South Side School District

South Side School District ("SSSD") is committed to protecting the privacy of our students. We take very seriously our obligation to maintain the privacy of health care information that is shared with us confidential and secure. The terms "you" and "your" used throughout this Notice refer to the individual student to whom the health care information pertains.

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.

Purpose of this Notice: SSSD is required by law to maintain the privacy of certain health care information, known as Protected Health Information or "PHI". PHI may include your child's name, address, and other identifying data or information on your child's health or the health services that have been or may be furnished to your child. SSSD is also required to provide your child with a notice of its legal duties and privacy practices regarding your child's PHI and to abide by the terms of this notice currently in effect. This notice describes SSSD's privacy practices, lets you know when the district is permitted to use and disclose your child's PHI and advises you of your rights. SSSD requires that all of its employees, staff, and independent contractors comply with these privacy practices.

Use and Disclosure of PHI for Treatment, Payment and Health Care Operations:" By law, SSSD is permitted to use and disclose PHI for treatment, payment and health care operations in most cases, without your permission for the following reasons:
Treatment generally means the care and services provided by doctors, hospitals and other health care providers. SSSD at times, performs various functions which make it a health care provider, for example: state mandated physicals, dental exams, or hearing tests; distribution of first aid and medication; athletic training or conditioning; occupational or physical therapy; student assistance; or psychological counseling services. When we perform such health care services or the related assessment, referral or support activities, either directly or through a third party, we are permitted to obtain, use and disclose verbal and written information about you and regarding your medical condition. This includes PHI received or transferred by phone, fax, written, electronic or other means.

Payment means any activities that SSSD must take in order to get reimbursed for services we provided to you and includes: organizing your PHI; verifying eligibility for services; coordinating benefits; submitting bills; or accessing available funding for such services, either directly or through a third party. For example, SSSD seeks funding from payment from various federal and/or state programs for some health related services provided to our students.

Health Care Operations means activities undertaken by SSSD that are required for its operations. Such activities may be performed by SSSD or in some instances by a third party. These activities may include: quality assessment and improvement activities; credentialing and licensing; training programs; and other management, legal or financial services. For example, SSSD evaluates staff performance to ensure that our policies and procedures are followed for internal reviews.

Reminders, Information and Fundraisers: SSSD may contact you to remind you of scheduled appointments for health care related services, to notify you about other services we provide or health-related benefits and services that may be of interest to you. For example, mandated student physicals, dental exams or athletic training events.

Use and Disclosure of PHI Without Your Authorization: Under certain circumstances, SSSD may use or disclose your child's medical information without your written authorization or other permission, or your opportunity to object. These circumstances are as follows:
In treatment situations by receiving and disclosing medical and identifying information about you child via telephone, written, electronic or other oral means; communicating with the appropriate parties and completing and filing the required written documentation regarding treatment.
In treatment situations, for our use in order to treat your child, to obtain payment for services provided to your child, or for other health care operations.
To another health care provider for the treatment activities of that provider.
To another health care provider or entity for the payment activities of that provider or entity.
To another health care provider or entity for the health care operations of that provider or entity if the provider receiving the information has or had a relationship with your child and the PHI pertains to that relationship.
To a family member, relative, friend or other individual involved in your child's care, or for disaster relief. SSSD may provide medical information about your child to such individuals if we obtain your verbal agreement, if we give you an opportunity to object to such disclosure and you do not object, or if we infer from the circumstances that you would not object. When we are not able to obtain your agreement or because you are not immediately present, we will use our professional judgment to determine whether it is in your child's best interest to disclose such information to a family member, relative, friend or other individual involved in your child's case. Only health information relevant to that person's involvement with your child's care will be disclosed. For example, we may inform the person whom you list as an emergency contact for your child in emergency or health related situations involving your child.
As required by law. Numerous state, federal and local laws permit or require certain uses and disclosures of medical information. In such cases, SSSD may only use or disclose your child's medical information to the extent authorized by law.
To a public health authority. SSSD may be asked or required by law to disclose medical information to a public health authority under the following circumstances:
to report a birth, death, disease or injury;
as part of a public health investigation;
to report child or adult abuse or neglect, or domestic violence;
to report adverse events such as product defects, to tract products or assist in product recalls or repairs or replacements, or to conduct post-marketing surveillance as required by the Food and Drug Administration; and
to notify a person about exposure to a possible communicable disease.
For health over site activities including: audits, government investigations, inspections, disciplinary proceedings and other administrative and judicial actions undertaken by the government or its contractors by law to oversee the health care system;
For health care fraud and abuse detection or compliance related activities.
For judicial and administrative proceedings. SSSD may disclose medical information as required by court or administrative order or in some cases pursuant to a subpoena, discovery request or legal process.
To law enforcement. Police and other law enforcement may seek medical information from SSSD. We may release this information to law enforcement under limited circumstances, such as when the request is accompanied by a warrant, or when law enforcement needs specific information to locate a suspect or to stop a crime.
To coroners, medical examiners and funeral directors. SSSD may release information regarding a decedent to such persons as authorized by law or in order to identify the deceased, determine cause of death, or carry out other duties.
For organ, eye and tissue donation. SSSD may release medical information to organ, eye and tissue procurement organizations and similar entities in order to facilitate such types of donation, if applicable.
For research purposes. SSSD may be approached by researchers to provide medical information for research purposes, such as tracking a particular condition. We may provide medical information to a researcher if the researcher has obtained a special waiver from a committee established under federal law to oversee medical research to allow the researcher to not have to obtain the individuals permission prior to collecting the information. Also, the researcher must demonstrate that the information is necessary to the research and poses a minimal risk of an inappropriate use or disclosure. If the researcher does not obtain the waiver, then SSSD may not disclose the information without your Authorization.
To avert a serious health and safety. SSSD may use or disclose your child's medical information to avert a serious and imminent threat to an individual or the public's health and safety.
For military and other specialized governmental functions. Medical information may be disclosed for military, defense, national security, intelligence or correctional activities.
For workers' compensation. SSSD may share medical information regarding work-related illness and injuries in order to comply with workers' compensation laws.
In a manner that does not personally identify your child.
Any other use or disclosure of PHI, except those listed above will only be made by SSSD after receiving a written authorization for your child. An Authorization is a written document that must specifically identify the information that we seek to use or disclose and when and how we seek to use or disclose it. You may revoke an Authorization at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on you Authorization.

Individual Rights: You have a number of rights with respect to you child's PHI. Such rights are as follows:
Restrictions: You have the right to restrict how we use and disclose your child's medical information that we have for treatment, payment or health care operations purposes, or to restrict the information provided to family, friends and other individuals involved in your child's health care. However, we do not have to agree to any restrictions, but if we do, we will abide by our agreement unless the information is needed in order to provide your child with emergency treatment. For example, if you request a restriction on information that is needed to provide your child with emergency treatment, then we may use such information and disclose it to a health care provider so that they may provide your child with emergency treatment. Any restrictions must be agreed to in writing by SSSD. Please contact the Privacy Officer listed at the end of this notice if you wish to request a restriction.
Confidential Communications: You have the right to request that SSSD reasonably accommodate you regarding the way in which we communicate to you involving your child's health, health care services or payment. For example, you may ask that we communicate with you only at your home. If we receive such a request in writing, we will do our best to reasonably accommodate such request.
Access: You have the right to review your child's educational record as defined under the Family Educational Rights and Privacy Act (FERPA). FERPA controls the privacy of information entered into a student's record, including health related information. However, there may be instances where health information is not entered into the student's educational record by school personnel or is not considered a part of the educational record and in such cases, FERPA does not apply and HIPAA does. Under HIPAA, you have the right to inspect and copy most of your child's medical information maintained by SSSD under HIPAA. We have forms available for you to use to request access to you child's PHI. Normally, we will provide you with access within 30 days of your request. We may charge you a reasonable copying fee. In limited cases, we may deny you access to your child's medical information. You may appeal certain types of denials. If we deny access, we will provide you with a written response and inform you about your appeal rights. Please contact the Privacy Officer listed at the end of this notice if you wish to request an amendment to your child's medical information.
Accounting: You have the right to request an accounting from SSSD of certain disclosures of your child's PHI made by us during the last six (6) years prior to the date of your request after April 14, 2004. We will generally provide you with an accounting within 60 days of your request. We are not required to give you an accounting of information that we have used or disclosed for treatment, payment or health care operations, or when we share your child's PHI with our business associates. We are also not required to give you an accounting of our uses or disclosures of PHI for which you have already provided us with a written authorization. Please contact the Privacy Officer listed at the end of this notice if you wish to request an accounting of your child's medical information that we have used or disclosed, which is not exempt from the accounting requirement.
Electronic and Paper Notice: We currently maintain a web site that provides information about our school district. SSSD is required to prominently post its Notice of Privacy Practices on such web site and to make the notice available electronically through the web site. If you have obtained this Notice electronically, you may obtain a paper copy by requesting such notice from the Privacy Officer listed below. SSSD Web site is found at www.sssd.k12.pa.us.
Complaints: You may complain to SSSD, or to the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated. Under no circumstances will SSSD take any retaliation against your child for filing a complaint. If you have any questions, comments or complaints, please contact the Privacy Officer listed below.
Revisions to Privacy Notice: SSSD reserves the right to change the terms of this Notice at any time. Any revised Notice will be promptly posted at the Central Administration Offices and also Posted to our web site, if we maintain a web site at the time of such revision and available at the Central Administration Offices for you to request a copy. We also reserve the right to make the new Notice provisions effective for all PHI that we maintain.

Privacy Notice/Compliance Contact Officer: If you have any questions or comments or if you wish to file a complaint or exercise any of your individual rights listed in this Notice, please contact:

Superintendent, Mr. Alan Fritiz
4949 State Rt. 151
Hookstown, PA 15050
(724) 573-9581

Effective Date: The effective date of this Notice of Privacy Practices is April 14, 2004.