About Us
Privacy Policy
NOTICE OF PRIVACY
- Participant Rights
I understand that Association House (the Agency) staff, regardless of the individual program for which they work, are considered to be one staff except under limitations explained in the agency confidentiality policy and governmental regulations. If I am enrolled or receive services from more than one Agency program, staff may exchange information among themselves without my written consent for the purpose of service coordination. This includes team activities, demographic and case status information related to our Central Intake Department, as well as for treatment, payment and health care operations.
Association House provides recreational, educational, and supportive services for individuals and families. My access to services will not be denied nor will I be discriminated against or harassed on the basis of race, religion, ethnicity, age, gender, disability, sexual orientation, financial status, political affiliation, national origin, HIV status, or for exercising any of the rights contained herein. The following procedures are designed to respect my dignity and to protect my human rights. These procedures/rights will be observed in all cases.
- Services/Treatment
As a program participant of Association House I and/or my legal guardian have the right to be actively involved in determining my services and service plans. I have the right to ask questions and be informed about other services available. I will be offered services based on my presenting needs. I have the right to refuse to participate in services or any recommendations from staff. If staff makes recommendations to refer me to other services either within Association House or to an outside agency, they will be discussed with me. Staff will inform me of the consequences if I refuse service or medications.
- Confidentiality
My participation in treatment and information regarding my participation in services is protected under federal and state laws. This means Association House cannot tell anyone including my family and friends that I am receiving services here unless I sign a release form of information, which gives written permission. Association House also cannot ask for or send any part of my record to another agency without written permission. I have the right to review my record by writing a formal request to my designated staff. Staff has the responsibility of showing me my record within two weeks of receiving the written request. I have the right to insert correction or amendment to record and to request and receive a record of releases of information. I do not have the right to see parts of my record that have been sent by other agencies. I may also request to have any communication sent to a different address or via different means, such as email.
There are certain situations when Association House has the right to disclose information about me and my services without permission. Association House is mandated by law to report any suspected child, senior, or disabled abuse or neglect. Other situations may be if I commit or threaten to cause harm to myself or others and if I have a medical emergency or because a judge issues a court order for the release of the record. In addition, AHC may disclose information to arrange for and monitor services.
- Confidentiality and Rights Regarding HIV/AIDS status
I have certain rights regarding HIV/AIDS. If I choose to disclose information regarding my HIV/AIDS status, staff cannot inform anyone else unless I give written consent. Information about my status cannot be kept in my record, but will be kept in a separate file.
- Auditing
For the purposes of funding, accreditation, audit, licensure, statistical compilation, research, evaluation, or other similar purpose, my record may be used by the person(s) conducting the review to the extent that this is necessary to accomplish the purpose of the review. No personal identifying data will be disclosed without my prior written consent, except as allowed by the AHC Confidentiality Policy and as may be dictated by the respective funding state agencies. I understand that my record may be one of those and I agree to allow it to be included in the audit.
- Grievance Procedure
If I have a disagreement or grievance regarding any of my rights or services, or I have been denied to see my record, I will use the following procedure:
Step 1 I will discuss my disagreement with my assigned staff.
Step 2 If I cannot resolve my disagreement by discussing it with staff, then I will in writing state my disagreement and give it to the program supervisor. The supervisor and staff will meet to try to resolve this.
Step 3 If I am still not satisfied with the resolution, I can appeal this to the division director by submitting the disagreement in writing. The division director will meet with the supervisor, staff and myself.
Step 4 If I am not satisfied, I can appeal to the executive director by following the same procedure. The executive director will make the final decision.
Step 5 If I am not satisfied, I can appeal to the AHC Human Rights Panel for final review of the procedures followed.
I will be informed of my right to contact the appropriate state agencies or oversight bodies. Staff will assist me to contact the appropriate state agency or oversight body by providing its address and telephone numbers.
I may not be denied, suspended or terminated from services or treatment or have these reduced for exercising my participant rights.
- If you need additional information, please contact CQI Manager Dan Bishop at (773) 772-7170, or dbishop@associationhouse.org
