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.
When you receive services or benefits (such as Texas Human and Health Services) from D.O.R.S. Youth Transition Center (D.O.R.S), we may obtain and/or create health information about you. Health information includes any information that relates to (1) your past, present, or future physical or mental health or condition; (2) the health care provided to you; and (3) the past, present, or future payment for your health care.
The following notice tells you about our duty to protect your health information, your privacy rights, and how we may use or disclose your health information.
The law requires us to protect the privacy of your health information. This means that we will not use or let other people see your health information without your written permission except in the ways we tell you in this notice. We will safeguard your health information and keep it private. This protection applies to all health information we have about you, no matter when or where you received or sought services. We will not tell anyone if you sought, are receiving, or have ever received services from us, unless the law allows us to disclose that information.
We will ask you for your written permission (authorization) to use or disclose your health information. There are times when we are allowed to use or disclose your health information without your permission, as explained in this notice. If you give us your permission to use or disclose your health information, you may take it back (revoke it) at any time. If you revoke your permission, we will not be liable for using or disclosing your health information before we knew you revoked your permission. To revoke your permission, send a written statement, signed by you, to D.O.R.S, providing the date and purpose of the permission and saying that you want to revoke it.
We are required to give you this notice of our legal duties and privacy practices, and we must do what this notice says. We will ask you to sign an acknowledgement that you have received this notice. We can change the contents of this notice and, if we do, we will have copies of the new notice at our facilities and on our website, www.dorscommunityservices.org. The new notice will apply to all health information we have, no matter when we got or created the information.
Our employees must protect the privacy of your health information as part of their jobs. We do not let our employees see your health information unless they need it as part of their jobs. We will punish employees who do not protect the privacy of your health information.
We will not disclose information about you related to HIV/AIDS without your specific written permission, unless the law allows us to disclose the information.
As an individual receiving alcohol or drug abuse services, your records are protected by federal law and regulations found in the Code of Federal Regulations at Title 42, Part 2. Violation of these laws that protect alcohol or drug abuse treatment records is a crime, and suspected violations may be reported to appropriate authorities in accordance with federal regulations. Federal law will not protect any information about a crime committed by you either at D.O.R.S or against any person who works for D.O.R.S or about any threat to commit such a crime. Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.
Your Privacy Rights at the D.O.R.S.
You can look at or get a copy of the health information that we have about you. There are some reasons why we will not let you see or get a copy of your health information, and if we deny your request we will tell you why. You can appeal our decision in some situations. You can choose to get a summary of your health information instead of a copy. If you want a summary or a copy of your health information, you may have to pay a reasonable fee for it.
You can ask us to correct information in your records if you think the information is wrong. We will not destroy or change our records, but we will add the correct information to your records and make a note in your records that you have provided the information.
You can get a list of when we have given health information about you to other people in the last six years. The list will not include disclosures for treatment, payment, health care operations, national security, law enforcement, or disclosures where you gave your permission. The list will not include disclosures made before April 14, 2003. There will be no charge for one list per year.
You can ask us to limit some of the ways we use or share your health information. We will consider your request, but the law does not require us to agree to it. If we do agree, we will put the agreement in writing and follow it, except in case of emergency. We cannot agree to limit the uses or sharing of information that are required by law.
You can ask us to contact you at a different place or in some other way. We will agree to your request as long as it is reasonable.
You can get a copy of this notice any time you ask for it.
If you are also being treated for alcohol or drug abuse, D.O.R.S will not tell any unauthorized person outside of the D.O.R.S that you have been admitted to a treatment facility or that you are being treated for alcohol or drug abuse, without your written permission. We will not disclose any information identifying you as an alcohol, drug, or substance user, except as allowed by law.
D.O.R.S may only disclose information about your treatment for alcohol or drug abuse without your permission in the following circumstances:
Pursuant to a special court order that complies with 42 Code of Federal Regulations Part 2 Subpart E;
To medical personnel in a medical emergency;
To qualified personnel for research, audit, or program evaluation;
To report suspected child abuse or neglect;
To Advocacy, Inc. and/or the Texas Department of Protective and Regulatory Services, as allowed by law, to investigate a report that you have been abused or have been denied your rights.
Federal and State laws prohibit re-disclosure of information about alcohol or drug abuse treatment without your permission.
If you believe that D.OR.S. has violated your privacy rights, you have the right to file a complaint. You may complain by contacting:
East Texas Council on Alcoholism and Drug Abuse
Linda Oyer, Chief Executive Officer
708 Glencrest Lane
Longview, TX 75601
You may also file a complaint with: Texas Health and Human Services (HHS)
As required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, you have the right to file a complaint. If you believe that the Texas Health and Human Services (HHS) violated your (or someone else's) health information privacy rights or committed another violation of the HIPAA or the Privacy Act 1976, you may file a complaint with the HHS Privacy Office. HHS has the independent authority to receive and investigate complaints against HHS staff and business associates.
If you have questions or need help filling out a form, call the Privacy Office toll-free at 877-378-9869.
Civil Rights Office
Health and Human Services Commission
701 W. 51st Street, MC W206
Austin, Texas 78751
Phone: 1-888-388-6332 or 512-438-4313
Region VI, Office for Civil Rights
U.S. Department of Health & Human Services
1301 Young St. - Suite 1124
Phone Number: (214) 767-3301
Fax Number: (214) 767-3617
You must file your complaint within 180 days of when you knew or should have known about the event that you think violated your privacy rights.
You may also contact:
Office of the Attorney General
PO Box 12548
Austin, TX 78711-2548
For complaints against alcohol or drug abuse treatment programs, contact the United States Attorney’s Office for the judicial district in which the violation occurred.
D.O.R.S. Youth Transition Center will not retaliate against you if you file a complaint.
For further information:
Contact the D.O.RS. privacy officer by calling (903) 753-7633 (Longview) or (800) 441.8639 (toll free),
Or in writing to 708 Glencrest Lane, Longview, TX,
Or email email@example.com
Call Us: (903) 753-7633
TTY: (903) 247-9651 | (800) 441-8639
708 Glencrest Lane, Longview, TX 75601
Call Us: (903) 753-7633
211 Mill St., Pittsburg, TX 75686
2323 W. Front Street
Tyler, TX 75712
1820 Shiloh Road Suite 1302
Tyler, TX 75703
2654 Lamar Avenue
Paris, TX 75460