Over 140 years of service to children and families

Christian Home Association – Children’s Square USA

Privacy Notice Summary

This is a one page summary of the Organization’s Notice of Privacy Practices which is effective as of 09/9/2016.  Please refer to the entire Notice of Privacy Practices for full details.

We are committed to protecting the health care information of your child and family.  We adhere to all Federal, State, and local laws in protecting this information.

The following categories describe different ways that we use and disclose health information:

  • For treatment
  • For payment
  • For health care operations
  • For fund raising activities
  • For health oversight activities
  • For law enforcement purposes

Health Information not covered by the above will be disclosed only with your written permission.  You may revoke that permission at any time in writing to your child’s case manager.

You have the following rights regarding Health Information about the child for which you are the legal guardian:

  • The right to inspect and copy your child’s health information
  • The right to request in writing to amend your child’s health information
  • The right to psychotherapy notes through the use of Authorization
  • The right to an accounting of the disclosures of your child’s health information
  • The right to request restrictions on the disclosure of your child’s health information (please note that we are not required to comply with your request.)
  • The right to restrict certain disclosures of PHI to a health plan where the individual pays out of pocket in full for health care service or item.
  • The right to request confidential communications regarding your child’s health information
  • The right of affected individuals to be notified following a breach of unsecured protected health information
  • The right to request alternative channels of communication
  • The right to revoke the consent or authorization to use information
  • The right to a paper copy of the Organization’s Privacy Notice
  • The right to an electronic copy of electronic medical records
  • The right to opt out of communication for marketing purposes
  • The right to file a complaint if you believe your child’s health privacy rights have been violated (There will not be any retaliation against you or your child for filing a complaint.)  Contact Mark Duman, Security Officer, Box 8C, Children’s Square, Council Bluffs, IA  51502 or electronically at mduman@childrenssquare.org or by phone at 712-322-3700 X5833

For a copy of the Organization’s complete Notice of Privacy Practices please contact Beverley Wright, Privacy Officer, Box 8C, Children’s Square, Council Bluffs, IA  51502 or electronically at bwright@childrenssquare.org or by phone at 712/322-3700/712-828-7445

Privacy Notice Summary 3/15/13, 5/10/13, 5/20/13, 9/12/16, 4/23/21

Children’s Square USA-Centro Cristiano Resumen del Reglamento de Privacidad

Esta es una pagina del Reglamento Privado de las practicas de la Organizacion las cuales son efectivas desde September 9, del 2016. Por favor referirse al documento completo de las Practicas Privadas para mas deta!les.

Nuestro compromiso is proteger la informacion de! cuidado de salud de su nino(a) y de su familia. Nosotros nos apegamos a las !eyes Federates, Estatales y locales para proteger esta informacion.

Las siguientes categorias describen diferentes maneras que usamos y revisamos la inforrnacion de salud.

  • Para tratamiento
  • Para pagos
  • Para operaciones de! cuidado de salud
  • Para actividades para recaudar fondos
  • Para actividades de seguimiento de salud
  • Para propositos legales

La informacion de salud descrita anterionnente sera usada unicamente con penniso por escrito.
Ud puede revocar disho penniso en cualquier momento, escribiendo al representante del caso de su nino(a)

Usted tiene las siguientes derechos de acuerdo a la informacion de salud de su nino (a) del cual usted es el Guardian Legal:

  • Derecho a inspeccionar y copiar la informacion de salud de su nino(a)
  • Derecho a solicitar por escrito la informacion de salud de su nino(a)
  • Derecho a las notas psicornetricas atraves de una autorizacion.
  • Derecho a una infonnacion confiable de la salud de su nino(a).
  • Derecho a requerir restricciones de la infom1acion de salud de su nino(a). (por favor tome nota que nostros no requerimos acatar esta restriccion).
  • Derecho a restringir cie1ta info1macion de PHI, al plan de salud donde el individuo paga en la totalidad de su bolsillo el servicio de salud, examenes etc.
  • Derecho a requerir comunicaciones confidenciales acera de la informacion de salud de su n.ino(a).
  • Derecho a ser notificado si se filtra la informacion de salud protegida.
  • Derecho a pedir canals altemativos de comunicacion.
  • Derecha a revocar el consentimiento de la aurorizacion para usar la informacion.
  • Derecha a fotocopiar el Reglamento de Privacidad de la Organizacion
  • Derecha a una copia electronica de los records medicos electronicos
  • Derecho a decir que no a la communicacion si es con proposisos de mercadeo.
  • Derecho a hacer una queja si ud cree que el derecho a la privacidad de la salud de su nino(a) ha sido violentado. (No habraninguna accion contra ud. 0 su nino(a) por llenar di.cha queja). Contacte a Mark Duman, security Officer, Box 8-C, Children’s Square, Council Bluffs, IA 51502 o electronicamente a mdmnan@childrenssquare.org o por telefono as 712-828-7460.

Para una copia del Reglament y las Practicas de Privacidad de la Organizacion contacte a Beverley Wright, Privacy Officer, Box 8-C. Children’s Square, Council Bluffs, lA 51502 o electronicamente a bright(@.chiJdrenssguare.org o por telefono a 712-828-7445 Shortcut to Beverley/documents/Privacy Notice Summary or Y Drive/HIP AA Policy & Procedure/Attachments 3/15/13, 5/10/13, 5/20/13, 9/12/16, 2/1/21, 2/25/21

4-26-2021

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