1. The right to be treated with consideration and respect for personal dignity, autonomy, and privacy;

2. The right to service in a humane setting, which is the least restrictive feasible as defined in the treatment plan;

3. The right to be informed of one’s own condition, of proposed or current services, treatment or therapies, and of the alternatives;

4. The right to consent or refuse any service, treatment, or therapy upon full explanation of the expected consequences or refusal. Any parent or legal guardian may consent to or refuse any service, treatment, or therapy on behalf of a minor client;

5. The right to a current, written, individualized treatment plan that addresses one’s own mental health, physical health, social and economic needs, and that specifies the provision of appropriate and adequate services, as available, either directly or by referral;

6. The right to active and informed participation in the establishment, periodic review, and reassessment of the treatment plan;

7. The right to freedom from unnecessary or excessive medication;

8. The right to freedom from unnecessary restraint or seclusion;

9. The right to participate in any appropriate and available agency service, regardless of refusal of one or more other services, treatment, or therapies, or regardless of relapse from earlier treatment in that or another service, unless there is a valid and specific necessity which precludes and/or requires the client’s participation in other services. This necessity shall be explained to the client and written in the client’s current treatment plan;

10. The right to be informed of and refuse any unusual or hazardous treatment procedures. 

11. The right to be advised of and refuse observation by techniques such as one-way vision mirrors, tape recorders, televisions, movies, or photographs;

12. The right to have the opportunity to consult with independent treatment specialists or legal counsel, at one’s expense;

13. The right to confidentiality of communication and of all personally identifying information within the limitations and requirements for disclosure or various funding and/or certifying sources, state or federal status, unless release of information is specifically authorized by the client or person of an adult client in accordance with Rule 5122:2-3-11 of the Administrative Code;

14. The right to have access to one’s own psychiatric, medical, or other treatment records, conducted in the presence of professional personnel on the organization’s premises, unless access to particular identified items of information is specifically restricted for that individual client for clear treatment reasons in the client’s treatment plan. “Clear treatment reasons” shall be understood to mean only severe emotional damage to the client such that dangerous or self-injurious behavior is an imminent risk. The person restricting the information shall explain to the client and other persons authorized by the client the factual information about the individual client that necessitates the restriction. The restriction must be renewed at least annually to retain validity. Any person authorized by the client has unrestricted access to all information. Individuals shall be informed in writing of agency policies and procedures for viewing or obtaining copies of personal records. The client can challenge the accuracy of the record and insert his or her own statement. If Children's Advantage personnel insert a statement in response, such statements are inserted with the knowledge of the person served.

15. The right to be informed in advance of the reason(s) for discontinuance of service provision, and to be involved in planning for consequences of that event;

16. The right to receive an explanation of the reasons for denial of service;

17. The right not to be discriminated against the provision of service on the basis of religion, race, color, creed, sex, national origin, age, lifestyle, physical or mental handicap, developmental disability, or inability to pay;

18. The right to know the cost of services;

19. The right to be fully informed of all rights;

20. The right to exercise any and all rights without reprisal in any form including continued uncompromised access to treatment;

21. The right to file a grievance; and

22. The right to have oral and written instructions for filing a grievance.

B. The client shall have access to his/her own treatment record as described in #14 above. However, the Center will also indicate in the individual client record if access to particular identified items of information should be specifically restricted for that individual client (i.e., child, parent, or guardian) for clear treatment reasons. “Clear treatment reasons” shall be understood to mean risk of severe emotional damage to the client including, but not limited to, risk of dangerous or self-injurious behavior. “Clear treatment reasons” also include risk of substantially weakening family relationships through the release, to other family members, of information viewed as private by a particular family member or members or by a guardian. An individual’s right to access to treatment records extends only to those portions of the records generated by the individual himself/herself or as a record of contact between the individual and an agency staff member. An individual also has the right to access the records of contacts in which this agency releases information regarding him/her to another party. Portions of treatment records generated by sources outside the agency or as a result of private contact with other persons (e.g., other family members) are inaccessible to the individual without the consent of the outside source or the other person(s) with whom contact was made. The term “individual”, as used above, refers to a child, parent, or guardian. Decisions regarding portions of records to be restricted for an individual will be made jointly by the individual’s therapist and another therapist at Children’s Advantage. If the individual’s therapist has left the agency, the decision will be made by the therapist’s immediate supervisor and another therapist or, if the supervisor has left the agency, by the agency Chief Executive Officer and another therapist.

The persons making the restriction will explain the reasons for the restriction to the individual. The restriction must be reviewed at least annually to retain validity. Individuals shall be informed in writing of agency policies and procedures for viewing or obtaining.

C. The Client Rights Officer, Mary McCracken, may be contacted in person at 520 N. Chestnut Street, Ravenna, Ohio 44266 or by phone Monday-Friday 8:00 a.m.-5:00 p.m. at 330-296-5552. The client right officer will be available to deal with a complaint in a timely manner. In the event that the client rights officer is the subject of a grievance or is otherwise unavailable, the Chief Executive Officer, Kathy Regal, MBA, will serve as the alternate client rights officer. It is the responsibility of the client rights officer to accept and oversee the process of any grievance filed by a client or other person or agency on behalf of a client.

CHILDREN’S ADVANTAGE hours of operation are Monday through Thursday, 8:00am-8:00pm and Friday, 8:00am-5:00pm.

A copy of the Client Rights summary will be distributed to all clients at intake or at the first session with the opportunity for a verbal explanation of same, and clients will be informed that the Grievance Process is available upon request. In a crisis or emergency situation, clients will be verbally informed immediately of pertinent rights with the written copy and full verbal explanation delayed to a subsequent meeting. Clients or recipients of community services (such as information and referral services, consultation, or mental health education) or any Portage County resident may have a copy and full verbal explanation of the Client Rights and Grievance Processes upon request. Additionally, a copy of the Client Rights and Grievance Process will be posted in the agency. All staff of the agency will be trained to understand the client rights and grievance process of the agency sufficiently to inform any client with a complaint to file a grievance.

Effective Date: September 16, 2019

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. 

If you have any questions about this Notice, please contact the Children’s Advantage (CA) Privacy Officer at (330) 296-5552. 

OUR DUTIES 

At CA we understand that health information about you and your health is personal. We are committed to protecting health information about you and safeguarding that information against unauthorized use or disclosure. We are required by law to: 1) maintain the privacy of your health information; 2) provide you Notice of our legal duties and privacy practices with respect to your health information; 3) to abide by the terms of the Notice that is currently in effect; and 4) to notify you if there is a breach of your unsecured health information. 

HOW WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION 

When you receive service from CA, health information is collected and created about you. We may receive, use or share your health information for such activities as payment for services provided to you, conducting our internal health care operations, communicating with your healthcare providers about your treatment and for other purposes permitted or required by law. The following are examples of the types of uses and disclosures of your personal information that we are permitted to make: 

Payment - We may use or disclose information about the services provided to you and payment for those services for payment activities such as confirming your eligibility, obtaining payment for services, managing your claims, utilization review activities and processing of health care data. 

Health Care Operations - We may use your health information to train staff, manage costs, conduct quality review activities, perform required business duties, and improve our services and business operations. 

Treatment - We may share your personal health information with your health care providers to assist in coordinating your care. 

Other Uses and Disclosures - We may also use or disclose your personal health information for the following reasons as permitted or required by applicable law: To alert proper authorities if we reasonably believe that you or your child/ward may be a victim of abuse, neglect, domestic violence or other crimes; to reduce or prevent threats to public health and safety; for health oversight activities such as evaluations, investigations, audits, and inspections; to governmental agencies that monitor your services; for lawsuits and similar proceedings; for public health purposes such as to prevent the spread of a communicable disease; for certain approved research purposes; for law enforcement reasons if required by law or in regards to a crime or suspect; to correctional institutions in regards to inmates; to coroners, medical examiners and funeral directors (for decedents); as required by law; for organ and tissue donation; for specialized government functions such as military and veterans activities, national security and intelligence purposes, and protection of the President; for Workers’ Compensation purposes; for the management and coordination of public benefits programs; to respond to requests from the U.S. Department of Health and Human Services; and for us to receive assistance from consultants that have signed an agreement requiring them to maintain the confidentiality of your personal information. Also, if you have a guardian or a power of attorney, we are permitted to provide information to your guardian or attorney in fact. 

Uses and Disclosures That Require Your Permission - We are prohibited from selling your personal information, such as to a company that wants your information in order to contact you about their services, without your written permission. We are prohibited from using or disclosing your personal information for marketing purposes, such as to promote our services, without your written permission. All other uses and disclosures of your health information not described in this Notice will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your health information for the purposes stated in your written permission except for those that we have already made prior to your revoking that permission. 

PROHIBITED USES AND DISCLOSURES 

If we use or disclose your health information for underwriting purposes, we are prohibited from using and disclosing the genetic information in your health information for such purposes. 

POTENTIAL IMPACT OF OTHER APPLICABLE LAWS

If any state or federal privacy laws require us to provide you with more privacy protections than those explained here, then we must also follow that law. For example, drug and alcohol treatment records generally receive greater protections under federal law.

YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION 

You have the following rights regarding your health information: 

• Right to Request Restrictions. You have the right to request that we restrict the information we use or disclose about you for purposes of treatment, payment, health care operations and informing individuals involved in your care about your care or payment for that care. We will consider all requests for restrictions carefully but are not required to agree to any requested restrictions.* 

• Right to Request Confidential Communications. You have the right to request that when we need to communicate with you, we do so in a certain way or at a certain location. For example, you can request that we only contact you by mail or at a certain phone number. 

• Right to Inspect and Copy. You have the right to request access to certain health information we have about you. Fees may apply to copied information.* 

• Right to Amend. You have the right to request corrections or additions to certain health information we have about you. You must provide us with your reasons for requesting the change.* 

• Right to an Accounting of Disclosures. You have the right to request an accounting of the disclosures we make of your health information, except for those made with your permission and those related to treatment, payment, our health care operations, and certain other purposes. Your request must include a timeframe for the accounting, which must be within the six years prior to your request. The first accounting is free but a fee will apply if more than one request is made in a 12-month period.* 

• Right to a Paper Copy of Notice. You have the right to receive a paper copy of this Notice. This Notice is also available at our web site: www.childrensadvantage.org, but you may obtain a paper copy by contacting the CA office. 

To exercise any of the rights described in this paragraph, please contact the CA Privacy Officer at: 

520 N. Chestnut Street, Ravenna OH 44266 (330) 296-5552 or email kregal@childrensadvantage.org 

* To exercise rights marked with a star (*), your request must be made in writing. 

Please contact us if you need assistance. 

CHANGES TO THIS NOTICE 

We reserve the right to change this Notice at any time. We reserve the right to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of our current Notice at our office and on our website at: www.childrensadvantage.org. In addition, each time there is a change to our Notice, you will receive information about the revised Notice and how you can obtain a copy of it. The effective date of each Notice is listed on the first page in the top center. 

TO FILE A COMPLAINT 

If you believe your privacy rights have been violated, you may file a complaint with the CA (see above) or with the Secretary of the Department of Health and Human Services. To file a complaint with CA, contact the Privacy Officer at the address above. You will not be retaliated against for filing a complaint. If you wish to file a complaint with the Secretary you may send the complaint to: Office for Civil Rights, U.S. Department of Health and Human Services, Attn: Regional Manager, 233 N. Michigan Ave., Suite 240, Chicago, IL 60601. 

CA Privacy Officer: 520 N. Chestnut Street, Ravenna, OH 44266 (330) 296-5552 kregal@childrensadvantage.org..