Information regarding your health care, including payment for health care, is protected by two federal laws: the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 C.F.R. Parts 160 and 164, and the Confidentiality Law, 42 C.F.R. Part 2.

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). It describes how Alaska Family Services may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside the Alaska Family Services system except when the release is required or authorized by law or regulation.

Under HIPAA and the Confidentiality Law, Alaska Family Services may not say to a person outside Alaska Family Services that you attend our programs, nor may Alaska Family Services disclose any information identifying you as an alcohol or drug abuser, or any other protected health information except as permitted by federal law.

You will be asked to provide a signed acknowledgement of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights.

Alaska Family Services must obtain your written consent before it can disclose information about you for payment purposes. For example, Alaska Family Services must obtain your written consent before it can disclose information to your health insurer in order to be paid for services rendered. Generally, you must also sign a written consent before Alaska Family Services can share health care information for treatment purposes or for heath care operations.

Who Will Follow This Notice

This Notice describes the privacy practices of Alaska Family Services including:

• all workforce,
• volunteers,
• students/trainees,
• foster parents, and
• licensed providers while providing services at our agency.

When you come into our agency there are many forms that you will need to complete and data that you will provide. We are required to compile much of this information by our funders and under Alaska law. Typically, the information we retain contains health information, including your symptoms, examinations and test results, diagnoses, treatment, a plan for future care or treatment, information from other providers, and billing and payment information. We understand your information is personal and we are committed to protecting health information about you. For many of the situations described below, we will use, disclose, or receive the minimum amount of health information necessary to accomplish the intended purpose.

The following categories describe the different ways we use and disclose your health information and give examples of the same. Not every use or disclosure in a category is listed. But, the ways we are permitted to use and disclose your health information will fall within one of the categories.

Treatment: For consumers that are covered by 42 CFR, Part 2, Alaska Family Services will only disclose treatment information without written consent if it is a medical emergency. For those consumers that are not covered by 42 CFR, Part 2 we may use your health information to provide, coordinate, or manage your care and any related services. This includes the coordination or management of your care. This includes sharing information that you provide with supervisors or our internal team members so that they can assist in determining the best course of care and services for you. To assist with your care outside our agency, we may disclose your health information to outside providers. For example, if you are referred to a hospital, then your information is shared with practitioners at that facility.

Payment: We may use and disclose your health information, as needed, to obtain payment for the services that we provide. This may include certain activities that your health insurance plan or service funder may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant health information be disclosed to the health plan/funder to obtain approval for the hospital admission. We may also disclose your information to another provider involved in your care for their payments purposes as part of ensuring your eligibility for services.

Healthcare Operations: We may use and disclose, as-needed, your health information for our own health care operations in order to provide quality care to all consumers, to assess staff training needs or to ensure the efficiency of program operations. Health care operations include such activities as:

• quality assessment and improvement activities;
• employee review activities;
• training programs including those in which students, trainees, or practitioners in health care learn under supervision;
• accreditation, certification, licensing, or credentialing activities;
• review and auditing, including compliance reviews, record reviews, legal services and maintaining compliance programs; or
• business management and general administrative activities.

In certain situations, we may also disclose patient information to another provider or health plan for their health care operations.

Other Uses and Disclosures: As part of treatment, payment and health care operations, we may also use or disclose your protected health information for the following purposes:

• to remind you of an appointment;
• to inform you or recommend potential treatment alternatives or options;
• to inform you of health-related benefits, products, or services that may be of interest to you; and
• to inform you about general health matters, our services, health fairs, wellness programs, and similar events.

Legally Designated or Personal Representatives: Certain minors and incapacitated adults may have legally designated or personal representatives that act on their behalf for health care matters. Our agency may disclose health information about you to these legally designated or personal representatives. These individuals may be able to act on the person’s behalf and exercise the person’s privacy rights. If we have a reason to believe an individual poses a past or future harm to the person, we may elect not to treat the individual as a person’s personal representative.

Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law, such as audits; civil, administrative or criminal investigations, proceedings or actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight as authorized by law. We will not disclose your health information if you are the subject of an investigation and your health information are not directly related to your receipt of health care or public benefits.

Research Purposes: Under certain conditions, we may use or disclose your health information to researchers, when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information. We may use or disclose your health information to prepare for a research project. In other cases, we will only disclose health information pursuant to your authorization.

Qualified Service Organization/Business Associates: We may disclose health information to a qualified service organization or our business associates, with whom we contract to perform services on our behalf. For example, if a provider dictates a report on your care, we may use a transcription company with which we have a contract to type the report.

Public Health Activities: We may disclose your health information for public health activities. These activities generally include disclosures to: a public health authority authorized by law to collect information to prevent or control disease, injury, or disability, such as reporting disease, injury, and vital events (births, deaths, etc.), including mandated registries, or for public health surveillance, investigations, and interventions; a person responsible for federal Food and Drug Administration (?FDA?) activities for purposes related to the quality, safety, or effectiveness of FDA-regulated products or activities; a person who may have been exposed to a communicable disease or may be at risk for contracting or spreading a disease or condition, as authorized by law; or an employer about an employee, in certain situations.

Victims of Abuse, Neglect or Domestic Violence: We may disclose health information about an individual we reasonably believe to be the victim of abuse, neglect, or domestic violence to a government authority authorized by law to receive such reports. We will make the disclosure if the individual agrees to the disclosure. We will also make the disclosure if the disclosure is required by law. If the disclosure is authorized by law, but not required, then we will disclose the information as long as the individual agrees or if we believe the disclosure is necessary to prevent harm to the individual or other potential victims.

Law Enforcement Activities: We may disclose health information if asked to do so by a law enforcement official: as required by laws that require reporting of certain types of wounds; in response to court orders, warrants, summons, grand jury subpoenas, certain administrative requests, or similar processes; to identify or locate a suspect, fugitive, material witness, or missing person (but we will give only limited information); about the victim of a crime in certain circumstances; about a death we suspect may be the result of criminal conduct; about criminal conduct on our premises; and in emergencies, to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.

Coroners, Medical Examiners, and Funeral Directors: We may release health information to a medical examiner or coroner as necessary, or required, to identify a deceased person or determine the cause of death. We also may release health information about individuals to funeral directors so they can perform their duties.

Organ and Tissue Donations: We may release health information to organizations that handle organ procurement or organ, eye, or tissue transplants or to an organ donation bank, as required and needed for organ or tissue donation and transplants.

To Avert a Serious Threat to Health or Safety: We may use and disclose your health information when we reasonably believe it is necessary to prevent a serious threat to the health and safety of you, the public, or another person. The disclosure would be only to someone who is likely to help prevent the threat.

Workers Compensation: We may disclose health information about you for workers compensation or similar programs.

National Security, Intelligence Activities, and Protective Services: We may disclose health information about you to authorized federal officials for intelligence, counterintelligence, special investigations, and other national security activities authorized by law and so they may protect the President or other authorized persons.

Military Personnel: If you are a member of the armed forces, then we may release health information about you as required by your military command authorities.

Inmates: If you are an inmate of a correctional institution or under custody of a law enforcement official, then we may disclose health information about you to the correctional institution or a law enforcement official.

Incidental Disclosures: Certain incidental disclosures of your health information may occur as a by-product of permitted uses and disclosures. For example, a roommate may inadvertently overhear a discussion about your care if you share a room.

Limited Data Sets: We may disclose limited health information, contained in a limited data set, to certain third parties for research, public health, and health care operations. Before disclosing limited data sets, we will contract with the recipient to limit the recipient’s use and disclosure of this information.

De-identified Information: We may use and disclose health information that reasonably has been de-identified by removing certain identifiers (such as name and address) making it unlikely that you could be identified.

Before Alaska Family Services can use or disclose protected health information about you in a manner, which is not described above or covered in the laws that apply to us, it must first obtain your specific written consent allowing us to make the disclosure. Any such written consent may be revoked by you in writing. If you revoke your authorization, then we will no longer use or disclose your health information for the reasons covered by your written authorization. We cannot take back any disclosures we already have made with your authorization. We must retain our records of the care we provide to you.

Right to Inspect and Copy: You have the right to inspect and receive a copy of your health information that may be used to make decisions about your care, except to the extent that the information contains psychotherapy notes or information complied for use in a civil, criminal, or administrative proceeding or in other limited circumstances. You must make your request in writing. If you request a copy of the information, we may charge a fee for the costs or copying, mailing, or other supplied associated with your request.

In limited circumstances, Alaska Family Services may deny your request to see or get copies of your records. If you are denied access to your protected health information, you may request that the denial be reviewed. The person conducting the review will not be the person who denied your request. Alaska Family Services will comply with the outcome of the review.

Right to Request Restrictions: You have the right to request a limitation on the health information we use about you for treatment, payment, or health care operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply.

Alaska Family Services is not required to agree to any restrictions you request. If Alaska Family Services believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If Alaska Family Services does agree to the requested restrictions, we are bound by that agreement and may not use or disclose any protected information, which you have restricted, except as necessary in a medical or disaster emergency, so your family and/or other individuals involved in your care can be notified of your condition and location.

Right to Request Confidential Communications: You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You must make this request in writing. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We may end our accommodation to your request if payment arrangements are not honored.

Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may have to request an amendment of the health information we have about you. This request must be in writing and provide a reason for the amendment. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, we will do so in writing. You have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. These documents will be made part of your record. Please contact our agency if you request an amendment.

Right to an Accounting of Disclosures: You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This accounting will not include disclosures:

• for treatment, payment, or health care operations;
•  to you under your right of access to your records;
• that you authorized;
• through a facility directory, to persons involved in your care, or for notification;
•  incidental to an otherwise permitted use or disclosure;
• as part of a limited data set;
• for national security or intelligence purposes;
• to correctional institutions or other custodial law enforcement officials;
• that occurred before August 1, 2009; or
•  for any period longer than six years prior to your request.

To request this list or accounting, you need to submit your request in writing. The first list you request within a 12-month period will be free. We may charge you a reasonable fee for the cost of providing subsequent lists. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before you are charged.

Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

Protected health information is individually identifiable health information. This information includes demographics that may identify you, and related to your past, present, or future physical or mental health or condition and related health care services Alaska Family Services is required by law to do the following:

• maintain the privacy of your health information;
• give you this Notice of our legal duties and privacy practices with respect to the; information we collect and maintain about you;
•  follow the terms of the Notice that is currently in effect; and
• communicate any changes in the Notice to you.

If you believe your privacy rights have been violated, you may file a complaint with the Compliance Officer at 746-4080 or via mail at Alaska Family Services: 1825 S. Chugach St. Palmer, AK 99645. You also may file a complaint with the Secretary of United States Department of Health and Human Services of the Office for Civil Rights.

You may also file a complaint with the Secretary of Health and Human Services at 200 Independence Avenue, S.W.; Washington, DC 20201, or reach the Secretary by phone at (202) 690-7000. There will be no retaliation for filing a complaint.