This notice describes how information about your child may be used and disclosed and how you can get access to this information. Please review it carefully.

Understanding Your Health Record/Information
Each time your child sees a healthcare provider, a record of the visit is made. Typically, this record contains symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment.

This information, often referred to as the health or clinical record, serves as a:

• basis for planning care and treatment
• means of communication among the many health professionals who contribute to care
• legal document describing the care received
• means by which you or a third-party payer can verify that services billed were actually provided
• a tool in educating health professionals
• a source of data for research
• a source of information for public health officials
• a source of data for facility planning and marketing
• a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in the record and how health information is used helps you to:

• ensure its accuracy
• better understand who, what, when, where and why others may access health information
• make more informed decisions when authorizing disclosure to others

Your Health Information Rights
Although the health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to the client and the parent/guardian. You have the right to:

• request a restriction on certain uses and disclosures of information as provided by 45 CFR 164.522
• obtain a paper copy of the notice of information practices upon request
• inspect and obtain a copy of the health record as provided for in 45 CFR 164.524
• amend the health record as provided in 45 CFR 164.528
• obtain an accounting of disclosures of health information as provided in 45 CFR 164.528
• request communications of health information by alternate means or at alternative locations
• revoke authorization to use or disclose health information except to the extent that action has already been taken

Our Responsibilities
This organization is required to:

• maintain the privacy of health information
• provide a notice as to our legal duties and privacy practices with respect to information we collect and maintain about your child
• abide by the terms of this notice
• notify you if we are unable to agree to a requested restriction
• accommodate reasonable requests to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you've supplied us.

We will not use or disclose health information without authorization, except as described in this notice.

For More Information or to Report a Problem
If have questions and would like additional information, you may contact the Privacy Officer at 216-932-2800.

If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Examples of Disclosures for Treatment, Payment and Health Operations
We will use health information for treatment.

For example: Information obtained by a member of the healthcare team will be recorded in the record and used to determine the course of treatment that should work best for your child. The child's clinician will document in the record his or her expectations of the members of the healthcare team. Members of the healthcare team will then record the actions they took and their observations. In that way, the clinician will know how the child is responding to treatment.

We will also provide any subsequent healthcare provider with copies of various reports that should assist him or her treating the child who is discharged from this facility.

We will use health information for payment.

For example: A bill may be sent to you or a third-party payer. The information on accompanying the bill may include information that identifies your child, as well as his/her diagnosis, treatment and supplies used.

We will use health information for regular health operations.

For example: Members of the staff, the risk or quality improvement manager, or members of the quality improvement team may use information in the health record to asses the care and outcomes in your child's case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

Business associates: There are some services provided in our organization through contracts with business associates. Examples include physician services, prescription drugs, certain laboratory tests, and a copy service we use when making copies of your health record. When these services are contracted, we may disclose health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect health information, however we require the business associate to appropriately safeguard our information.

Research: We may disclose information to researches when their research has been approved by an institutional review board that has reviewed the research proposal and establish protocols to ensure the privacy of health information.

Law enforcement: We may disclose health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member of business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

Effective Date: 1/1/2002