Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW PERSONAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW THIS INFORMATION CAREFULLY.

Your Safe Homes record contains personal information about you that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.  This information is referred to as Protected Health Information (“PHI”).  This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law.  It also describes your rights regarding how you may gain access to and control your PHI.

We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI.  We are required to abide by the terms of this Notice of Privacy Practices.  We reserve the right to change the terms of our Notice of Privacy Practices at any time.  Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time.  We will provide you with a copy of the revised Notice of Privacy Practices at your next appointment.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU 

For Services.  Your PHI in your file at Safe Homes is considered to be confidential and will only be released verbally or in writing to those whom you authorize by written release of the information in this office, within certain limitations.  Legal exceptions to confidentiality are explained under the heading “Without Authorization” that follows on this form.  In addition, your PHI may be used and disclosed to Safe Homes staff members who are involved in your care for the purpose of providing, coordinating, or managing your services.  We may disclose PHI to other agencies only with your written authorization.  In addition, the Safe Homes program is funded in part by grants which require that demographic information about clients be submitted monthly in order for Safe Homes to be reimbursed for services provided and in order to continue to provide services free of charge.

Required by Law. Under the law, we must make disclosures of your PHI to you upon your request.  Files are kept for five (5) years at the end of which time they are destroyed.  If you wish to have a copy of your file or copies of any portion of your file, you must make a written request and give it to your Case Advocate or another Safe Homes staff member.  Copies of your file can only be made during normal office hours - Monday through Friday from 8:00 a.m. to 4:00 p.m.  Please allow 24 business hours to complete your request.

If you have exited the shelter, you will need to bring a picture ID before records are released to you.  If you are unable to personally pick up your copy of your files, you should have your written request notarized and include an address where files should be sent.  If you are having someone else pick up your files, that person’s name should be on the notarized statement, and he/she must have a picture ID to pick up the copies.  This is to protect your confidentiality and ensure that your files are not being released to someone you have not authorized.

Without Authorization.  Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of situations.  The types of uses and disclosures that may be made without your authorization are those that are:
* Required by law, such as the mandatory reporting of child abuse or neglect or mandatory government agency audits or investigations
* Required by Court Order
* Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.  If information is disclosed to prevent or lessen a serious threat, it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

With Authorization.  Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which you may withdraw at any time.


YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding PHI we maintain about you.  To exercise any of these rights, please submit your request in writing to our Privacy Officer, Maggie Tucker, LMSW,  at P.O. Box 3187, Augusta, GA., 30914-3187.

* Right of Access to Inspect and Copy.  You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that may be used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those circumstances where there is compelling evidence that access would cause serious harm to you.  
* Right To Amend.  If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment.
* Right to an Accounting of Disclosures.  You have the right to request an accounting of certain of the disclosures that we make of your PHI.  
* Right to Request Restrictions.  You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations.  We are not required to agree to your request.
* Right to Request Confidential Communication.  You have the right to request that we communicate with you about your personal information in a way to guarantee confidentiality.
* Right to a Copy of this Notice.  You have the right to a copy of this notice.

COMPLAINTS

If you believe we have violated your privacy rights, you have the right to file a complaint in writing with our Privacy Officer, Maggie Tucker, LMSW, at P.O. Box 3187, Augusta, GA 30914 or by calling (706) 736-2499 or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W., Washington, D.C. 20201 or by calling (202) 619-0257.  We will not retaliate against you for filing a complaint.
The effective date of this Notice is April 14, 2003.
	4/5/2006