Notice of Privacy Practice

Effective April 14, 2003


This notice will tell you how we may use and disclose protected health information about your rights and our duties with respect to health information about you. In addition, it will tell you how to complain to us if you believe we have violated your privacy rights.


How we may use and disclose health information about you:


For Treatment-

To provide, coordinate or manage the services, supports and health care you receive from us and other providers. For example, staff may share information to coordinate needed services, such as medical tests, transportation to a doctor’s visit, physical therapy, etc.

For Payment-

So we can be paid for the services we provide to you. For example, we may need to provide the state Medicaid program information about you and/or the services we provide to you so we will be reimbursed for those services.

For Business Operations-

For our own business operations. These are necessary for us to to operate CSCSO and to maintain quality for our customers. For example, we may use health information about you to review the quality of services we provide and the performance or our employees supporting you.

How we will contact you-

To contact you by either telephone or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail.

Appointment Reminders-

To contact you to remind you of an appointment for treatment or services.

Treatment and Services Alternative-

To contact you about treatment and service alternatives that may be of interest to you.

Health Related Benefits and Services-

To contact you about health-related benefits and services that may be of interest to you.

Marketing Communications-

To communicate with you about a product or services that may be of interest to you.


To raise funds for CSCSO. If you do not want CSCSO to contact you for fundraising you must notify the CSCSO Privacy Policy in writing.

Disclosures to Family and Others-

To keep informed of your case a parent/guardian, personal representative, relative or any other person identified to you.

Disaster Relief-

To a public of private entity authorized by law or by it’s charter to assist in disaster relief efforts.

Required by Law-

When we are required to do so by law.

Public Health Activities-

For public health activities and purposes such as disease control.

Victims of Abuse, Neglect or Domestic Violence-

To a government authority authorized by law to receive reports of abuse, neglect or domestic violence. If we believe that you are a victim of abuse neglect or domestic violence.

Health Oversight Activities-

To a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions.

Judicial and Administrative Proceedings-

In the course of any judicial or administrative proceeding in response to a subpoena or an order of the court or administrative tribunal.

Disclosures for Law Enforcement Purposes-

To a law enforcement official for law enforcement purposes.

Coroners, Medical Examiners, Funeral Directors and Organ, Eye or Tissue Donation-

For identification purposes to assist determining the cause of death or other duties as necessary to assist  in carrying out their duties.

To Avert Serious Threats to Health or Safety-

If we believe the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public.

Military Activity-

If you are a member of the Armed Forces, to the appropriate military command authorities.

National Security and Intelligence-

To authorized federal officials for the conduct of intelligence, counter-intelligence and other national security activities authorized by law.

Protective Services for the President-

To authorized federal officials so they can provide protection to the President of the United States, certain other federal officials or foreign heads of state.

Inmates; Persons in Custody-

To a correctional institutional or law enforcement official having custody of you.

Workers Compensation-

To the extent necessary to comply with workers’ compensation and laws.

Other Uses and Disclosures-

Other uses and disclosures will be made only with your written authorization. You may revoke such an authorization at any time by notifying the CSCSO Privacy Officer in writing of your desire to revoke it. However, if you revoke such an authorization, it will not have any affect or actions taken by us in reliance on it.


Your Rights With Respect to Health Information About You


Right To Request Restrictions of Your Health Information-

You have the right to ask us to place additional restrictions on our use and disclosure of your health information for our treatment, payment and operations. For example, you could ask that we not disclose health information about you or your brother or sister. We are not required to agree to these restrictions. Your written request must state the specific restriction requested and to whom you want the restriction to apply.

Right to Receive Confidential Communications-

You have the right to request that we communicate health information about you to you in a certain way or at a certain location. For example, you can ask that we can only contact you by mail or at work. You will not be required to explain your reasoning for the request. Your written request for confidential communication must state how or where you can be contacted. We will attempt to honor your request.

Right to Inspect and Copy Your Health Information-

With a few very limited expectations and with written request, you have the right to inspect and obtain a copy of health information about you. You may be charged a fee for the costs of copying and if you ask that it be mailed to you, the cost of mailing.

Right to Attend-

You have the right to ask us in writing to charge health information about you. You have this right as long as the health information is maintained by us. We can deny your request for certain reasons, but we must give you a written reason for our denial.

Right to an Accounting of Disclosures-

You have the right t0 receive a list of disclosures of health information about you made after April 14, 2003. This list will not include the time that information was disclosed for treatment, payment or operations. You may may be charged a fee for the costs of copying and, if you ask that it be mailed to you, the cost of mailing.

Right of Copy of this Notice-

You have the right to obtain a paper copy of our Notice of Privacy Practices. You may obtain a paper copy even though you agreed to receive the notice electronically.