide some examples. These examples do not include all of the specific ways we may use or disclose your information. But any time we use your information, or disclose it to someone else, it will fit one of the reasons listed here.

1. Treatment. We will use your health information to provide you with treatment services. This means that our employees, staff, students, volunteers and others whose work is under our direct control, may read your health information to learn about your health condition and use it to make decisions about your treatment plan. For instance, a social worker/case manager may read your health record in order to develop an appropriate treatment plan. We will also disclose your information to others who need it in order to provide you with services.

2. Payment. We will use your health information, and disclose it to others, as necessary to obtain payment for the services we provide to you. For instance, an employee in our business office may use your health information to prepare a bill. And we may send that bill, and any health information it contains, to the financially responsible party. We may also disclose some of your health information to companies with whom we contract for payment-related services. For instance, we may give information about you to a collection company that we contract with to collect bills for us. We will not use or disclose more information for payment purposes than is necessary.

3. Health Care Operations. We may use your health information for activities that are necessary to operate this organization. This includes reading your health information to review the performance of our staff. We may also use your information and the information of other clients to plan what services we need to provide, expand, or reduce. We may also provide health information to students who are authorized to receive training here. We may disclose your health information as necessary to others whom we contract with to provide administrative services. This includes our lawyers, auditors, accreditation services, and consultants, for instance.

4. Legal Requirement to Disclose Information. We will disclose your information when we are required by law to do so. This includes reporting information to government agencies that have the legal responsibility to monitor the health care system. For instance, we may be required to disclose your health information, and the information of others, if we are audited by Medicare or Medi-Cal. We will also disclose your health information when we are required to do so by a court order or other judicial or administrative process.

5. Public Health Activities. We will disclose your health information when required to do so for public health purposes. This includes reporting certain diseases, births, deaths, and reactions to certain medications. It may also include notifying people who have been exposed to a disease.

6. To Report Abuse. We may disclose your health information when the information relates to a victim of abuse, neglect or domestic violence. We will make this report only in accordance with laws that require or allow such reporting, or with your permission.

7. Law Enforcement. We may disclose your health information for law enforcement purposes. This includes providing information to help locate a suspect, fugitive, material witness or missing person, or in connection with suspected criminal activity. We must also disclose your health information to a federal agency investigating our compliance with federal privacy regulations.

8. Specialized Purposes. We may disclose your health information for a number of specialized purposes. We will only disclose as much information as is necessary for the purpose. For instance, we may disclose your information to coroners, medical examiners and funeral directors. We may disclose your information to organ procurement organizations (for organ, eye, or tissue donation). We may also disclose your health information to your employer for purposes of workers' compensation and work site safety laws (OSHA, for instance).

9. To Avert a Serious Threat. We may disclose your health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual. The disclosure will only be made to someone who is able to prevent or reduce the threat.

10. Family and Friends. We may disclose your health information to a member of your family or to someone else who is involved in your treatment plan or payment for care. We may notify family or friends if you are in the hospital, and tell them your general condition. In the event of a disaster, we may provide information about you to a disaster relief organization so they can notify your family of your condition and location. We will not disclose your information to family or friends if you object.

12. Research. We may disclose your health information in connection with research projects. Federal rules govern any disclosure of your health information for research purposes without your authorization.

13. Information to Patients. We may use your health information to provide you with additional information. This may include sending appointment reminders to your address. This may also include giving you information about your treatment plan or other services that we provide.


B. PSYCHOTHERAPY NOTES

Psychotherapy notes are notes recorded by a mental health professional documenting or analyzing conversations during a private, joint, group, or family counseling session. We will not use or disclose psychotherapy notes without your authorization except for the following:

1. Treatment. The originator of the psychotherapy notes may use the notes for treatment.

2. Training. We may use the psychotherapy notes for our training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family, or individual counseling.

3. Legal Proceeding Brought by You. We may use or disclose psychotherapy notes to defend FamiliesFirst, Inc. in a legal action or other proceeding brought by you.

4. Required by Law. We will use or disclose psychotherapy notes if we are required to do so by law or if required to do so during an investigation into our compliance with federal privacy laws.

5. Government Oversight. We may disclose psychotherapy notes to a health oversight agency for oversight activities authorized by law, including audits, civil, administrative, or criminal investigations, inspections, licensure or disciplinary actions, civil, administrative, or criminal proceedings or actions, or other activities necessary for appropriate oversight of any of our programs. For instance, we will disclose psychotherapy notes to Medi-Cal as part of its regular audit of the files of our clients who are Medi-Cal beneficiaries.

6. Public Safety. We may disclose your health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual. The disclosure will only be made to someone who is able to prevent or reduce the threat.


YOUR RIGHTS
1. Authorization. We may use or disclose your health information for any purpose that is listed in this notice without your written authorization. We will not use or disclose your health information for any other reason without your authorization. If you authorize us to use or disclose your health information, you have the right to revoke the authorization at any time. For information about how to authorize us to use or disclose your health information, or about how to revoke an authorization, contact the person listed under "Whom to Contact" at the end of this notice. You may not revoke an authorization for us to use and disclose your information to the extent that we have taken action in reliance on the authorization. If the authorization is to permit disclosure of your information to an insurance company, as a condition of obtaining coverage, other law may allow the insurer to continue to use your information to contest claims or your coverage, even after you have revoked the authorization.

2. Request Restrictions. You have the right to ask us to restrict how we use or disclose your health information. We will consider your request, but we are not required to agree. If we do agree, we will comply with the request unless the information is needed to provide you with emergency treatment. We cannot agree to restrict disclosures that are required by law.

3. Confidential Communication. You have the right to ask us to communicate with you at a special address or by a special means. For example, you may ask us to send mail to a different address rather than to your home. Or you may ask us to speak to you personally on the telephone rather than sending your health information by mail. We will not ask you to explain why you are making the request. We will agree to any reasonable request.

4. Inspect And Receive a Copy of Health Information. Except for psychotherapy notes, you have a right to inspect the health information about you that we have in our records, and to receive a copy of it. This right is limited to information about you that is kept in records that are used to make decisions about you. For instance, this includes billing records. If you want to review or receive a copy of these records, you must make the request in writing. We may charge a fee for the cost of copying and mailing the records. To ask to inspect your records, or to receive a copy, contact the person listed under "Whom to Contact" at the end of this notice. We will respond to your request within 30 days. We may deny you access to certain information. If we do, we will give you the reason, in writing. We will also explain how you may appeal the decision.

5. Amend Health Information. You have the right to ask us to amend health information about you that you believe is not correct, or not complete. You must make this request in writing, and give us the reason you believe the information is not correct or complete. We will respond to your request in writing within 30 days. We may deny your request if we did not create the information, if it is not part of the records we use to make decisions about you, if the information is something you would not be permitted to inspect or copy, or if it is incomplete and inaccurate.

6. Accounting of Disclosures. You have a right to receive an accounting of certain disclosures of your information to others. This accounting will list the times we have given your health information to others. The list will include dates of the disclosures, the names of the people or organizations to whom the information was disclosed, a description of the information, and the reason. We will provide the first list of disclosures you request at no charge. We may charge you for any additional lists you request during the following 12 months. You must tell us the time period you want the list to cover. You may not request a time period longer than six years. We cannot include disclosures made before April 14, 2003. Disclosures for the following reasons will not be included on the list: disclosures for treatment, payment, or health care operations; disclosures required by law; disclosures required for public health purposes; disclosures when the information relates to a victim of abuse, neglect or domestic violence; disclosures for law enforcement purposes; disclosures necessary to prevent serious harm to the public or to an individual; disclosures to family and friends involved in your treatment plan or payment for care; disclosure in connection with research projects; disclosures that you have authorized; and disclosures made directly to you.

7. Paper Copy of this Privacy Notice. You have a right to receive a paper copy of this notice. If you have received this notice electronically, you may receive a paper copy by contacting the person listed under "Whom to Contact" at the end of this notice.

8. Complaints. You have a right to complain about our privacy practices, if you think your privacy has been violated. You may file your complaint with our Quality Systems Department, or with the person listed under "Whom to Contact" at the end of this notice. All complaints must be in writing. We will not retaliate against you if you file a complaint.

9. Filing Complaints to the Office of Civil Rights. If you believe that FamiliesFirst, Inc. has violated your (or someone else's ) health information privacy rights or committed another violation of the Privacy Rule, you may file a complaint with the Office for Civil Rights (OCR).

Complaints to the Office for Civil Rights must: (1) Be filed in writing, either on paper or electronically; (2) name the entity that is the subject of the complaint and describe the acts or omissions believed to be in violation of the applicable requirements of the Privacy Rule; and (3) be filed within 180 days of when you knew that the act or omission complained of occurred. Any alleged violation must have occurred on or after April 14, 2003 for OCR to have authority to investigate.

If you need help filing a complaint you may call the OCR toll free number: 1-800-368-1019. You should send your complaint to the appropriate OCR Regional Office, based on the region where the alleged violation took place. You can submit your complaint in any written format, or use the OCR’s recommended Health Information Privacy Complaint Form found on the OCR web site or at an OCR Regional office. If you prefer, you may submit a written complaint in your own format. OCR's website for additional information: http://www.hhs.gov/ocr/hipaa.

OUR RIGHT TO CHANGE THIS NOTICE
We reserve the right to change our privacy practices, as described in this notice, at any time. We reserve the right to apply these changes to any health information that we already have, as well as to health information we receive in the future. Before we make any change in the privacy practices described in this notice, we will write a new notice that includes the change. We will post the new notice in lobby area of all FamiliesFirstInc. office locations and on the FamiliesFirstInc.'s website. The new notice will include an effective date.


WHOM TO CONTACT
- Contact the person listed below: For more information about this notice, or
- For more information about our privacy policies, or
- If you want to exercise any of your rights, as listed on this notice, or
- If you want to request a copy of our current notice of privacy practices.

FamiliesFirst, Inc. Privacy Officer
2100 Fifth St.
Davis, California 95616-6591
Phone: (530) 753-0220

Copies of this notice are available:

1) At all lobby areas of all FamiliesFirst office locations.

2) By e-mail. Contact the person named above, or send an e-mail to: PrivacyOfficer@FamiliesFirstInc.org

3) Download it in PDF format -- Click Here.



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