In compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

This notice is intended for clients, potential clients, personal representatives and employees for the express purpose of describing how client or employee medical information may be used and disclosed and how client, employee or personal representative can get access to this information.

Review this notice carefully!

Understanding Your Health Record and Related Information
Our Agency is responsible for obtaining health information of clients, potential clients and employees in order to make decisions including, but not limited to accepting clients into our programs, appropriate care for health conditions, selection of health providers, payment for services and other related matters. We are also responsible for creating and maintaining records of symptoms, diagnosis and treatment plans for future care. This information, often referred to as client case record or employee confidential record, serves as a basis for planning client or employee care and treatment. Client and employee health information is also used by third-party payers to verify that billed services were provided.

Uses and Disclosures
Our Agency will not disclose client health information without the client's authorization, except as described in this notice. The client's legal guardian may also provide authorization.

Treatment. The Agency will use the client or employee health information for treatment: for example, information obtained by staff will be recorded in the client case record or employee confidential record and used to determine the course of treatment. The therapist/worker and other health care professionals will communicate with one another personally and through the case record or employee confidential record to coordinate care provided to that client or employee. The client or employee may receive more than one services during the treatment period with such information shared between service entities.

Payment. The Agency will use client or employee health information for payment for services rendered. For example, a bill may be sent to client, employee or a third-party payer. The information on or accompanying the bill may include information that identified the client or employee, as well as that person's diagnosis and treatment procedures.

Health Care Operations. The Agency will use client health information for health care operations. For example, Agency staff may use information in the client's care record to assess the care and outcomes of the case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of services we provide. Regulatory and accrediting organizations may review client case record or employee record to ensure compliance with their requirements.

Notification. In an emergency, the Agency may use or disclose health information to notify or assist in notifying a family member, personal representative or another person responsible for the care of client or employee, of client location and general condition.

Occupational Injury. The Agency may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to occupational injury, workers compensation or other similar programs established by the law.

Public Health. As required by federal and state law, the Agency may disclose client or employee health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Law Enforcement. As required by federal and state law, the Agency will notify authorities of alleged abuse/neglect; and risk or threat of harm to self or others. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Charges against the Agency.  In the event client, personal representative, employee or former employee should file against the Agency, the Agency may disclose health information necessary to defend such action.

Duty to Warn. When a client or employee communicates to the Agency a serious threat of physical violence against himself, herself or a reasonably identifiable victim or victims, the Agency will notify either the threatened person(s) and/or law enforcement.

The Agency may also contact clients or employees about appointment reminders, treatment alternatives or for public relations activities.

In any other situation, the Agency will request client, personal representative or employee's written authorization before using or disclosing any identifiable health information. If client, personal representative or employee chooses to sign such authorization to disclose information, that client, personal representative or employee can revoke that authorization to stop any future uses and disclosures.

Individual Rights
Clients and employees have the following rights with respect to their protected health information.

1. Clients and employees may request in writing that the Agency not use or disclose their information for treatment, payment or administration purposes or to persons involved in their care except when specifically authorized by the client or employee, when required by law, or in emergency situations. The Agency will consider that request; however, the Agency is not legally required to accept it.

Clients or employees have the right to request that their health information be communicated to them in a confidential manner such as sending mail to an address other than their home.

2. Within the limits of the Texas statutes and regulations, clients and employees have the right to inspect and copy their protected health information. If they request copies, the Agency will charge them a reasonable amount, as allowed by statutes.

3. If clients or employees believe that information in their record is incorrect or if important information is missing, they have the right to submit a request to the Agency to amend their protected health information by correcting the existing information or adding the missing information.

4. Clients and employees have the right to receive an accounting of disclosures of their protected health information.

5. If this notice was sent to you electronically, you may obtain a paper copy of the notice upon request to the Agency.

Agency's Duties

1. The Agency 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.

2. The Agency is required to abide by the terms of the Notice currently in effect, and

3. The Agency reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that it maintains. Prior to making any significant changes in our policies, Agency will change its Notice and post the new Notice on the web site. You can also request a copy of our Notice at any time. For more information about our privacy practices, contact the individual listed below.

Complaints
If you are concerned that the Agency has violated your privacy rights, or you disagree with a decision the Agency made about access to your records, you may contact the person listed below. You may also send a written complaint to the federal Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request. Under no circumstances will you be retaliated against for filing a complaint.

Contact Information
The Agency is required by law to protect the privacy of your information, provide this Notice about our information practices, and follow the information practices that are described in this Notice.

If you have any questions or complaints, please contact Donna Wilcoxson at the address or phone number listed below.

Donna Wilcoxson
Human Resources Manager
Dillon International, Inc.
3227 East 31st Street, Suite 200
Tulsa, OK  74105
Phone: 918-749-4600