Effective Date: January 1, 2016

If you have questions about this policy, please call (713) 667-9336

Each time you visit with your counselor or case manager, he or she makes a record of your visit. Typically, this record contains some information about your mental health and/or health history, your current symptoms, a diagnosis, treatment, and a plan for future treatment. This information serves as: a basis for planning your care and treatment, a legal document describing the care you received, the means by which you or a third-party payer can verify that you actually received the services billed for, a tool to assess the appropriateness and quality of care you received, and a tool to improve the quality of services we provide and to achieve better treatment outcomes.

We understand that information about you and your mental health and/or health is personal. We are committed to protecting all information about you. This notice applies to all of the records of your care generated by Alexander Jewish Family Service or records provided to Alexander JFS by other providers for the purpose of coordinating care. We are required by law to make sure that any information that identifies you is kept private; to give you this notice of our legal duties and privacy practices with respect to mental health and/or health information about you, and to follow the terms of the notice that is currently in effect.

How We May Use and Disclose Mental Health and/or Health Information About You

For Treatment: We may use mental health and/or health information about you to provide you with counseling and/or case management services. We may disclose mental health and/or health information about you to agency personnel who are involved in your care. For example, your counselor or case manager may share information about you with his or her Clinical Supervisor for the purposes of case consultation or supervision.

For Payment: We may disclose mental health and/or health information about you so that the services you receive may be billed to and payment may be collected from you, an insurance company or a third party such as an Employee Assistance Program. For example, if you have Medicaid or Medicare we may need to give your mental health and/or health plan information about the services you received at our agency so that your mental health and/or health plan will pay us for the services we provided to you. You will be asked to sign a specific consent before any such information will be released to a third party, however.

For Mental Health and/or Health Care Operations: We may use and disclose mental health and/or health information about you for agency operations. These disclosures are necessary to make sure that you receive quality care. For example, we may use mental health and/or health information to review our treatment and services and to evaluate the performance of our staff in caring for you.

Appointment Reminders and Customer Satisfaction Surveying: We may use and disclose mental health and/or health information to contact you as a reminder that you have an appointment for counseling or case management, or to follow-up on missed appointments. We may also mail to your home address a questionnaire to determine your satisfaction with our programs.

To Avert a Serious Threat to Mental Health and/or Health or Safety: We may use and disclose mental health and/or health information about you when necessary to prevent a serious threat to your mental health and/or health and safety or the mental health and/or health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

As Required by Law: We will disclose mental health and/or health information about you when required to do so by federal, state or local law. Examples include to report child or elder abuse and/or neglect, or to report specified communicable diseases to the Health Department.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose mental health and/or health information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Texas Law (THSC 241.153) permits disclosure of mental health and/or health information without written authorization in the following cases:

1. To a transporting emergency medical service provider. For example, if you became seriously ill and had to be transported, we could share mental health and/or health information with the ambulance team.
2. To the American Red Cross to fulfill its duties. The American Red Cross is responsible for providing evacuation during natural disasters. We would release information to them to coordinate a plan to evacuate you if you requested such assistance.