In cases where we deny a request, you may write a statement that you disagree with us. We will then add our response and your statement to the record. With your written permission, we will also make reasonable efforts to inform those people that have received the challenged information that an amendment has been made.

To Request Restrictions

You have the right to ask us to restrict or limit the information we use or disclose about you for delivery of services, payment or business operations. We are not required to agree to your request. If we do agree, we will comply with your request unless there is an emergency or we are otherwise required by law to disclose information.

To Request Confidential Communications. You have the right to request how we communicate with you to preserve your privacy. For example, you may request that we only call you at work or by mail at a special address or post office box instead of your home address. Your request must be in writing and must specify how or where we are to contact you. We will accommodate all reasonable requests.

HOW WE MAY USE YOUR INFORMATION

For Service Delivery - We will use your protected health and service information to provide, coordinate, or manage the services we will provide to you. The minimum amount of protected information necessary to accomplish treatment goals may be disclosed to supervisors, other treatment team members, consultants and administrators.

For Payment - Upon receipt of written consent, we may use and disclose you protected health and service information so that we can receive payment from you, your insurance company or other funding sources. The minimum amount of protected information will be disclosed to secure reimbursement for the services delivered to you. For example: we may disclose information that identifies you, your diagnosis and the services that you received.

For Business Operations - We may use your protected information to support our business activities and to improve the quality of our services. For example: we may use your records when evaluating the services you received. We may also disclose your protected information to health oversight and accrediting agencies and for activities authorized by law such as audits, investigations, inspections and licensure. Examples include the following:

• Governmental Entities - We are required to share protected information with State and Federal governmental entities to determine our compliance with federal and state laws related to health care or for other purposes as required by law. Governmental entities that may receive protected information about you include, but are not limited to, the US Department of Health and Human Services, the Illinois Department of Human Services Office of Mental Health and the Office of the Illinois Inspector General.
• Appointments and Communication - We may contact you at the phone number you provided with regard to appointments, treatment and/or other issues that relate to the services you are receiving.
• Training and Fundraising - Protected information that does not contain your personal identifiers may be disclosed for training and fundraising purposes.
• Business Associates - There are some services provided at Metropolitan Family Services through a third party "business associate". Examples include financial auditors, answering services, and psychiatrists. Whenever service delivery to you requires the use or disclosure of your protected information, Metropolitan Family Services will have a written contract that contains terms to protect the privacy of your service information.

For Reporting Child and Elder Abuse - Staff with reasonable cause to believe that a child may be subjected to abuse or neglect are required by law to report this to the Illinois Department of Children and Family Services. Staff with reasonable cause to believe that an older person, who is incapable of seeking assistance because of some dysfunction, has been subjected to abuse or neglect are required by law to report this to the Illinois Department on Aging or one of its elder abuse provider agencies.

For Reporting Risk of Harm to Clients and Others Staff with reasonable cause to believe that a risk exists of serious, immediate, physical or emotional injury or death may inform law enforcement agencies and persons who may be affected by threatened action. Staff may also take steps to facilitate or secure the client’s hospitalization, if warranted.

Criminal activity on our premises may require the sharing of information with law enforcement agencies.

For Continuous Quality Improvement - Continuous Quality Improvement (CQI) or "Peer Review" is another valuable process that Metropolitan Family Services uses to improve services. CQI activities may include the review of client records. Some of the findings may be published for use within and outside of Metropolitan Family Services but your name and other information that would identify you will not be used in any publications and reports.

For Research - We may use and disclose your protected information to researchers provided the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information.

CLIENT COMPLAINT AND GRIEVANCE

You Have Legal Guarantees of Confidentiality and Rights of Grievance Your rights are protected in accordance with Chapter 2 of the Illinois Mental Health and Development Disabilities Code and your right to confidentially is governed by the Mental Health and Developmental Disabilities Confidentiality Act and the Federal Health Insurance Portability and Accountability Act (HIPAA). There will be no retaliation if you file a complaint.

Confidentiality and Privacy Complaints - If you want to file a privacy or confidentiality complaint with Metropolitan Family Services or have any questions regarding your privacy rights or the information in this notice, please contact the Metropolitan Family Services Privacy Officer by mail or phone: