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Catholic Charities CYO
Serving people of all faiths since 1907
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.

When you receive services from us, we may collect personal medical information. We use personal medical information in order to provide quality services. Sometimes we store personal medical information about you in records. Records can be stored on paper or electronically on a computer.

For many years, Catholic Charities CYO has protected personal medical information. Now a new federal law known as HIPAA spells out how we must protect personal medical information. This law (HIPAA) says that we must give you this Notice. If you have any questions about this Notice, please contact the Privacy Officer at (415) 972-1226. Our Notice is in five parts:

  1. What your health care records are and your rights
  2. Who can see your health care records without your written okay
  3. Who cannot see your health care records without your written okay
  4. How you can use your rights or make a complaint
  5. Changes to this Notice

Your Health Care Records and Your Rights

You have the following rights regarding the personal medical information in your health care record:

  • The right to see and get a copy of your health care record. Requests to see and copy your health care record must be in writing and must be made to the Privacy Officer at (415) 972-1226.

  • The right to have your personal medical information changed if you believe it is incorrect and we agree. Requests must be in writing. Forms for this purpose are available from the Program Director at the program where you receive services or from the Privacy Officer at (415) 972-1226.

  • The right to see a list of those we have shared your personal medical information with. The list won't include personal medical information we were required by law to share for national security purposes or with law enforcement personnel. The list also won't include the times we've shared your personal medical information when you had already given your consent. Finally, the list won't include any personal medical information that we shared before April 15, 2003.

  • The right to ask us not to share your personal medical information. You may ask us in writing not to share your personal medical information. For example, you may ask that we not share personal medical information with a family member or friend involved in your care. Or you might ask that we limit the medical information that is given out to bill for service. Request forms for this purpose are available from the Program Director at the program where you receive services or from the Privacy Officer at (415) 972-1226.

  • The right to ask how we communicate with you. You have the right to request that we communicate with you in a particular way. For example, you might want us to send mail to a post office box. You might want to receive information by email. Or you might not want us to call you at home.

  • The right to a paper or email copy of this Notice. You have a right to a paper copy of this Notice. You may also request that we email you a copy of this Notice.

Who Can See Your Health Care Records Without Your Written Okay

When you receive health care services at Catholic Charities CYO, we record personal medical information. We may also collect personal medical information that is necessary for participation in a Catholic Charities CYO program. We may share or use your personal medical information for treatment, payment, and operations.

  • For treatment. We may share or use personal medical information with another health care provider involved in your care. We may also disclose or use personal medical information for the purpose of emergency medical treatment.

  • For payment. We may share or use personal medical information to bill for services.

  • For operations. When necessary, we may share or use personal medical information in operating our programs and services. For example, we might use personal medical information to measure how well our staff cared for you.

Federal, state, and local laws may also require us to disclose personal medical information for the following reasons:

  • Health Oversight. We may share or use health information with agencies that audit, investigate, and inspect health programs to benefit the public's health.

  • Judicial and Administrative Proceedings and Law Enforcement. When required by law, we will disclose personal medical information for judicial or administrative proceedings and for law enforcement purposes, including national security and intelligence activities. We will also share personal medical information if it is necessary to make reports about victims of abuse and neglect.

  • Public Health Activities. We may share or use personal medical information in order protect public health.

  • To Avoid Harm. If there is a serious threat to the health or safety of a person or the public, we may disclose or use personal medical information.

  • Military and Veterans. If you are a member of the armed forces, we may disclose your health information as required by military command authorities.

  • For Workers' Compensation. We may provide personal medical information in order to comply with Workers' Compensation laws.

  • Fundraising Activities. We may use your health and service information to contact you about our fundraising efforts. We may also share health and service information with a foundation that may contact you when raising money for Catholic Charities CYO. In such cases, we will only release contact information, such as your name, address, and phone number and the dates you received services at Catholic Charities CYO. If you do not want us to contact you for fundraising efforts, you must notify the Director of Development of Catholic Charities CYO in writing.

  • Research. We may contact you to request your participation in an authorized research study. If the study provides any type of healthcare treatment, the researcher will explain the benefits and risks of the treatment, how health information will be used during the course of the study, and whether any of your health information rights are affected. You will need to authorize the use of your health information and agree to any suspension of your rights to participate in the study. However, you may revoke this authorization at any time. In some cases, we may disclose your health information to researchers when an institutional review or privacy board has approved their research. Prior to giving any information, special procedures will be established to protect the privacy of your information.

  • As Required by Law. We will disclose medical information about you when required to do so by state, federal, or local law.

Who Cannot See Your Health Care Records Without Your Written Okay

In any situation not described above, we will ask for your written permission before we share your personal medical information. You may revoke your written permission at any time. If you revoke your permission, we will not share any personal medical information in the future. However, we may already have shared some personal medical information.

How You Can Use Your Rights Or Make a Complaint

If you want to use your rights or you believe your rights have been violated, please contact Catholic Charities CYO's Privacy Officer at

180 Howard Street, Suite 100
San Francisco, CA 94105-1617
(415) 972-1226

You may also file a complaint with the Secretary of the Department of Health and Human Services.

You will not be penalized or retaliated against for exercising your rights or making a complaint.

Changes To This Notice

We have the right to change this Notice at any time. If we do so, we will post a new copy at the office or program where you receive services. We will also post a revised copy on our website (cccyo.org). In addition, you may request a copy where you receive services.

Effective Date of This Notice

This Notice went into effect on April 14, 2003.