HIPAA Notice of Privacy Practices Policy

Connections for Kids

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 CAREFULLLY.

Connections for Kids uses certain personal information about you to pay for your health services. The law says we must make sure that protected health information is safe. This Notice tells you about your rights to your protected health information, and our duty to protect it. It also tells you how we may use and disclose your protected health information and gives a small number of examples to explain what we mean. Not every use or disclosure can be listed on this Notice. Although we are required to abide by the terms of the Notice that is currently in effect, we reserve the right to change our privacy practices at any time and to make the new Notice provisions effective for all protected health information that we maintain. If our privacy practices change, we will provide you with a revised Notice during your next visit. Please let us know if you have any questions about this form.

“Protected health information” (PHI) is information about you, including demographic and genetic information, that personally identifies you and relates to your past, present, or future physical or mental health or condition and related health care services. PHI also includes any health information and records provided to Connections for Kids (CFK) by other health care providers and facilities who have provided care to you or are involved in your care.

Authorized Uses and Disclosures of Your Protected Health Information

We may use and disclose your PHI without your authorization for the following purposes:

1. For Payment.

We may use and disclose PHI about you to your insurance company or other third-party payors such as Medicare or MaineCare (Medicaid) to obtain payment for your care, and to determine whether certain services are covered, unless you pay in full out of pocket for services and request in writing that your health information not be disclosed to third-party payors for payment purposes. Example:  We may share information about the MaineCare services that are covered or may require special permission (also called “prior authorization”). We may help coordinate your care, review your use of services, and tell you about program changes and updates.

 

1. For Treatment.

We help manage the health care treatment you get. We may use or disclose your PHI  to other providers who are treating you and to arrange for the provision, referral, coordination, and management of healthcare services for you.  Example:  CFK sends another provider information about your treatment plan so we can see what other services may help you.

 

 

3. For Healthcare Operations.

We can use and use and disclose your PHI to run our program and to help do our work and comply with government requirements, such as to monitor and evaluate the quality of care and services provided to you.  Examples:  We are permitted to use your information for audit and accounting purposes, for educating our staff, and for reviewing the quality of our program.

The law says that we may also use or disclose your PHI without your authorization in certain situations, including:

• To Personal Representatives:  To people authorized by law to act on your behalf, such as a guardian, healthcare power of attorney agent, or healthcare surrogate.
• As Required by Law:  To comply with state or federal law.

• To Business Associates: We may disclose your PHI to business associates performing contracted services on behalf of CFK that have agreed in writing to maintain the privacy of your PHI. To Persons Involved in Your Care and for Notification Purposes: We may disclose your PHI to family members and other persons involved in your care, involved in securing payment for your care, or for notification purposes, unless you (or your authorized representative) notify us that you object to and wish to prohibit or restrict such disclosures.
• For Reminders and Treatment Options: To remind you of an appointment or to provide you with information about treatment alternatives or other health related benefits and services that may be of interest to you.
• For Disaster Relief: We may use and disclose your PHI to public or private entities authorized by law to assist in disaster relief efforts, provided you have been given the opportunity to agree or to object to such uses and disclosures.

• For Public Health Activities:  To public health authorities to help prevent or reduce threats to public health and safety, and stop the spread of disease.

• For Abuse, Neglect, and Exploitation Reporting: We may disclose your PHI to public health authorities authorized by law to receive reports of abuse, neglect, and exploitation of children and of incapacitated or dependent adults.

• For Research Purposes:  For research where the information does not identify you or we have received permission from a special research review board or privacy board.
• For planning our programs:  We may disclose general information about a certain population of people.
• To comply with state or federal program requirements:  We may disclose protected health information to the Centers for Medicare and Medicaid Services, and the U.S. Department of Health and Human Services when required.
• For Judicial and Administrative Proceedings:  To comply with a valid court order, subpoena, or other appropriate administrative, judicial or legal request.
• For Disaster Relief:  In an emergency or for disaster relief purposes, such as to notify family members about your location and condition, provided you have been given the opportunity to agree or to object to such uses and disclosures.
• For Law Enforcement Purposes:  We may disclose your PHI for certain law enforcement purposes so long as applicable legal requirements are met, such as to report crimes committed on CFK’s premises or against CFK personnel.   
• For Specialized Government Functions:  We may disclose your PHI to military departments if you are a veteran or member of the armed forces. We may be required to disclose information for national security or intelligence purposes. If you are an inmate, we may release your information for your health or safety in the correctional facility.
• To Coroners, Medical Examiners, and Funeral Directors:  We may use and disclose your PHI to assist a coroner, medical examiner or funeral director in carrying out their duties.
• For Workers’ Compensation Purposes:  We may disclose your PHI in connection with Workers’ Compensation claims for benefits.
• To assist law enforcement where there was a possible crime on the premises. We may also share your information about where it is necessary to prevent or lessen a serious or imminent threat to you or another person.

• To Avert Serious Threats to Health or Safety: We may use and disclose your PHI when necessary to avert a direct threat of imminent harm to health or safety.

We will not use or disclose your information in any ways other than described in this Notice unless you tell us in writing that we can. If you sign an authorization, you may change your mind and take back your permission (revoke it) at any time, except to the extent that we have already shared your information based upon your written permission.

Special Confidentiality Protections for Certain Types of Protected Health Information

Certain Mental Health Information: If CFK maintains information about you derived from mental health services provided to you by a psychiatrist, psychologist, clinical nurse specialist, social worker or counseling professional, CFK will not disclose such mental health information to anyone outside of CFK or its organizational affiliates without your written authorization, unless such disclosure is necessary in an emergency or is otherwise authorized or required by law.

Psychotherapy Notes:  We will not use or disclose any psychotherapy notes we maintain about you separately from your other CFK medical records without your written authorization unless such use or disclosure is authorized by law. 

HIV Information:  If any information regarding your HIV status (such as HIV test results or medical records containing HIV information) is created or maintained by CFK, such information is afforded heightened protection under Maine law and we will maintain the confidentiality and privacy of such information, and will not use or disclose such information, except as specifically authorized or required by Maine’s HIV confidentiality laws.

PHI Related to Reproductive Health Care:  Unless an exception applies under Maine or other applicable law, we may not disclose in a civil or administrative action or proceeding, or in response to a subpoena issued in a civil or administrative action or proceeding, (i) any communication about reproductive health care services made by a patient or anyone acting on the patient’s behalf (including the patient’s authorized representative) to a health care practitioner, facility, or Maine’s state-designated statewide health information exchange (HealthInfoNet), or (ii) any information obtained through a personal examination of a patient relating to reproductive health care services.  Exceptions:  However, we may disclose such reproductive health care information:  (i) when authorized in writing by the patient or the patient’s authorized representative; or (ii) pursuant to a court order issued by a court of competent jurisdiction in Maine upon a showing of good cause as long as the court order limits the use and disclosure of the records and include sanctions for misuse of the records or sets forth other methods to ensure confidentiality.  Additionally, the above restrictions on the disclosure of reproductive health care information do not apply if the communication or information (i) relates to a patient who is a plaintiff in a medical malpractice action and the health care practitioner, facility or state-designated statewide health information  exchange (HealthInfoNet) from which the communication or information is requested is a defendant in the medical malpractice action, (ii) is requested by a professional licensing board that licenses health care practitioners in Maine and the request relates to and is made in connection with a complaint investigation, or (iii) is requested by a federal or state law enforcement agency responsible for investigating abuse, neglect or exploitation of a child or an incapacitated or dependent adult and the request is made in connection with such investigation under Maine law.

PHI Related to Gender-Affirming Health Care Services:  We may not use or disclose PHI related to a patient’s gender-affirming health care services in a civil or administrative action or proceeding, or in response to a subpoena issued in such an action or proceeding, without the patient’s (or the patient’s authorized representative’s) written authorization or unless we are authorized to do so pursuant to a special type of court order  or the disclosure falls within another exception under applicable law.     

Minors’ Privacy Rights:  If you are a minor authorized by law to consent to health care services on your own behalf and you in fact consent to such services on your own behalf, CFK is required to protect the privacy of your PHI related to such services in the same way that CFK protects the privacy of an adult’s PHI, unless a special exception applies under the law.  For example, CFK is authorized by law to notify your parent or guardian if, in the judgment of CFK, failure to inform your parent or guardian would seriously jeopardize your health or would seriously limit the ability of CFK to provide treatment to you.  Additionally, if you want CFK to bill your parent’s or parents’ health insurance plan for services provided to you, your parents will receive from their insurance company an Explanation of Benefits regarding the services provided to you by CFK and, as a result, the fact that you received services from CFK will not be confidential from your parents.  However, if you do not want your parents to know that you are receiving services from CFK, you must notify CFK of that fact at the time services are provided to you so that arrangements can be made for payment of such services privately or out-of-pocket, or to determine your eligibility for free or discounted care.

Summary of Your Rights Regarding Your Protected Health Information

You have the right to:

1. See and copy your protected health information. This request must be in writing.
• If you ask us to copy your record, we may ask for a reasonable, cost-based copy fee.
• You may ask for your electronic record in a digital format.
• You may ask us to send your protected health information to someone by email if you fill out the email section of the authorization form.
• Your provider may not allow you to see certain parts of your medical record. You may ask that this decision be reviewed by another licensed professional.

 

1. Ask us to contact you in a certain way.

You may ask us to contact you only in a certain way to keep your protected health information confidential and safe. For example, you may ask us only to call you at a certain phone number or send letters to a certain address. We are required to contact you in the way that you request, whenever possible.

1. Ask us not to use or disclose certain information in your medical record.

You may ask us to limit the information we use or disclose. You may ask us not to use or disclose certain kinds of information. We will carefully consider your request, but we are not required to agree to the request. We can refuse your request if it affects your care. If you ask us not to use or disclose certain information, we may not be able to pay your bill. In this case, you may be responsible for your bill.

1. Get a list of those to whom we have disclosed your protected health information.

You may ask for a list of those to whom we have disclosed your protected health information other than for treatment, payment, healthcare operations or where you have received the information or previously given us written permission to share your information. We can go back six years for paper files and three years for electronic records.

1. Ask us to fix your health and claims record if it is wrong or add a statement to your file.

You may ask us to fix a mistake to your information. While we cannot erase your record, we will add your written statement to your protected health information to correct or clarify the record.

1. You may file a complaint if you think your privacy rights have been violated. We cannot retaliate against you for making a complaint.

You may file a complaint in one of the following ways:

• Complain to the Privacy Official through your local DHHS office.
• Complain to MaineCare Member Services at 1-800-977-6740. TTY users dial 711.
• Complain to Office of Civil Rights, DHHS, Government Center, John F Kennedy Federal Building, Room 1875, Boston MA 02203 (Phone:  1-877-696-6775) or by going to the following webpage:

 

https://www.hhs.gov/hipaa/filing-a-complaint/index.html  

We must protect your protected health information:

• The law says we must keep your protected health information private and safe.
• The law says we must tell you about any breach in the security of your protected health information.

You have a right to receive a paper copy of this Notice of Privacy Practices, even if you have received this Notice electronically.

We reserve the right to change the terms of this Notice of Privacy Practices, but will comply with the Notice that is currently in effect. We will post the current Notice on our website and in our offices, and provide you with the newest Notice as the law requires.

This updated Notice is effective as of December 5, 2025.