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 treatment or benefits (such as Medicaid) from Camino Real Community Services (CRCS), CRCS will obtain and/or
create health information about you. This information is typically in the form of paper or electronic records and 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; or (3) the past, present or future payment of
your health care.
The following notice tells you about CRCS's duty to protect your health information, your privacy rights and how CRCS may use or disclose
your health information.
Your Privacy Rights
- CRCS is required by law to protect the privacy of your health information. This means that CRCS will not use or disclose your health
information without your permission except in the ways we tell you in this notice. CRCS will safeguard your health information and keep it private.
This protection applies to all health information CRCS has about you, no matter when you received services. CRCS will not allow anyone to
interview, photograph, film or record you without your written permission. CRCS will not tell anyone if you are receiving or have ever received
services from CRCS, unless the law allows CRCS to disclose this information.
- CRCS will ask you for your written permission to use or disclose your health information unless CRCS is allowed to use or disclose
your health information without your permission, as stated in this notice. IF you give your permission for CRCS to use or disclose your health
information, you may revoke it at any time, but CRCS will not be liable for uses or disclosures made before you revoked your permission. To
revoke your permission, send a written statement, signed by you, to the privacy officer of CRCS, saying that you want to revoke your
- CRCS is required to provide you with this notice of its legal duties and privacy practices. CRCS is required to ask you to sign the last
page of this notice saying that you received it. CRCS must follow the terms of this notice. CRCS can change the contents of this notice. If
CRCS changes the contents of this notice, it will make the new notice available at all of its facilities and on its website, www.CaminoRealCS.org within thirty days after the effective date of the changed notice. The new notice will apply
to all health information maintained by CRCS, no matter when CRCS received or created the information.
- CRCS employees must protect the privacy of your health information as part of their jobs with CRCS. CRCS does not give
employees access to your health information unless they need it as part of their jobs. CRCS will punish employees who do not protect the
privacy of your health information.
- If you are being treated for chemical dependency (drug and alcohol abuse), your records that relate to that treatment are protected by federal laws
and regulations found in the Code of Federal Regulations at Title 42, Part 2. Violation of these laws that protect chemical dependency treatment
records is a crime and suspected violations may be reported to appropriate authorities in accordance with federal regulations. Federal laws and
regulations do not protect any information about a crime committed by an individual either at CRCS or against any person who works for
CRCS 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 or local authorities.
- You have the right to look at or get a copy of the health information that CRCS has about you, in most situations.
- You have the right to ask CRCS to correct information in your records if you think the information is wrong. You may also ask CRCS
to correct or change information in your records. Your request to correct the records must be in writing and must explain why you believe the
correction should be made. CRCS cannot destroy or change its records, however, if it is determined that the information is incorrect, we will add
the correct information to your records and make a note of why the additional information was made. If CRCS does not agree with your request to
change the records, you may submit a short statement of dispute, which we will include in any future disclosure of information.
- You have the right to get a list of each time CRCS has disclosed health information about you for reasons other than treatment, payment,
health care operations and certain other reasons as provided by law to conduct daily operations, and certain other reasons as provided by law,
except when you have authorized CRCS to disclose the information. Your request for the list must be in writing.
- You have the right to ask CRCS to limit the ways it uses or discloses your health information. The law does not require CRCS to agree
to the limits you request, but if it does agree, it must do as you ask.
- You have the right to ask that CRCS contact you at a different location or in a different manner.
- You have the right to get a copy of this notice from CRCS when you ask for it.
Treatment, Payment, and Health Care Operations
- CRCS may use your health information to provide treatment to you, to obtain payment for services provided to you, or for CRCS's
own health care operations, as allowed by law. Health information about you may be exchanged between CRCS sites, Texas Department of
MHMR, other MHMR Community Centers across the state of Texas, other designated providers, and subcontractors of mental health and intellectual disabilities services, for the purposes of treatment, payment or health care operations, without your permission.
Treatment: CRCS can use your health information to provide, coordinate or manage health care or related services. This includes
providing care to you, consulting with another health care provider about you and referring you to another health care provider. For example,
CRCS can use your health information to prescribe medication for you.
Payment: CRCS can use your health information to get paid for providing health care to you or to provide benefits to you under a
health plan, such as the Medicaid program. For example, CRCS can use your health information to bill your insurance company for health
care provided to you.
Notice to applicants and recipients of financial assistance or payments under federal benefit programs: any information provided by you may be
subject to verification through matching programs.
Health Care Operations: CRCS can use your health information for health care operations. Health care operations include: activities
to improve the quality of health care; evaluating CRCS programs; developing procedures; case management and care coordination;
reviewing the competence, qualifications, and performance of health care professionals and others; conducting training programs in areas related
to review, legal services, or auditing functions; resolution of internal grievances; and engaging in business planning and management or the
general administrative activities of CRCS. For example, CRCS can use your health information to develop procedures for taking care of
people who also receive services from the agency.
CRCS may also contact you to remind you of an appointment or to provide treatment alternatives or other health-related information that may
If you are being treated for chemical dependency, CRCS will not disclose information about your treatment to anyone without your written
permission, unless the law allows CRCS to disclose the information. CRCS will use your health information to provide treatment to you.
CRCS will not disclose health information about you relating to HIV/AIDS without your specific written permission, unless the law allows
CRCS to disclose the information.
Unless you are receiving treatment for chemical dependency, CRCS is permitted to use or disclose your health information without your
permission for the following purposes.
- When required by certain Judicial and Administrative Proceedings.
- In a license revocation proceeding. CRCS may disclose your health information if you have filed a complaint against a doctor or other
mental or emotional health services provided to you.
- In a proceeding to collect payment. CRCS may disclose your health information to a court or administrative judge to collect payment for
mental or emotional health services provided to you.
- For court-ordered examination. CRCS may disclose your health information if a court orders that you be examined for a mental or emotional condition.
- In a proceeding regarding abuse or neglect. CRCS may disclose your health information to a court or administrative judge in a proceeding regarding the abuse or neglect of a person served by CRCS.
- In a commitment proceeding. CRCS may disclose your health information in an involuntary commitment proceeding for court-ordered
treatment or services.
- In other judicial and administrative proceedings. CRCS may disclose your health information in response to an order or subpoena
issued by a court or administrative judge.
For Other Purposes
- When required by law. CRCS can use or disclose your health information when state or federal law requires the use or disclosure.
- To address a serious threat to health or safety. CRCS may use or disclose your health information to medical or law enforcement
personnel if CRCS determines that you or others are in danger and the information is necessary to prevent physical harm.
- For audits and evaluations. CRCS may disclose your health information for management audits, financial audits or program
evaluations, but the people who received your information may not disclose your identity.
- For payment for services of a professional. CRCS may disclose certain parts of your health information to people, corporations or
government agencies to pay for mental or emotional health services provided by a doctor or other person licensed to provide those
- To doctors and other medical personnel. CRCS may disclose your health information to a doctor or other person licensed to provide
services for a mental condition or to personnel under their direction.
- In an emergency. CRCS may disclose you health information to medical personnel in an emergency.
- For research. CRCS my use or disclose your health information if a research board approves the use of confidential health information
for a research project, or if information identifying you is removed from the health information. Information that identifies you will be kept
- To a government authority if CRCS thinks you are a victim of abuse. CRCS may disclose your health information to a person
legally authorized to investigate a report that you have been abused or have been denied your rights.
- To Advocacy, Inc. CRCS may disclose your health information to Advocacy, Inc., in accordance with federal law, to investigate a
complaint by you or on your behalf.
- To comply with legal requirements. CRCS may disclose your health information to an employee or agent of a doctor or other professional
who is treating you, to comply with statutory, licensing or accreditation requirements, as long as your information is protected and is not
disclosed for any other reason.
- For purposes relating to death. If you die, CRCS may disclose health information about you to your personal representative and to
coroners or medical examiners for the purpose of identifying you or determining the cause of your death.
- To a correctional institution. If you are in the custody of a correctional institution, TDMHMR may disclose your health information to the
institution in order to provide health care to you.
- For continuity of care for special needs offenders. If you have been convicted of a crime and are in custody or under any form of criminal
justice supervision, or if criminal charges are pending against you, CRCS may disclose your health information to agencies or persons
involved in your treatment or supervision for the purpose of treatment, payment or health care operations.
- To locate you if you are missing from a facility. If you have been committed by a court to a mental health facility, CRCS can disclose
certain information about you to law enforcement personnel in order to return you to the mental health facility.
- For government benefit programs. CRCS may use or disclose your health information as needed for the administration of a government
benefit program, such as Medicaid.
- If you are receiving services for intellectual and developmental disabilities, CRCS may disclose health information about your current physical and mental
condition to your parent, guardian, relative or friend.
- To the Secretary of Health and Human Services. CRCS must disclose your health information to the United States Department of Health
and Human Services when requested in order to enforce the privacy laws.
If you are being treated for chemical dependency, CRCS may not say to any person outside of CRCS and Texas Department of MHMR
that you have been admitted to a treatment facility or that your are receiving chemical dependency treatment services, and may not disclose any
information identifying you as an alcohol or drug abuser.
CRCS/TDMHMR may only disclose information about treatment for chemical dependency 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
Federal and State laws prohibit re-disclosure of information about chemical dependency treatment without your permission. Effective Date:
If you believe that CRCS has violated your privacy rights, you have the right to file a complaint. If you believe that your rights have been violated, or
for further information, you can contact the Rights/Privacy Officer by telephone, fax or by mail. The Rights/Privacy Officer can be contacted:
- Toll Free: 1-800-491-5201
| By writing to:
- Camino Real Community Services
Attn. Rights/Privacy Officer
Lytle, Texas 78052
|By e-mail to:
You may also file a complaint with:
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.
- The Secretary of the United States Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue S.W.
Washington, D.C. 20201.
You may also contact:
- The Texas Attorney General
P.O. Box 12548
Austin, Texas 78711
You may also contact: HSSC 's Consumer Services and Rights Protection/Ombudsman Office at: 1-800-252-8154.
You will not be retaliated against for making a complaint.