CSB 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 review it carefully. 

Effective Date: April 14, 2003

Updated: July 30, 2009 and March 20, 2012

Your Privacy is Important

The Fairfax-Falls Church Community Services Board (CSB) understands your privacy is important. We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this notice. We will handle this information only as allowed by federal/state law and agency policy, adhering to the most stringent law that protects your health information.

If at any time you believe your privacy rights have been violated, you may verbally or in writing contact:

  • Your therapist/case manager
  • Your therapist's/case manager's supervisor
  • The Quality Assurance Coordinator for Mental Health Services, Intellectual Disability Services or Alcohol and Drug Services
  • The CSB HIPAA Coordinator
  • State Human Rights Advocate
  • Secretary of Health and Human Services of the Federal Government, Office of Civil Rights

Addresses and phone numbers to use are listed at the end of this notice. You will not suffer any change in services or retaliation for filing a complaint.

Each time you receive services from us, the provider makes a record of the visit. Typically, this record contains your assessment, service plan, progress notes, diagnoses, treatment and plan for future care or treatment.

You have federally defined privacy rights under the Health Insurance Portability and Accountability Act (45 C.F.R. Parts 160 and 164). Other federal and state privacy laws limit the disclosure of your health information. Such laws include, but are not limited to, Confidentiality of Alcohol and Drug Abuse Patient Records (42 USC 290dd), Health Records Privacy (VA Code 32.1-127.1:03), and Human Rights Regulations (VA Code 35-115).

There are several rights concerning your protected health information that we want you to be aware of:

  • You have the right to inspect or to request copies of your medical records. This process will be kept confidential. This right is not absolute. In certain situations, such as if access would cause harm, we can deny access. You must make this request in writing to your Primary Therapist/Case Manager or his/her Supervisor. If denied access, you will receive a timely, written notice of the decision and reason. A copy of this request and written reply becomes a part of your record.
  • You have the right to request amendment of your medical records if you believe information in the records is inaccurate or incomplete. You must make this request in writing to your Primary Therapist/Case Manager or his/her supervisor. We may deny the request but you will be provided with a written explanation of the denial.
  • You have the right to receive an accounting of the CSB's disclosures of your protected health information that were not for the purpose of treatment, payment, health care operations, or that were not otherwise authorized by you. You also have the right to be given the names of anyone, other than employees of the agency, who received information about you from the CSB.
  • You have the right to request from your Primary Therapist/Case Manager a restriction with regards to the use or disclosure of your protected health information.
  • This request will be given serious consideration by the CSB staff and you will be informed promptly whether we will be able to honor the requested restriction and still offer effective services, receive payment and maintain health care operations. Legally we are not required to agree to any restrictions you request, but if we do agree, we are bound by that agreement except under certain emergency circumstances.
  • You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. Such requests must be made in writing to your Primary Therapist/Case Manager. We will agree to all reasonable requests.
  • You have the right to obtain a paper copy of this Notice of Privacy Practices at any time upon request.

Use and Disclosure of Your Information

Upon signing the agency's Consent to Treatment/Service form, you are allowing us to use and disclose necessary information about you within the agency and with business associates in order to provide treatment/service, receive payment of provided treatment/service, and conduct our day to day health care operations.

Examples:

  • In order to effectively provide treatment/service, your Primary Therapist/Case Manager may consult with various service providers within the CSB. During those consultations health information about you may be shared.
  • In order to receive payment of services provided, your health information may be sent to those companies or groups responsible for payment coverage, and a monthly bill is sent to the Responsible Party identified by you and noted on the financial form.
  • In day-to-day health care operations, trained staff may handle your health record in order to have the record assembled, available for review by the Primary Therapist/Case Manager, or for filing of documentation. Certain data elements are entered into our computer system that processes most billing, and for state statistical reporting to the Department of Behavioral Health and Developmental Services (formerly the Department of Mental Health, Mental Retardation and Substance Abuse Services). As a part of our continuous quality improvement efforts to provide the most effective services, your record may be reviewed by professional staff to assure accuracy, completeness and organization. Records may also be reviewed during licensing reviews by DBHDS and accreditation surveys by the Commission on Accreditation of Rehabilitation Facilities (CARF).

Enhancing Your Healthcare

Some CSB programs provide the following support to enhance your overall health care and may contact you to provide:

  • Appointment reminders by call or letter
  • Information about treatment alternatives
  • Information about health-related benefits and services that may be of interest to you.

The Community Food Security (CFS) afternoon snack programs are required by the USDA to maintain a log of those participating.

Individuals Involved in Your Care or Payment for That Care

Unless you object, we may release medical information about you to a friend or family member who is involved in your care. We may also give information to someone who helps pay for your care.

Specific Circumstances for Disclosure

This agency is also allowed by Federal and State law in certain circumstances to disclose specific health information about you. These specific circumstances are:

  • As required by law (example: reports required for public health purposes, such as reporting certain contagious diseases)
  • Judicial and Administrative proceedings (example: order from a court or administrative tribunal, or legal counsel to the agency, or Inspector General)
  • Law Enforcement purposes (example: reporting of gun shot wounds; limited information requested about suspects, fugitives, material witnesses, missing persons; criminal conduct on premises)
  • To avert a serious threat to Health and Safety of another person (example: in response to a specific threat made by the person served to harm another)
  • Children or incapacitated adults who are victims of abuse, neglect or exploitation
  • Specialized government functions
  • Military Services (example in response to appropriate military command to assure the proper execution of the military mission)
  • National Security and Intelligence activities (example: in relation to protective services to the President of the United States)
  • State Department (example: medical suitability for the purpose of security clearance)
  • Correctional Facilities (example: to correctional facility about an inmate)
  • Workers Compensation to facilitate processing and payment
  • Coroners and Medical Examiners for identification of a deceased person or to determine cause of death
  • To the Federal Department of Health and Human Services in connection with an investigation of us for compliance with federal regulations.

Other Uses and Disclosures of Your Information by Authorization Only

We are required to get your authorization to use or disclose your protected health information for any reason other than for treatment/services, payment, or health care operations, and those specific circumstances outlined previously. We use an Authorization to Use/Disclose form that specifically states what information will be given to whom, for what purpose, and is signed by you or your legal representative. You have the ability to revoke the signed authorization at any time by a written statement except to the extent that we have acted on the authorization.

Changes to Privacy Practices

The CSB reserves the right to change its privacy policy and any of its privacy practices at any time, as allowed by Federal and State law and to make the change effective for all protected health information that we maintain.

A Revised Notice of Privacy Practices will be posted at all service sites, made available upon request by mailing or discussion with a CSB representative, electronically on the CSB's website, or a combination of the three.

Additional Information & Complaints

For additional information concerning our Privacy Practices or the Federal and State laws pertaining to privacy or to file a complaint please contact one of the following:

  • Your Primary Therapist/Case Manager
  • Your Primary Therapist/Case Manager's Immediate Supervisor
  • The CSB HIPAA Coordinator
    12011 Government Center Parkway, Suite 836
    Fairfax, VA 22035
    Phone: 703-324-5193
    TTY: 711
  • Fairfax County's HIPAA Compliance Manager

    Fairfax County Government Center
    12000 Government Center Parkway, Suite 527
    Fairfax, Virginia 22035
    Phone: 703-324-4136
    TTY: 703-968-0217
    HIPAA Manager feedback form

  • State Human Rights Regional Advocate

    Northern Virginia Training Center
    9901 Braddock Road
    Fairfax, Virginia 22032
    Phone: 703-323-2098

  • Office for Civil Rights

    U.S. Department of Health and Human Services
    150 South Independence Mall West, Suite 372
    Public Ledger Building
    Philadelphia, Pennsylvania 19106-9111
    Main line: 215-861-4441
    Hotline: 800-368-1019
    Fax: 215-861-4431
    TTY: 215-861-4440

Note to TTY Users: If direct dial number is not provided, please use the Virginia Relay Center (711) to contact any of the offices above.

Printable versions of the Privacy Practices are available in the following languages:

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Fairfax-Falls Church Community Services Board

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Phone: 703-573-5679 | TTY: 703-207-7737

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Tisha Deeghan, Executive Director

CSB Administrative Office
12011 Government Center Parkway, Suite 836, Fairfax, VA 22035-1100
Phone: 703-324-7000 | Fax: 703-653-6626 | TTY: 711

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