NOTICE OF PRIVACY PRACTICES 

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

PLEASE READ IT CAREFULLY

Trempealeau County Department of Social Services (TCDSS) must maintain the privacy of your personal health information and give you this notice that describes our legal duties and privacy practices concerning your health information.  When we release your health information, we must release only the information we need to achieve the purpose of the use of disclosure.  

TCDSS reserves the right to change this notice at any time.  In the event of a change, TCDSS will post a revised notice within the agency, make revised notices available upon request, and post revised notices on our website. 

HOW TREMPEALEAU COUNTY DEPARTMENT OF SOCIAL SERVICES

USES AND SHARES YOUR MEDICAL INFORMATION 

TCDSS uses your health information from your medical records to provide treatment to you, to arrange for payment and for health care operations. 

1. TREATMENT – We may use your health information for purposes of treatment. Any treatment would be noted in your records for any other caseworker or member of your social services treatment team.

2. PAYMENT - We may submit your health information to Medical Assistance or the State of Wisconsin for reimbursement. When we do that, we will share the least amount of information so that payment can be made.

3. HEALTH CARE OPERATIONS – We may look at your file to review operations.  These quality and cost improvement activities may include evaluating the performance of your home care providers or their agencies that are utilized to help you remain in your home.

We may review your health information if it is time for us to re-establish your eligibility, to conduct reassessments for case review or for a routine visit. 

THE LAW ALLOWS TREMPEALEAU COUNTY

DEPARTMENT OF SOCIAL SERVICES

TO SHARE YOUR PROTECTED HEALTH INFORMATION

WITHOUT YOUR AUTHORIZATION: 

1. As required by law – If any aspect of your medical information becomes the interest of a legal proceeding, court or administrative action or law enforcement.
2. For public health reasons – Certain information is gathered for statistical purposes and will be shared with the agency, i.e. Center for Disease Control, Wisconsin Department of Health and Family Services, Federal Drug Administration, etc.
3. Health oversight activities – The government monitors the activities of its benefit system, a review of which may include your personal health information.
4. Death records – Information about death is recorded and documented by various authorities, i.e. the register of deeds, medical examiner, coroner and funeral director.
5. Organ donation – In the case of organ donation, information must be shared to get a match.
6. Research – Upon approval only.
7. Health and safety threat – In order to avoid or lessen a serious threat to your health information with the necessary authorities.
8. Military, national security, incarceration, law enforcement custody – Your health information may be disclosed to the authority involved under the above circumstances.
9. Worker’s Compensation – Health information may be disclosed according to the law if it involves worker’s compensation laws and benefits.
10. To those involved in your care or payment for your care – Family members and other legally responsible parties may be given information regarding your care and treatment.
11. Victims of abuse, neglect or domestic violence – Victims may have their health information disclosed to a governmental entity authorized to receive such reports.
12. Statutory Exceptions – Wisconsin Statutes 51.30 and 252.

ALL OTHER DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION WILL REQUIRE AN AUTHORIZATON BY YOU. 

YOU DO NOT HAVE TO SIGN THE AUTHORIZATION TO RECEIVE TREATMENT.

IF YOU DO SIGN THE AUTHORIZATION, YOU MAY REVOKE IT AT ANY TIME. 

HEALTH INFORMATION is defined as any information, whether oral or recorded in any form or medium, that:

1. Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and
2. Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual.

YOUR HEALTH INFORMATION RIGHTS 

ACCESS:  You have the right to see your medical records and request copies.  You may request copies in writing to Trempealeau County Department of Social Services (TCDSS). 

DISCLOSURES:  We must keep a record to whom your information is disclosed after April 14, 2003, and you have a right to see the disclosure record.  You may request this information from TCDSS. 

RESTRICTIONS:  You have the right to request additional restrictions.  Your request must be made in writing to TCDSS.  However, we do not have to agree to all requests. 

CONFIDENTIAL COMMUNICATIONS:  You have the right to request that we make arrangements with you to communicate with you in a different manner than usual. This request must be in writing and we will accommodate reasonable requests. 

AMENDMENT:  You do not have the right to change your medical information.  You have the right to request that we clarify your medical information by adding information to your records.  Your request must be in writing, and it must explain why the information should be amended.  We have the right to deny your request. The denial will be in writing.  You may respond with a statement in writing as to why you would disagree with the decision, which will be added to the records.  If we agree to amend the records as requested then we may also make reasonable efforts to inform others, including specific parties named by the consumer of the changes. 

COMPLAINT PROCESS:  Trempealeau County Department of Social Services has a documented complaint process regarding the use and/or disclosure of protected health information.  If you wish to file a complaint, you may call, write or present in person to the Privacy Officer at: