At Family & Children’s Agency, we believe that both the client and the provider have a responsibility to each other to assure that the best possible service is provided and appropriately used.
Below we have outlined your rights and responsibilities as a client of Family & Children’s Agency (the Agency). We also have included information on your rights to access and control of your protected health information and certain obligations that we have regarding the use and disclosure of your protected health information.
Your “protected health information” is information about you which is created by us and received by us, including demographic information, that may reasonably identify you and that relates to your past, present or future physical or mental health, services rendered to you by the Agency, or condition of payment for the provision of your health care.
We are required by law to maintain the privacy of your protected health information. We are also required by law to provide you with notice of our legal duties and privacy practices with respect to your protected health information and to services rendered to you by the Agency and to abide by the terms of the Notice that is currently in effect.
Family & Children’s Agency, Inc.
Client Bill of Rights
THIS BILL OF RIGHTS IS IN COMPLIANCE WITH CONNECTICUT GENERAL STATUTES, SECTION 17, 206A THROUGH SECTION 17, 206K (Inclusive)
EACH CLIENT HAS THE RIGHT TO THE FOLLOWING IN REGARD TO SERVICES:
- To considerate and respectful service.
- To service provided by qualified personnel.
- To reasonable response (within Agency guidelines) to his/her request for service and reasonable continuity of care.
- To service without discrimination as to race, color, religion, age, marital status, sex, national or ethnic origin, sexual orientation, or source of payment.
- To receive a comprehensive consultation with recommendation(s) for treatment or service. If Family & Children’s Agency is unable to provide the level of care indicated, we will provide referrals to another appropriate service(s).
- To accurate assessment of his/her personal and social needs and complete information regarding his/her service plan.
- To give his/her informed consent for any treatment or service.
- To participate in the development of his/her service plan.
- To participate in a discharge plan for follow-up for psychotherapy, counseling, medication management, or other services offered by the Agency. If you decide to discontinue psychotherapy at the Agency without a discharge plan in place, the Agency cannot continue to provide medication management unless you are re-admitted to the program for concurrent psychotherapy or counseling.
- To contact Infoline (1-800-203-1234 or 2-1-1), our after hours service provider, in the event of an emergency.
EACH CLIENT HAS THE FOLLOWING RIGHTS IN THE AREA OF CONFIDENTIALITY AND PRIVACY:
- To privacy and confidentiality of all client information and records, except as otherwise provided by law or third party payment contracts.
- To have such records maintained in locked files within the Agency.
- To know that prior written consent by the client or designated representative is required for release of information to persons not otherwise authorized under law to receive it.
- To privacy to the extent consistent with providing services. This shall not rule out discreet discussion of the case between appropriate Agency personnel or discussions for operations such as quality assurance and improvement activities, medical review, legal services or auditing functions and general administrative activities and inadvertent and incidental disclosures such as names and schedules, etc.
- To be fully informed of his/her condition, and to have reasonable access to his/her record.
EACH CLIENT HAS THE FOLLOWING RIGHTS TO REQUEST AND RECEIVE INFORMATION:
- To be made aware of Family & Children’s Agency policies including criteria for admission to or exclusion from service, discharge from service, regulations and hours of service, fees, financial policies, and procedures for medical or psychiatric emergencies.
- To advance reasonable notice of and assistance with transfer to another agency or institution (on discharge), assuring continuity of services indicated.
- To examine and receive an explanation of his/her bill for service, regardless of payment source.
- To receive a copy of the Notice of Privacy Practices and the Client Bill of Rights at the time of admission.
- To receive a copy of the “Client Complaint and Grievance” procedure (Section 17a-20-34 of the Connecticut General Statutes)
- To the name, title, and affiliation of any person providing or supervising his/her service.
- To provide information, upon request, regarding the professional education and experience of the person(s) providing or supervising services.
- To be fully informed that all employees of Family & Children’s Agency, Inc. are designated as mandated reporters in cases of suspected child abuse or neglect or direct threats of harm (Section 17a-101 of the Connecticut General Statutes) and are mandated reporters of elder abuse and abuse of individuals with disabilities. (Section 17b-450, 17b-461 of the Connecticut General Statutes).
- To be informed in advance of the benefits, risks, and alternatives to planned services.
- To review the service plan and the service plan reviews.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
As permitted by Connecticut or federal law, we may use and disclose your protected health information so that we can bill and receive payment for the treatment and related services you receive. For billing purposes, we may disclose your health information to your payment source including an insurance or managed care company, Medicare, Medicaid, or another third party payer.
In addition we may use and disclose your protected health information in the following ways:
- FAMILY & CHILDREN’S AGENCY BUSINESS ASSOCIATES: As defined by HIPAA, there may be some services provided by our business associates, such as a billing service, transcription company or legal or accounting consultants. We may disclose your protected health information to our business associates so that they can perform the job we have asked them to do. To protect your health information, we require our business associates to enter into a written contract that requires them to appropriately safeguard your information.
- APPOINTMENT REMINDERS: We may use and disclose protected health information to contact you as a reminder that you have an appointment, unless otherwise directed by you.
- PUBLIC HEALTH ACTIVITIES: We may disclose your protected health information to a public health authority that is authorized by law to collect or receive such information such as for the purpose of preventing or controlling disease, injury or disability, reporting births or deaths, reporting child abuse or neglect, notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.
- HEALTH OVERSIGHT ACTIVITIES: We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure.
- JUDICIAL AND ADMINISTRATIVE PROCEEDINGS: We may disclose your protected health information in response to a subpoena, discovery request or other lawful process if such disclosure is permitted by law.
- LAW ENFORCEMENT: We may disclose your protected health information for certain law enforcement purposes if required by law.
- FUNDRAISING ACTIVITIES: With your consent, we may use information about you to contact you in an effort to raise money for the Agency and its operations. A description of how to opt out of receiving any further fundraising communications will be included with any fundraising materials you receive from the Agency. If you request that your information not be used or disclosed for fundraising purposes, we will make a reasonable effort to ensure that you do not receive future fundraising communications.
- RESEARCH PURPOSES: Your protected health information may be used for research purposes, but only if the privacy aspects of the research have been reviewed and approved by a special Privacy Board and the Board or Directors if Family & Children’s Agency, and only if you provide authorization.
- TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY: We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would be to someone able to help prevent the threat.
- MILITARY AND NATIONAL SECURITY: If required by law, if you are a member of the armed forces, we may use and disclose your protected health information as required by military authorities or the Department of Veterans Affairs.
Except as described in the above Notice, or as permitted by Connecticut or Federal law, we will not use or disclose your protected health information without your written authorization.
You have the right to:
- Access, inspect and copy your protected health information. You have the right to access, inspect and obtain a copy of your protected health information that is used to make decisions about your care for as long as the protected health information is maintained by us.
- Amend your protected health information. You have the right to request an amendment to your protected health information maintained by us, for as long as the information is maintained by or for the Agency. Your request must be made in writing to Family & Children’s Agency and must state the reason for the requested amendment. If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.
- Receive an accounting of disclosures of protected health information.
- If you have a complaint about the use and disclosure of your protected health information you may contact the Agency’s Privacy Officer at (203) 855-8765 and/or the Secretary at the U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20205, (877) 696 6775.
EACH CLIENT HAS THE RIGHT TO REFUSE SERVICE:
- To refuse any service or terminate such service if he/she so desires.
- To be aware of the Agency Criteria for Involuntary Termination of Agency Services.
EACH CLIENT HAS THE RIGHT TO VOICE CONCERN AND DISSATISFACTION:
- To voice grievances and concerns, and recommend changes to Agency staff, free from restraint, interference, coercion, discrimination, or reprisal.
- To contact the Director of the Division or Service rendered (e.g. Behavioral Health, Adoption, Child Welfare) or a designee, if he/she feels there is a question about any violation of his/her rights or possible deficiencies in the service received; and to have appropriate follow up on his/her concerns relative to services rendered.
- For Adoption, if further action is desired, the Vice President or President of the Agency and/or the head of Licensing and Policy at the Department of Children and Families in Hartford, CT may be contacted. Phone: (860) 550-6431.
- For Community Connections, if further action is desired, the President of the Agency, the Board of Directors or the Local Mental Health Authority, F.S. DuBois Center at (203) 921-4500, may be contacted.
Note: Directors, Vice Presidents or the President of Family & Children’s Agency or their designees may be reached at (203) 855-8765, Monday through Friday, between 8:30 a.m. and 4:30 p.m.
WHERE APPLICABLE, EACH CLIENT HAS THE RESPONSIBILITY:
- To keep all scheduled appointments or give 24 hours notice of cancellation or be charged a service fee.
- To pay the fee at the time of service, if applicable. Service will not be provided without payment.
- To be responsible for insurance deductibles and co-pays, if applicable.
- To immediately inform staff of changes in your insurance provider/status or other financial circumstances, which may affect the fee.
- To respect the confidentiality of others.
- To be responsible for the arrangements of your child’s arrival to and departure from the Agency’s facility and to be aware that no child is to be left unattended in the waiting room.