Notice of Privacy Practices at Lutheran Social Services

Notice of Privacy Practices

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.

Use and Disclosure of Protected Health Information (PHI)

Lutheran Social Services of Wisconsin and Upper Michigan, Inc. may use your Protected Health Information, for the purpose of providing treatment, obtaining payment for care and other related health care operations. Lutheran Social Services of Wisconsin and Upper Michigan, Inc. has established specific policies to further protect your health information against unnecessary disclosure.

Circumstances Involving Use and Disclosure of Protected Health Information

To Provide Treatment

Lutheran Social Services of Wisconsin and Upper Michigan, Inc. may use your Protected Health Information to consult with LSS employees or designated treatment providers to provide the best quality of care. For example, a coordinating physician may need to know additional information about your symptoms to prescribe appropriate medications.

Payment

Lutheran Social Services of Wisconsin and Upper Michigan, Inc. may use your protected health information to other parties involved in paying for your treatment or care. For example, if a customer needs to stay at a transitional living home for additional days, Lutheran Social Services of Wisconsin and Upper Michigan, Inc. will provide the minimum necessary information to county worker in order to authorize payment for additional days.

Operations

We may use the minimum required Health Information for quality assessment activities, licensing, statistical and accreditation purpose. For example, LSS’s Director of Quality Assurance and Compliance is required to review charts for formatting and signatures in order to remain licensed through the State of Wisconsin.

Note-Psychotherapy notes are never released to anyone internally or externally for treatment, payment or operations.

When Required by Law

Lutheran Social Services of Wisconsin and Upper Michigan, Inc. will disclose your Protected Health Information when it is required to do so by Federal, State and Local law. This includes responding to a subpoena.

To Report Abuse or Neglect

Lutheran Social Services of Wisconsin and Upper Michigan, Inc. and it’s employees are mandated by law to report suspected child abuse, either physical or sexual, and child neglect.

To Report a Serious Threat to Health or Safety

If an employee of Lutheran Social Services of Wisconsin and Upper Michigan, Inc. has good reason to believe that your safety is in jeopardy (for example because of a suicide threat) or that another’s safety is in jeopardy (for example because of a threat to harm another), we are mandated by law to disclose Protected Health Information for the purpose of preventing harm to yourself or to someone else.

Use and disclosure for any purpose described above is limited to the minimum necessary information needed by a third party to carry out services that are in the best interest of the customer. The customer will be notified by Lutheran Social Services of Wisconsin and Upper Michigan, Inc., when a disclosure must be made in the above instances.

Authorization and Rights Regarding Your Health Information

Other than stated above, Lutheran Social Services of Wisconsin and Upper Michigan, Inc. will not disclose your Protected Health Information other than with your written authorization. If you authorize the agency the agency to use or disclose your Protected Health Information, you may revoke the authorization in writing at any time.

You have the following rights regarding your health information:

Right to request restrictions on disclosure of your health information. We will respectfully consider your request, but there may be times when we are not required to agree to your request. (If disclosing information would jeopardize the customer or if the law requires disclosure.)
Right to inspect and copy your health information. You must request your health information in writing, signing your request, and allow the agency 72 hours to process your request.
Right to amend Protected Health Information. If you believe that your health care information is incorrect or incomplete, you may request to amend your record. Your request must be made in writing and be signed. We will respectfully consider your request, but there may be times when we are not required to abide by your request.
Right to an accounting of disclosures. You have the right to request an accounting of the disclosures that Lutheran Social Services of Wisconsin and Upper Michigan, Inc. makes of your health information.

Complaints

If you believe Lutheran Social Services of Wisconsin and Upper Michigan, Inc. has violated your privacy rights, you have the right to file a complaint in writing with the Privacy Officer, Danielle Summers at 647 W. Virginia Street Milwaukee, WI 53204 (414) 325-3170 or with the Secretary of Health and Human Services at 200 Independence Avenue SW, Washington DC 20201 or by calling (202) 619-0257.

Effective Date

This notice is effective January 15, 2004 and replaces any previous notice of privacy practices issued by Lutheran Social Services of Wisconsin and Upper Michigan, Inc.

Questions

If you have any questions regarding this notice, please contact your Program Manager.