Notice of Privacy Practices

Effective Date: April 14, 2003

Jewish Family and Children's Service (JF&CS) collects specific information about you in order to provide you the services you need. The information we collect about your mental and physical health is considered private, and is protected by state and federal Jaws. We refer to this information as Protected Health Information or PHI.

JF&CS staff follows all state and federal laws protecting your PHI and we limit and protect any sharing of information about you to the minimum that is necessary to do our jobs. We expect all of our employees, volunteers and business partners to respect your privacy and abide by the same laws.

A record of your care is created at JF&CS in order to provide you with quality care and to document our services for legal and billing purposes. This notice informs you of the ways that we may use this information, to whom and how we may share it, and also what rights you have regarding your PHI.

PERMITTED USES AND DISCLOSURES

1. Upon your signing of this notice, JF&CS is permitted to use and share with others involved in your care your protected health information for treatment, payment and health care operations, as described in the following examples:

a. For treatment, a doctor or nurse you are seeing may need to consult with your psychologist, counselor or social worker to provide the best care.

b. For payment, our staff member who handles billing needs to provide information to your health insurance company so we can receive payment for our services.

c. For health care operations, we may use information in your record to review the quality of our care and the performance of our staff.

2. JF&CS is permitted or required, under specific circumstances, to use or share protected health information without your written authorization. For example, we are obligated by law to report suspected abuse of a child or a vulnerable adult, notify a person exposed to a communicable disease, disclose health information to federal and state government oversight committees, disclose information in response to law enforcement's official request regarding a crime against a person, for purposes of research, to avoid harm to another person, for worker's compensation purposes, for appointment reminders, and to contact you to raise funds for us to continue or expand our services.

3. Other uses and disclosures will be made only with your written authorization, and you may revoke such authorization.

4. JF&CS may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

5. You have the following rights regarding protected health information:

a. The right to request restrictions on certain uses and disclosures of protected health information. JF&CS is not required to agree to a requested restriction, however.

b. The right to receive confidential communications of protected health information, as applicable.

c. The right to inspect/copy protected health information, as per the Privacy Regulation.

d. The right to amend protected health information, as provided in the Privacy Regulation.

e. The right to receive an accounting of disclosures of protected health information.

f. The right to obtain a paper copy of JF&CS Notice of Privacy Practices upon request.

g. The right to obtain within 30 days of a written request a summary of your protected health information. We may charge a fee for copying or preparing a summary for you.

6. JF&CS is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and Privacy Practices with respect to protected health information.

7. JF&CS is required to abide by the terms of the Notice currently in effect.

8. JF&CS reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.

9. JF&CS will provide individuals or patients with a revised Notice by mail or e-mail.

Individuals may complain to JF&CS or to the Secretary of the Department of Health and Human Services, without fear of retaliation by JF&CS, if they believe their privacy rights have been violated. Complaints may be made in person to any JF&CS staff member who will then forward the complaint to the appointed Privacy Officer. You may file a complaint directly with the Privacy Officer (listed below) in person, by telephone, or in writing. Please remember to include details of the exact nature of your complaint, the names of any staff persons involved, your name and a daytime phone number.

Martha Kreipke

Jewish Family and Children's Service

l0950 Schuetz Road

St. Louis, MO 63146

(314) 812-9354