HIPAA Notice

HIPAA Notice of Privacy Practices for

Personal Health Information

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.   PLEASE REVIEW IT CAREFULLY.

Dear Kinship Caregiver/Resource Parent:

This is your Health Information Privacy Notice A Second Chance, Inc. (ASCI).  Please read it carefully.   You have received this notice because documentation of your medical examination is maintained on file with our agency as required by state law.  A Second Chance, Inc. values your right to privacy and takes pride in its great efforts to protect the confidentiality and security of information we collect about you.

This notice describes how we protect the personal health information we have about you which relates to your role as a state-licensed foster parents, and how we may use and disclose the information under the law.  Personal health information includes individually identifiable information which relates to your past, present or future health, treatment or payment for health care services.  This notice also describes how you can exercise those rights.

A Second Chance, Inc. is required to give you this Notice by the Health Insurance Portability and Accountability Act (“HIPAA”).  For more information on our HIPAA Privacy Policy, please see the Notice of Privacy Practices on our website, www.asecondchance-kinship.com.  For answers to questions on your privacy rights, you may write the HIPAA Compliance Specialist, 8350 Frankstown Avenue, Pittsburgh, PA 15221 or call 412-665-2300.

A Second Chance, Inc. is required by law to:

  • Maintain the privacy of your personal health information;
  • Give you this notice of our legal duties and privacy practices regarding your personal health information; and
  • Follow the terms of this notice.

We protect your personal health information from inappropriate use or disclosure.  All employees of A Second Chance, Inc. are required to abide by the requirements that protect the privacy and confidentiality of personal health information.  They may look at your personal health information only when there is an appropriate reason, such as assisting you in meeting requirements to become a state-approved foster parent (certification) or maintaining your status as a state-approved foster parent in Pennsylvania (annual re-certification. 

A Second Chance, Inc.- will not disclose your personal health information to any other agency or company for use in marketing products or services to you.  However, as described below, we will use and disclose personal health information about you for purpose of ensuring that children in your care are safe.

The main reasons we may use and disclose your personal health information are to assess your ability to care for the child in your care and to process your application for state approval as a foster parent.  The following describe these and other permitted uses and disclosures, along with some examples:

  • Where Required by Law or for Public Health Activities:
    A Second Chance, Inc. discloses personal health information when required by federal, state or local law.  For example, a mandatory disclosure includes notifying state or local health authorities regarding particular communicable disease, or providing personal health information to a governmental agency with health care oversight responsibilities.  We may also release personal health information to a coroner or medical examiner to assist in identifying a deceased individual or to determine the cause of death.
  • To Avoid Serious Threat to Health or Safety:
    A Second Chance, Inc. discloses personal health information to avoid a serious threat to someone’s health or safety. We may disclose personal health information to federal, state or local agencies engaged in disaster relief as well as to private disaster relief or disaster assistance agencies to allow such entitles to perform their responsibilities in specific disaster situations.
  • For Health Related Services:
    A Second Chance, Inc. may use personal health information to provide you information on benefits or services that may be of interest to you or your family.
  • For Law Enforcement or Specific Government Functions:
    A Second Chance, Inc. may disclose personal health information in response to a request by law enforcement officials made through a court order, subpoena, warrant, summons or similar process.  We may disclose personal information about you to federal officials for intelligence, counterintelligence, or other national security activities authorized by law.
  • When Requested as Part  of a Regulatory or Legal Proceeding:
    A Second Chance, Inc. may disclose personal health information about you in response to court order, subpoena or request during an investigation of any governmental agency or regulator, particularly during any investigation of suspected child abuse or neglect.
  • Other  Uses of Personal Health Information:
    Other uses and disclosures of your personal health information not covered by this notice and permitted by the laws that apply to A Second Chance, Inc. will be made only with your written authorization or that of your legal representative.  You or your legal representative may revoke that authorization, in writing , at any time , except when we have taken action relying on the authorization.  Please understand that we may not be able to take back any disclosures we have already made with authorization.

Your Rights Regarding Personal Health Information We Maintain About You

You have various legal rights under HIPAA concerning your personal health information.  If you have questions about a specific right, please write us at :

A Second Chance, Inc.
HIPAA Compliance Specialist
8350 Frankstown Avenue
Pittsburgh, PA 15221

  • Right to Inspect and Copy Your Personal Health Information:
    In most cases, you have the right to inspect and to obtain a copy of the personal information we maintain about you.  To inspect and obtain a copy of the personal information, you can write or call the HIPAA Compliance Specialist at A Second Chance, Inc. 8350 Frankstown Avenue, Pittsburgh, PA 15221, 412-665-2300.  Please note that in order for you to receive a copy of personal health information, you may be charged a fee, for the cost of copying, mailing or other supplies associated with your request.
  • Right to Amend Your Personal Health Information:
    If you have any reason to believe that the personal health information maintained by A Second Chance, Inc. is materially incorrect, or that an important part is missing, you have the right request that we change or amend the personal health information while it is maintained by us.  You may request to amend personal health information to the HIPAA Compliance Specialist at A Second Chance, Inc. 8350 Frankstown Avenue, Pittsburgh, PA 15221, 412-665-2300.  Please note that in order for you to amend personal health information you must have a valid reason and we may deny a request to amend personal health information if it is:
  • Accurate and Complete;
  • Not Created by A Second Chance, Inc.;
  • Not Personal Health Information Kept by A Second Chance, Inc.;
  • Right to a List of Disclosures:
    You have the right to request a list of disclosures we have made of personal information about you, unless those disclosures are made to law enforcement authorities, government agencies, or made pursuant to your express authorization.  You may request the list of disclosures by contacting HIPAA Compliance Specialist at A Second Chance, Inc. 8350 Frankstown Avenue, Pittsburgh, PA 15221, 412-665-2300. Please note that in order for you to obtain a list of disclosures, you must specify the time period of disclosures and may not include any dates before the effective date of this notice, April 14, 2003.
  • Right to Request Restrictions:
    You have the right to request a restriction or limitation on personal health information we use or disclose, unless the use or disclosure is required by law.  While A Second Chance, Inc. will consider your request, we are not required to comply with requests that jeopardize the health, safety or well-being  of a child in your care, including a child born or adopted by you or a member of your household.  To request a use or disclosure restriction, contact the HIPAA Compliance Specialist, at A Second Chance, Inc. 8350 Frankstown Avenue, Pittsburgh, PA 15221, 412-665-2300.   Please note that we will not comply with requests to limit or restrict uses or disclosures of personal health information that are necessary to carry out the stated mission or to administer the business operations of A Second Chance, Inc.
  • Right to Request Confidential Communications:
    You have the right to request that we communicate with you about personal health information in a certain way or in a certain location if you believe that any communication in another way would endanger you, your family or a member of your household, including a child in your care.  For example, you may request that we discuss personal health information about you only in writing.  To request confidential communications about personal health information, you may contact the HIPAA Compliance Specialist at A Second Chance, Inc. 8350 Frankstown Avenue, Pittsburgh, PA 15221, 412-665-2300.  Please note that for you to have confidential communications about personal health information, the request must be reasonable.
  • Right to File a Complaint:
    If you believe your privacy rights have been violated, you may file a complaint with the HIPAA Compliance Specialist at A Second Chance, Inc. 8350 Frankstown Avenue, Pittsburgh, PA 15221, 412-665-2300.  Note that you may also send a written complaint to:  The Secretary of the Department of Human Services, Washington, D.C.   You and your family will not be denied access to services of A Second Chance, Inc. if you file a complaint believing that any of your privacy rights have been violated.

ADDITIONAL INFORMATION

Changes to This Notice:

A Second Chance, Inc. reserves the right to change the terms of this notice at any time.  You will receive a copy of revised privacy notice in writing from A Second Chance, Inc.

More Information:

You may have additional rights to privacy and confidentiality under the law.  For more information on privacy and confidentiality of personal health information, please contact the HIPAA Compliance Specialist at A Second Chance, Inc. 8350 Frankstown Avenue, Pittsburgh, PA 15221, 412-665-2300.

A Second Chance, Inc.                                                               Effective April 14, 20