Privacy Statement

As you visit our web site, you may request specific information about our program not contained on our web site. In order to respond to your request for information, we ask that you include your name, address and phone number. If applicable, you may include your e-mail address. In the event you choose to provide us with this information, we will only use it for the purpose of responding to your specific request.

Transmittal of your personal data shall constitute your acknowledgment and agreement to the terms and conditions contained in this Privacy Statement. Please note, your information is used for internal purposes only — we do not sell or distribute our lists to anyone.

Notice of Privacy Practices in Accordance with HIPAA


NOTICE OF PRIVACY PRACTICES AND CONFIDENTIALITY OF
ALCOHOL AND DRUG ABUSE CLIENT RECORDS

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.
 
This Notice describes how Excelsior Youth Center protects the personal health information that we have about you which relates to health care services that you receive from us and how we may use and disclose this information.  It also describes your rights with respect to your personal health information that we maintain or create and how you can exercise those rights.  “Personal health information” is information about you that may identify you and that relates to your medical condition, the health care services you receive, any plan for future care to you, or the payment for health care services provided to you. 
 
Our Pledge Regarding Your Health Information.
 We understand that your health information is personal, and we are committed to protecting this information.  We create a record of the care and services you receive at Excelsior Youth Center.  We need this record to provide you with quality care and to comply with certain legal requirements.  This Notice applies to all of the records relating to your health that we maintain, whether created by us or another provider.  We are required by law to:

• follow the terms of the Privacy Notice;
• give you this notice of our legal duties and privacy practices with respect to your personal health information; and
• maintain the privacy of your personal health information. 

Changes to This Notice. 
We may change the terms of our Notice at any time.  The new notice will be effective for all personal health information that we maintain at that time.  If we make changes to this Notice, you may obtain a copy of the revised Notice by contacting the Privacy Officer at the address and phone number listed below.  We will also make the revised Notice available at our reception desk and posted on this website page.
 
How We May Use and Disclose Your Personal Health Information. 
  The following categories describe different ways that we may use and disclose your personal health information. 
 
A. Treatment, Payment and Health Care Operations
 
We may use your personal health information to provide services to you, to get paid for our services or for the operations of Excelsior Youth Center, as described below:

• Treatment - We may use and disclose health information about you to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, technicians, and others who are involved in your care.  For example, we may send personal health information to a specialist as part of a referral.  In addition, to the extent that you receive education services on campus as part of your treatment plan, we will share health information about you with educators within our program that is needed by the educators to provide services to you. 
• Payment - We may use and disclose your personal health information so that the treatment and services you receive at Excelsior Youth Center may be billed to and payment collected from you, your health plan or referring agency, or a third party.  For example, we may give your health plan or the third party administrator who manages your health plan information about services you received at Excelsior Youth Center so that your health plan will pay us or reimburse you for the services of Excelsior Youth Center.
• Health Care Operations - We may use and disclose personal health information to support the operations of Excelsior Youth Center.  These uses and disclosures are necessary to run Excelsior Youth Center and make sure that all of our clients receive quality care.  For example, we may use personal health information to review our treatment and services.

B. Other Uses and Disclosures
 
We may also use and disclose personal health information for the following purposes under limited circumstances:

• To contact you for appointment reminders and to provide information about or recommend possible treatment options or alternatives that may be of interest to you. 
• To a friend or family member who is involved in your care (such as to help with follow-up care).
• To our business associates if they need to receive personal health information to provide a service to us.  Examples of such business associates are billing companies, data processing companies, or companies that provide general administrative services.  Our business associates are also required to keep your personal health information confidential.
• To government regulatory agencies that have a right to collect health information or for audits, inspections and investigations.
• To law enforcement officials in response to a request made through a court order, subpoena, warrant, summons or to prevent danger or injury.
• To coroners, funeral directors or organ donation organizations to allow them to carry out their duties.
• To prevent a serious threat to life or safety of a person or the public.
• For research studies that meet all privacy law requirements.
• For other purposes required or permitted by law.

C. Uses and Disclosures of Alcohol and Drug Information
 
If you are in a drug and alcohol treatment program that is subject to the federal alcohol and drug abuse confidentiality laws, 42 C.F.R. Part 2, generally, information that identifies you as an alcohol or drug abuser or a Client in such program will not be disclosed by the program without your written consent unless:

• The disclosure is for treatment
• The disclosure is allowed by a court order
• The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation
• To report crimes on the premises or against program personnel
• To report suspected child abuse or neglect.

D. Uses and Disclosures Not Covered by this Notice

• Other Uses of Personal Health Information - Other uses and disclosures of personal health information not covered by this Notice will be made only with your written authorization or that of your legal representative.  You may revoke that authorization, in writing, at any time.  Such authorization will be effective except to the extent that we have taken action in reliance on the authorization or if your authorization was obtained as a condition of obtaining health care services. 

Your Rights Relating to Your Personal Health Information.

• Right to Inspect and Copy Your Personal Health Information – In most cases, you have the right to inspect and obtain a copy of your personal health information that we maintain for as long as we maintain it.  If you want to copy your personal health information, you may be charged a fee for the costs of copying and mailing the information.  In limited circumstances, we may deny your request to review or obtain a copy of your personal information.  If we deny your request, we will advise you in writing of the reasons for the denial and explain your right to have the denial reviewed.
• Right to Amend Your Personal Health Information – If you believe that information that we maintain about you is incorrect or if important information is missing, you have the right to request that we amend it.  We may deny your request to amend the information under certain circumstances.  If we deny your request, we will advise you in writing of the reason for the denial and explain your right to submit a statement disagreeing with the denial.
• Right to Obtain a List of the Disclosures We Have Made – You have the right to obtain a list of the instances where we have disclosed your personal health information for purposes other than treatment, payment, health care operations, disclosures made directly to you, or where you have specifically authorized a disclosure.  The first list you request within a 12-month period will be free.  We may charge you for our costs in responding to any additional requests.
• Right to Request Restrictions on the Use and Disclosure of Your Personal Information – You have the right to request that we limit the way we use or disclose any part of your personal health information.  We are not required to agree to a requested restriction.  If we do agree, we will comply with your request except when you require emergency treatment. 
• Right to Request Confidential Communications – You have the right to request that we communicate with you about personal health information in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail.  We will accommodate all reasonable requests. 
• Right to Obtain a Copy of this Notice – You have the right to request a copy of this Notice.  A copy will be provided to you at your request.
• Right to File a Complaint – If you believe your privacy rights have been violated, you may file a written complaint with us or with the Secretary of the Department of Health and Human Services.  Under no circumstances will you be penalized or retaliated against for filing a complaint.

If you wish to request any of the above rights or if you have any questions about our privacy practices, you may contact the Privacy Officer at KellyD@excelsioryc.org or Kelly Davis, Excelsior Youth Center, 15001 E. Oxford Ave, Aurora, CO 80014.  You may also contact our Privacy Officer if you have questions or comments about our privacy practices. 
 
This notice was published and becomes effective on April 14, 2003.

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