MARY LEE FOUNDATION

Notice of Privacy Rights

In this Privacy Notice, the word “Foundation” means the Mary Lee Foundation and to include any program operated by the Mary Lee Foundation.

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law. This law will be effective April 14, 2003. This law gives you important rights; the most important right under this law is your privacy.

We are required by applicable federal and state laws to maintain the privacy of your personal and health information. Both under law and our policy, Mary Lee Foundation has a responsibility to protect the privacy of your personal and health information. Personal and health information includes both medical information and individually identifiable information, (whether oral or recorded in any form or medium) such as your name, address, telephone number or social security number.

You are receiving this notice because you receive services from the Foundation. Because you are a client or consumer of the Mary Lee Foundation, the Foundation will request certain medical and personal information about you.

This notice tells you about your privacy rights, the Foundation’s duty to protect personal and health information that identifies you, and how the Foundation may use or disclose personal and health information that identifies you without your permission.

This notice describes how the Foundation protects you privacy by limiting who may see your personal and health information, how we may use or disclose your personal and health information, informs you of our legal duties with respect to your personal and health information and explains our privacy policies.

Your Privacy Rights

The Health Insurance Portability and Accountability Act (HIPAA) gives you the right to:

  • Review or obtain copies of your personal and health information the Foundation has about you in most situations;
  • You have the right to request that the Foundation correct certain information, including certain health information about you if you believe the information is wrong or incomplete. Most of the time, the Foundation cannot change or delete information, even if it is incorrect. However, if the Foundation decides it should make a change, it will add the correct information to the record and note that the new information takes the place of the old information. The old information will remain in the record. If the Foundation denies your request to change the information, you can have your written disagreement placed in your record. You may submit this request in writing to your administrator.
  • Request a list of the times the Foundation has disclosed personal and health information about you;
  • Ask the Foundation to limit the use or disclosure of personal and health information about you more than the law requires. However, the privacy law does not make the Foundation agree to that;
  • Tell the Foundation where and how to send your information that includes personal and health information if sending the information to your usual address could put you in danger. This request must be put in writing and be specific regarding where and how to contact you;
  • Ask for and get a paper copy of this Notice from the Foundation;
  • Withdraw permission you have given to the Foundation to use or disclose personal and health information that identifies you, unless the Foundation has already provided the information based on your permission. You must withdraw your permission in writing.

Uses and Disclosures of Mary Lee Foundation’s Client and Consumer Personal and Health Information

The Foundation may use and disclose your personal and health information without your consent/authorization, in the following ways:

  • Treatment: We may use or disclose your personal and health information in order for Foundation staff to provide treatment and services.
  • Payment: We may use and disclose your personal and health information in order for the Foundation to collect payment for your care from the sponsoring agency and/or agencies as applicable.
  • Health Care Operations: The Foundation may use or disclose personal and health care operations. Health care operations include:
    • Conducting quality assessment and improvement activities;
    • Reviewing the competence, qualifications, and performance of health care professionals or health care plans;
    • Training health-care professionals and others;
    • Conducting accreditation, certification, licensing, or credentialing activities;
    • Carrying out activities related to the creation, renewal or replacement of a contract for health insurance or health benefits;
    • Providing medical review, legal services, or auditing functions including fraud and abuse detection, and compliance program;
    • Engaging in business management or the general administrative activities of the Foundation.

Examples of uses and disclosures for health care operations include facilities and program surveys.

Family member, other relative, or close personal friend: The Foundation may disclose health information about you to a family member, other relatives or a close personal friend when:

  • The health information is related to that person’s involvement with your care, or payment for your care.

The Foundation may not disclose personal or health information to a family member, relative, or friend without your written permission or the written permission of your guardian.

Health oversight activities: The Foundation may sometimes use or disclose health information about you for health oversight activities and then only to another health oversight agency. For example, health oversight activities may include looking into Medicaid fraud. A health oversight agency must be a government agency or someone acting on behalf of a government agency.

Public Health: The Foundation may disclose health information about you to:

  • A public health authority for purposes of preventing or controlling disease, injury or disability
  • An official of a foreign government agency who is acting with the public health authority; and
  • A government agency allowed to receive reports of child abuse or neglect.

Victims of abuse, neglect, or domestic violence: If the Foundation believes you are the victim of abuse, neglect, or domestic violence, the Foundation may sometimes disclose health information about you to a government agency that receives reports of abuse, neglect, or domestic violence if:

  • A law requires the disclosure;
  • You agree to the disclosure;
  • A law allows the disclosure and the disclosure is needed to prevent serious harm to you or someone else; or
  • The law allows the disclosure, you are unable to agree or disagree, the information is needed for immediate action and the information will not be used against you.

If the Foundation makes a report under this section, the Foundation will tell you or your representative unless it believes that telling you would place you at risk.

Serious Threat to Health or Safety: The Foundation may use or disclose health information about you if it believes the use or disclosure is needed:

  • To prevent or lessen a serious and immediate threat to the health and safety of a person or the public:
  • For law enforcement authorities to identify or catch an individual who has admitted participating in a violent crime that resulted in serious physical harm to the victim, unless the information was learned while initiating or in the course of counseling or therapy; or
  • For law enforcement authorities to catch an individual who has escaped from lawful custody.

Process and Proceedings: We may disclose your personal and health information in response to a court or administrative order, subpoena, discovery request, or other lawful process.

Law Enforcement: We may disclose limited information to law enforcement officials concerning the personal and health information of a suspect, fugitive, material witness, crime victim or missing person and when a law requires the use or disclosure. We may disclose the personal and health information of an inmate or other person in lawful custody to a law enforcement official or correctional institution.

Research: The Foundation may use or disclose your personal and health information for research purposes in limited circumstances. The Foundation will ensure that your privacy is protected when your personal and health information is used for research.

As required by Law: The Foundation must use or disclose personal and health information about you when a law requires the use or disclosure.

Other uses and Disclosures: The foundation may use or disclose health information about you:

  • To create health information that does not identify any specific individual:
  • To the U.S. military or a foreign military for military purposes, if you are a member of the group asking for the information;
  • For the purpose of lawful national security activities;
  • To federal officials to protect the President and others;
  • To a prison or jail, if you are an inmate of that prison or jail, or to law enforcement personnel if you are in custody;
  • To comply with workers’ compensation laws or similar laws; and
  • To tell or help in telling a family member or another person involved in your care about your location, general condition or death. The Foundation may not share health information about you with a family member or anyone without your written permission of your guardian.

Authorizing Use and Disclosure of Mary Lee Foundation’s Client and Consumer Personal and Health Information

The law requires the Foundation to protect the privacy of personal and health information that identifies you. It also requires the Foundation to give you this Notice of its legal duties and privacy practice.

  • In most situations the Foundation may not use or disclose personal and health information that identifies you without your written permission. This Privacy Notice explains when the Foundation may use or disclose personal and health information that identifies you without your permission. The Foundation will not use or disclose your personal and health information for any reason except those described in this notice without your written authorization.
  • For all other uses and disclosures, the Foundation must obtain your written permission, which you may withdraw at any time.
  • The Foundation reserves the right to change its privacy policies at any time, as allowed by applicable law, rules and regulations. If the Foundation changes its privacy practices, it must notify you of the changes. Foundation employees must protect the privacy of identifying personal and health information as part of their job with the Foundation. The Foundation does not give employees access to personal and health information unless they need it for a business reason. Business reasons for needing access to personal and health information include planning the care you need, administrative and financial decisions and any other information covered by the laws of the United States Government or the State of Texas.

The Foundation will counsel and orient employees who do not protect the privacy of personal and health information that identifies you. Disclosure of confidential information may be cause for termination of employment and/or possible legal action.

If You Have a Complaint

If you are concerned that the Foundation may have violated your privacy rights or you disagree with a decision we made about access to your personal and health information, you may file a complaint in writing to your administrator.

You may also submit a written complaint to:

  • The United States Secretary of Health and Human Services
    200 Independence Avenue, S.W.
    Washington, D.C. 20201
    or call (800)368-1019
  • The Texas Office of the Attorney General
    Post Office Box 12548, Austin, Texas 78711-2548
    or call (800)806-2092

The Foundation supports your right to protect the privacy of your personal and health information. We will not retaliate in any way if you choose to file a complaint with us or with the United States Department of Health and Human Services or the Texas Attorney General’s Office.

If you want more information regarding our privacy practices, have questions regarding your privacy rights, you may contact us in the following ways:

Mary Lee Foundation
Privacy Office
P.O. Box 3174
Austin, Texas 78764

Telephone: (512)443-5777
E-mail:
marylee (at) maryleefoundation.org

Business hours are 8:00am to 5:00pm Monday through Friday.

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