Patient Rights & Privacy

Jewish Family Service of Dallas desires for all clients to understand their rights. This handout serves to provide more detailed explanation of your rights and specific information related to the limitations of your right to confidentiality. Please read this handout carefully and discuss any questions you have with a JFS staff member or your clinician. Your Rights As a client of JFS, you have the right to service that: (a) recognizes each person as unique; (b) treats everyone with dignity and respect, and without judgment; (c) understands and honors diversity, (d) supports a person’s right to self-determination and independence, (e) promotes wellness and growth; (f) is staffed by qualified and trained professionals; (g) adheres to all applicable laws and regulations pertaining to confidentiality; and (h) is non-coercive. As a client of JFS, you have the right to know: (a) a client may end services at any time, though participation in a termination session is always recommended; and, (b) a client has the right to refuse or request modification of any clinician’s techniques that she or he believes might be harmful. As a client of JFS, you have the right to information concerning: (a) all agency services and criteria for eligibility; (b) any fees for service, before receiving such service; (c) circumstances under which a client’s record may be made available; (d) reasons for termination of service; and, (e) the client grievance procedure.Other important client rights include:

A.Right to Inspect and Obtain a Copy of Your Clinical Record: You have the right to inspect and receive a copy of your Clinical Record at any time. Professional records constitute an important part of the clinical process and help with continuity of care over time. Records are kept and maintained in the form of electronic records and paper files. Clinicians are required to maintain client records for a period of 7 years after the last contact and until a minor is 18 years old, after which time such records may be properly destroyed.

Should you or someone you authorize request JFS to provide relevant records, please be aware there is a fee for records. The fee is $25.00 for the first 20 pages + $0.50/page thereafter. Be aware a clinical summary can be provided, free of charge. In either case, a “Release of Records” form must be signed. JFS will respond to yourrecords request within 15 business days. Records will be furnished within 15 business days after the date of the receipt of the request, payment of associated fees, and authorization to release records have been provided. Inthe event there is shared custody of a minor, multiple individuals may have rights to these documents. If one custodian formally requests a copy of these documents, additional copies will be provided to the other legally authorized party.

B.Right to Request a Correction or Have an Addendum Added to Your Clinical Record: If you believe there is an inaccuracy in your clinical record, you may submit a written request to have the error corrected. However, if the clinician believes the information is correct, or if it has been provided by a third party (e.g., previous therapist, primary care physician, etc.), the request may be denied. If your request is denied, you will receive an explanation in writing, including the clinician’s reasons for denial of the request. Additionally, you have theright to request a copy of her or his written disagreement be placed in the record.

C.Right to an Accounting of Disclosures of Your Psychological Information to Third Parties: A client has the right toknow if, when, what, and to whom psychological information has been disclosed.

D.Right to Request Restricted Disclosures: A client has the right to request restrictions on certain uses or disclosures of psychological information. Such requests must be in writing; JFS will do its best to comply.

E. Right to Specify Forms of Communications: A client has the right to request specific forms of communicationoutside the clinical setting. For example, a client may ask not to be contacted during work hours, or may prefer an e-mail about changes to appointment times. To promote safety, a client may request mail be sent to alocation other than her or his residence. JFS prefers a written request that includes specifics regardinghow/when/where to contact the client.

F.Right to Withdraw Permission for Disclosure of Clinical Record: A client has the right to withdraw permission given JFS for continued or future release of protected health information (PHI). In order to withdraw permission, the client must revoke consent on the Consent for Release of Psychological/Mental Health Information.

G.Right to be Notified of a Breach or Potential Breach of Protected Health Information (PHI): A client has the rightto be notified if: (a) there is a breach in the use or disclosure that violates law; (b) that PHI has not beenencrypted to legal standards; and (c) a JFS risk assessment fails to determine that there is a low probability thatyour PHI has been compromised.

Notice of Privacy Practices

In order to protect our clients’ privacy, including as required by law, and to maximize the quality and benefits of our service, it is the policy of JFS that client records, information, and communications remain confidential. While you are never required to waive any right to such confidentiality, you should be aware of the following exceptions and limitations:

1)Authorization: You may authorize your information be released to a provider or individual by completing andsigning the Consent for Release of Psychological/Mental Health Information. This authorization allows you to identify what may or may not be shared. You also are able to revoke this consent at any time by telling a JFS staff and signing the revocation section of the form.

2)Governmental Requirements: If information about your case is legally required by the courts or other authorized government agencies, JFS will comply. However, JFS will limit its release to the minimum needed to satisfy the request. Examples of typical requests include: social security disability applications, child custody or visitation cases; legal actions involving mental health issues; or criminal proceedings, etc.

3)Abuse/Neglect of Children, Older Adults, or Other Vulnerable Population: If there is suspected or knowledge ofabuse or neglect involving children, older adults, or other protected populations, clinicians are required by law toreport such concerns to the proper authorities. When appropriate, a clinician will discuss with you the need tomake such a report.

4)Harm to Self/Others: If there is reason to believe you are in immediate danger to yourself, either physically or emotionally, or to others, we have the right to contact medical personnel or law enforcement in order to maintain safety.

5)Professional Harm: If sexual contact or other unethical professional conduct between you and another helpingprofessional is disclosed, your clinician is obligated to breach confidentiality and make a report to theappropriate authority.

6)Records: Your personal health information (PHI) and records are maintained in accordance with governmentrules and regulations, including HIPAA. This means that anyone with JFS authorized access to PHI is bound by these rules and regulations, including consultants and technology service providers. By endorsing InformedConsent, of which receipt of this document is part of, you agree to allow the clinician to discuss your case withhis or her supervisor or related professionals for consultation purposes. Please note that the Agency maintainsclient records until a client is 18 years old and for 7 years after services are provided.

7)Consultation: In order to best serve you, clinical staff sometimes seek consultation or supervision with other mental health professionals outside the Agency. In such instances, clinicians are legally and ethically required to protect your identity from the outside consultant or supervisor.

8)Research/Funding: Data contained in your clinical record may be used for archival purposes, ongoing research,or in the pursuit of grant funding. JFS is legally and ethically required to remove any personal identifyinginformation from the data used. Any research to be conducted at JFS is subject to an institutional review boardthat exists to safeguard the client’s privacy and health.

9)Training: Since we are involved in training clinicians, your clinician may ask to record sessions for the purposesof consultation and supervision. You have the right to refuse your sessions from being recorded. If you choose to allow the recording, know that personal identifying information remains protected; furthermore, audio or video recordings are not considered part of the clinical record and are routinely destroyed.

Phone/Email: Electronic means of communication including phone and email have inherent limitations withregard to privacy. Should you and your clinician agree to use such communications, you understand and accept the risks to privacy and confidentiality.

INTERDEPARTMENTAL RELEASE OF INFORMATION

You understand and accept that in order to provide you with the most comprehensive services, clinical staff, including psychiatric and psychological consultants, may, from time to time, share with other pertinent JFS staff information regarding your case when needed. Such sharing is limited to these efforts: coordination of services, diagnostic evaluation, treatment planning, or ongoing treatment. Additionally, you understand and accept that clinicians may communicate with JFS staff who work at other locations such as partner schools (DISD, PISD, Akiba Academy of Dallas, Levine Academy, JCC’s Early Childhood Center, and Torah Day School, Roseland, Pedi Place, and Jubilee Park, amongst others) and PLAN Clubhouse. Any professionals included in this kind of exchange are bound by rules of confidentiality.

Record Requests

You have the right to receive a copy of your records. Records may be requested by completing the Record Request Form, which can be accessed through your provider or the receptionist.

Please be aware that a fee applies for records. JFS will respond to record requests within 15 business days. Records will be furnished within 15 business days after the date the request is received, payment of applicable fees has been made, and authorization to release records has been provided.

(Note: It would be beneficial for the new website to include an option to download the Record Request Form.)

Grievance Procedures

You have the right to file a grievance regarding your care or any aspect of your experience at Jewish Family Service of Dallas (JFS). JFS ensures that all grievances—whether oral or written—that are not resolved at the point of care are treated as patient grievances, documented, investigated, and resolved in a timely manner. JFS takes all complaints seriously and has established the following process:

1. 1. Initial Concern
      You may communicate dissatisfaction with your care to any JFS staff member. The staff member will ask for the reason for dissatisfaction and the desired resolution and will make a reasonable effort to resolve the issue immediately.
   2. Formal Grievance

If the grievance is not adequately addressed, you may complete a Grievance Form, or a staff member may document the grievance on your behalf. The Chief Operating Officer (COO) or their designee will review the grievance and notify you of the disposition within five (5) business days, including whether JFS will take further action.

You may appeal the disposition of a grievance by submitting a written request for appeal to the COO within thirty (30) days. Assistance may be requested to submit the appeal. The COO will forward the written appeal to the Chair of the Board of Directors Quality Committee within seven (7) business days. The Quality Committee will convene a hearing within thirty (30) days of receiving the appeal.

If your grievance or complaint involves concerns related to clinical licensure rules or ethical compliance, you may also contact the Texas Behavioral Health Executive Council at (800) 821-3205 or visit bhec.texas.gov/contact-us. You may additionally file a complaint through the Office of the Attorney General’s Consumer Protection website at texasattorneygeneral.gov/consumer-protection.