Discovering each child's lifelong potential

Notice of Privacy Practices

Mary Cariola Children’s Center
1000 Elmwood Avenue, Suite 100
Rochester, NY 14620
Privacy Officer

(585) 271-0761

THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOUR 
CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS 
INFORMATION. PLEASE REVIEW IT CAREFULLY.
Mary Cariola Children’s Center is required by law to maintain the privacy of your child’s health 
information and to provide you with notice of its legal duties and the use and disclosure of your 
child’s health information, as well as your rights with respect to this information. Mary Cariola 
Children’s Center is required to abide by the terms of this notice as currently in effect. If you have 
questions about any part of this notice or if you want more information about the privacy practices 
at Mary Cariola Children’s Center please contact the Privacy Officer.
Effective Date of This Notice: September 23, 2013
I. How Mary Cariola Children’s Center may Use or Disclose Your Child’s Health Information
Mary Cariola Children’s Center compiles health information about your child and stores it in a 
chart and on a computer. This is your child’s medical record. The medical record is the property 
of Mary Cariola Children’s Center but the information in the medical record belongs to you. Mary 
Cariola Children’s Center protects the privacy of your child’s health information. The law permits 
Mary Cariola Children’s Center to use or disclose your child’s health information for the following 
purposes:
1. Information provided to you.
2. Treatment. Mary Cariola Children’s Center provides clinical, educational, residential and 
advocacy services for children with developmental disabilities. Some examples include 
evaluation, development of your child’s program objectives and communication among 
team members.
3. Payment. Mary Cariola Children’s Center reports information about your child’s services 
to a variety of funding sources in order to receive payment for your child’s treatment and 
services. Funding sources include county health departments, school districts, New York 
State Medicaid and the Office for People with Developmental Disabilities.
4. Regular Health Care Operations. Mary Cariola Children’s Center may use and disclose 
information about your child for our health care operations, which include internal 
administration and planning and various activities that improve the quality and cost 
effectiveness of the care that we deliver to your child. For example, we may disclose this 
information to evaluate the quality and competence of our Day Program and Community 
Services staff. We may disclose this information to our Privacy Officer in order to resolve 
any complaints you may have and ensure that you are satisfied with the quality of our 
services.5. Directory. Mary Cariola Children’s Center maintains a directory list of children, service 
locations and medical conditions. Although federal regulations permit agencies to 
disclose this information in a public directory, it is not Mary Cariola Children’s Center’s 
practice to do so.
6. Notification and communication with family. We may disclose your child’s health 
information to notify or assist in notifying a family member, your personal representative 
or another person responsible for your child’s care. This disclosure may be about your 
child’s location, your child’s general condition or a serious medical issue for your child. If 
you are able and available to agree or object, we will give you the opportunity to object 
prior to making this notification. If you are unable or unavailable to agree or object, our 
staff will use their best judgment in communication with your child’s family and others.
7. Required by law. As required by law, we may use and disclose your child’s health 
information.
8. Public health. As required by law, we may disclose your child’s health information to 
public health authorities for purposes related to: preventing or controlling disease, injury 
or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the 
Food and Drug Administration problems with products and reactions to medications; and 
reporting disease or infection exposure.
9. Health oversight activities. We may disclose your child’s health information to health 
agencies during the course of audits, investigations, inspections, licensure and other 
proceedings.
10. Judicial and administrative proceedings. We may disclose your child’s health information 
in the course of any administrative or judicial proceeding.
11. Law enforcement. We may disclose your child’s health information to a law enforcement 
official for purposes such as identifying or locating a suspect, fugitive, material witness or 
missing person, complying with a court order or subpoena and other law enforcement 
purposes.
12. Deceased person information. We may disclose your child’s health information to 
coroners, medical examiners and funeral directors.
13. Research. We may disclose your child’s health information to researchers conducting 
research that has been approved by an Institutional Review Board. However, we would 
not give specific identifying information about your child without your consent.
14. Public safety. We may disclose your child’s health information to appropriate persons in 
order to prevent or lessen a serious and imminent threat to the health or safety of a 
particular person or the general public.
15. Specialized government functions. We may disclose your child’s health information for 
military or national security purposes.
16. Workers’ compensation. We may disclose your child’s health information as necessary 
to comply with workers’ compensation laws.
17. Marketing. We may contact you to provide reminders or to give you information about 
other treatments or benefits and services that may be of interest to you.
18. Fund-raising. We may contact you to participate in fund-raising activities for Mary Cariola 
Children’s Center. You have the right to opt out of receiving fundraising communications. The money raised will be used to expand and improve the services and programs we 
provide to the community. You are free to opt out of fundraising solicitation and your 
decision will have no impact on the services received or payment for services at Mary 
Cariola Children’s Center.
19. Change of Ownership. In the event that Mary Cariola Children’s Center is sold or merged 
with another organization, your health information/record will become the property of the 
new owner.
20. For any other purpose with your written authorization. Except as described in this Notice 
of Privacy Practices, Mary Cariola Children’s Center will not use of disclose your child’s 
health information without your written authorization. If you do authorize Mary Cariola 
Children’s Center to use or disclose your child’s health information for another purpose, 
you may revoke your authorization in writing at any time except to the extent that:
(i) The Mary Cariola Children’s Center has disclosed the information prior to the 
revocation, or
(ii) If the authorization was granted to obtain insurance coverage and the insurer has 
the right to contest a claim, the information may be disclosed.
II. Your Health Information Rights
1. You have the right to request restrictions on certain uses and disclosures of your child’s 
health information. Mary Cariola Children's Center is not required to agree to the 
restriction that you requested. In the event that the Mary Cariola Children’s Center 
agrees to a restriction, it may not use or disclose protected health information in violation 
of such restriction, except that, if there is a need for emergency treatment and the 
restricted protected health information is needed to provide the emergency treatment, the 
Mary Cariola Children’s Center may use the restricted protected health information, or 
may disclose such information to a health care provider, to provide such treatment to the 
individual. If restricted protected health information is disclosed to a health care provider 
for emergency treatment, the Mary Cariola Children’s Center must request that such 
health care provider not further use or disclose the information.
2. You have the right to request receipt of your child’s health information through a 
reasonable alternative means or at an alternative location. Mary Cariola Children’s 
Center is not required to agree to this request. You also have the right to choose how you 
would like us to communicate with you: electronically by email, over the phone or by mail.
3. You have the right to inspect and copy your child’s health information. Information kept 
electronically will be available to you electronically if requested. Legal restrictions 
regarding certain portions of the information may apply. Mary Cariola Children’s Center 
may deny your request to inspect or copy your child’s health information and will provide 
you with information about Mary Cariola Children’s Center denial and how you can have 
the denial reviewed.
4. You have a right to request that Mary Cariola Children's Center amend your child’s health 
information that you believe is incorrect or incomplete. Mary Cariola Children's Center is 
not required to change your child’s health information. If your request is denied, we will
provide you with information about Mary Cariola Children's Center’s denial and how you 
can have the denial reviewed.5. You have a right to receive an accounting of disclosures of your child’s health information 
made by Mary Cariola Children's Center for the six years prior to the date you request the 
accounting, except that Mary Cariola Children's Center does not have to account for the 
disclosures described in parts 1 (information provided to you), 2 (treatment), 3 (payment), 
4 (regular health care operations), 5 (directory listings) and 16 (specialized government 
functions) of section I of this Notice of Privacy Practices.
6. You have the right to a paper and/or electronic copy of this Notice of Privacy Practices.
7. You have the right to complain about this Notice of Privacy Practices or how Mary Cariola 
Children's Center handles your child’s health information. Complaints should be directed 
to the Privacy Officer at 271-0761. If you are not satisfied with the manner in which this 
office handles a complaint, you may submit a formal complaint to Department of Health 
and Human Services, Office of Civil Rights, Hubert H. Humphrey Bldg., 200 
Independence Avenue, S.W., Room 509F HHH Building, Washington, DC 20201. You 
will not be retaliated against for filing a complaint.
If you would like to have a more detailed explanation of these rights or if you would like to 
exercise one or more of these rights, contact the Privacy Officer at the telephone number listed 
above.
III. Changes to this Notice of Privacy Practices
Mary Cariola Children's Center reserves the right to amend this Notice of Privacy Practices at any 
time in the future, and to make the new provisions effective for all information that it maintains, 
including information that was created or received prior to the date of such amendment. You will 
be notified in writing by mail about any changes made to Mary Cariola Children's Center’s Notice 
of Privacy Practices.
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOUR 
CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS 
INFORMATION. PLEASE REVIEW IT CAREFULLY.

Mary Cariola Children’s Center is required by law to maintain the privacy of your child’s health 
information and to provide you with notice of its legal duties and the use and disclosure of your 
child’s health information, as well as your rights with respect to this information. Mary Cariola 
Children’s Center is required to abide by the terms of this notice as currently in effect. If you have 
questions about any part of this notice or if you want more information about the privacy practices 
at Mary Cariola Children’s Center please contact the Privacy Officer.
Effective Date of This Notice: September 23, 2013
I. How Mary Cariola Children’s Center may Use or Disclose Your Child’s Health Information
Mary Cariola Children’s Center compiles health information about your child and stores it in a 
chart and on a computer. This is your child’s medical record. The medical record is the property 
of Mary Cariola Children’s Center but the information in the medical record belongs to you. Mary 
Cariola Children’s Center protects the privacy of your child’s health information. The law permits 
Mary Cariola Children’s Center to use or disclose your child’s health information for the following 
purposes:
1. Information provided to you.
2. Treatment. Mary Cariola Children’s Center provides clinical, educational, residential and 
advocacy services for children with developmental disabilities. Some examples include 
evaluation, development of your child’s program objectives and communication among 
team members.
3. Payment. Mary Cariola Children’s Center reports information about your child’s services 
to a variety of funding sources in order to receive payment for your child’s treatment and 
services. Funding sources include county health departments, school districts, New York 
State Medicaid and the Office for People with Developmental Disabilities.
4. Regular Health Care Operations. Mary Cariola Children’s Center may use and disclose 
information about your child for our health care operations, which include internal 
administration and planning and various activities that improve the quality and cost 
effectiveness of the care that we deliver to your child. For example, we may disclose this 
information to evaluate the quality and competence of our Day Program and Community 
Services staff. We may disclose this information to our Privacy Officer in order to resolve 
any complaints you may have and ensure that you are satisfied with the quality of our 
services.5. Directory. Mary Cariola Children’s Center maintains a directory list of children, service 
locations and medical conditions. Although federal regulations permit agencies to 
disclose this information in a public directory, it is not Mary Cariola Children’s Center’s 
practice to do so.
6. Notification and communication with family. We may disclose your child’s health 
information to notify or assist in notifying a family member, your personal representative 
or another person responsible for your child’s care. This disclosure may be about your 
child’s location, your child’s general condition or a serious medical issue for your child. If 
you are able and available to agree or object, we will give you the opportunity to object 
prior to making this notification. If you are unable or unavailable to agree or object, our 
staff will use their best judgment in communication with your child’s family and others.
7. Required by law. As required by law, we may use and disclose your child’s health 
information.
8. Public health. As required by law, we may disclose your child’s health information to 
public health authorities for purposes related to: preventing or controlling disease, injury 
or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the 
Food and Drug Administration problems with products and reactions to medications; and 
reporting disease or infection exposure.
9. Health oversight activities. We may disclose your child’s health information to health 
agencies during the course of audits, investigations, inspections, licensure and other 
proceedings.
10. Judicial and administrative proceedings. We may disclose your child’s health information 
in the course of any administrative or judicial proceeding.
11. Law enforcement. We may disclose your child’s health information to a law enforcement 
official for purposes such as identifying or locating a suspect, fugitive, material witness or 
missing person, complying with a court order or subpoena and other law enforcement 
purposes.
12. Deceased person information. We may disclose your child’s health information to 
coroners, medical examiners and funeral directors.
13. Research. We may disclose your child’s health information to researchers conducting 
research that has been approved by an Institutional Review Board. However, we would 
not give specific identifying information about your child without your consent.
14. Public safety. We may disclose your child’s health information to appropriate persons in 
order to prevent or lessen a serious and imminent threat to the health or safety of a 
particular person or the general public.
15. Specialized government functions. We may disclose your child’s health information for 
military or national security purposes.
16. Workers’ compensation. We may disclose your child’s health information as necessary 
to comply with workers’ compensation laws.
17. Marketing. We may contact you to provide reminders or to give you information about 
other treatments or benefits and services that may be of interest to you.
18. Fund-raising. We may contact you to participate in fund-raising activities for Mary Cariola 
Children’s Center. You have the right to opt out of receiving fundraising communications. The money raised will be used to expand and improve the services and programs we 
provide to the community. You are free to opt out of fundraising solicitation and your 
decision will have no impact on the services received or payment for services at Mary 
Cariola Children’s Center.
19. Change of Ownership. In the event that Mary Cariola Children’s Center is sold or merged 
with another organization, your health information/record will become the property of the 
new owner.
20. For any other purpose with your written authorization. Except as described in this Notice 
of Privacy Practices, Mary Cariola Children’s Center will not use of disclose your child’s 
health information without your written authorization. If you do authorize Mary Cariola 
Children’s Center to use or disclose your child’s health information for another purpose, 
you may revoke your authorization in writing at any time except to the extent that:
(i) The Mary Cariola Children’s Center has disclosed the information prior to the 
revocation, or
(ii) If the authorization was granted to obtain insurance coverage and the insurer has 
the right to contest a claim, the information may be disclosed.
II. Your Health Information Rights
1. You have the right to request restrictions on certain uses and disclosures of your child’s 
health information. Mary Cariola Children's Center is not required to agree to the 
restriction that you requested. In the event that the Mary Cariola Children’s Center 
agrees to a restriction, it may not use or disclose protected health information in violation 
of such restriction, except that, if there is a need for emergency treatment and the 
restricted protected health information is needed to provide the emergency treatment, the 
Mary Cariola Children’s Center may use the restricted protected health information, or 
may disclose such information to a health care provider, to provide such treatment to the 
individual. If restricted protected health information is disclosed to a health care provider 
for emergency treatment, the Mary Cariola Children’s Center must request that such 
health care provider not further use or disclose the information.
2. You have the right to request receipt of your child’s health information through a 
reasonable alternative means or at an alternative location. Mary Cariola Children’s 
Center is not required to agree to this request. You also have the right to choose how you 
would like us to communicate with you: electronically by email, over the phone or by mail.
3. You have the right to inspect and copy your child’s health information. Information kept 
electronically will be available to you electronically if requested. Legal restrictions 
regarding certain portions of the information may apply. Mary Cariola Children’s Center 
may deny your request to inspect or copy your child’s health information and will provide 
you with information about Mary Cariola Children’s Center denial and how you can have 
the denial reviewed.
4. You have a right to request that Mary Cariola Children's Center amend your child’s health 
information that you believe is incorrect or incomplete. Mary Cariola Children's Center is 
not required to change your child’s health information. If your request is denied, we will
provide you with information about Mary Cariola Children's Center’s denial and how you 
can have the denial reviewed.5. You have a right to receive an accounting of disclosures of your child’s health information 
made by Mary Cariola Children's Center for the six years prior to the date you request the 
accounting, except that Mary Cariola Children's Center does not have to account for the 
disclosures described in parts 1 (information provided to you), 2 (treatment), 3 (payment), 
4 (regular health care operations), 5 (directory listings) and 16 (specialized government 
functions) of section I of this Notice of Privacy Practices.
6. You have the right to a paper and/or electronic copy of this Notice of Privacy Practices.
7. You have the right to complain about this Notice of Privacy Practices or how Mary Cariola 
Children's Center handles your child’s health information. Complaints should be directed 
to the Privacy Officer at 271-0761. If you are not satisfied with the manner in which this 
office handles a complaint, you may submit a formal complaint to Department of Health 
and Human Services, Office of Civil Rights, Hubert H. Humphrey Bldg., 200 
Independence Avenue, S.W., Room 509F HHH Building, Washington, DC 20201. You 
will not be retaliated against for filing a complaint.
If you would like to have a more detailed explanation of these rights or if you would like to 
exercise one or more of these rights, contact the Privacy Officer at the telephone number listed 
above.
III. Changes to this Notice of Privacy Practices
Mary Cariola Children's Center reserves the right to amend this Notice of Privacy Practices at any 
time in the future, and to make the new provisions effective for all information that it maintains, 
including information that was created or received prior to the date of such amendment. You will 
be notified in writing by mail about any changes made to Mary Cariola Children's Center’s Notice 
of Privacy Practices.