Rights and Privacy
Title VI Notice to the Public
Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, or national origin in programs and activities receiving Federal financial assistance. Specifically, Title VI provides that "no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance" (42 U.S.C. Section 2000d).
EnCircle is committed to ensuring that no person is excluded from participation in or denied the benefits of its transportation services on the basis of race, color, or national origin, as protected by Title VI in Federal Transit Administration (FTA) Circular 4702.1B. If you feel you are being denied participation in or being denied benefits of the transit services provided by enCircle, or otherwise being discriminated against because of your race, color, national origin, gender, age, or disability, our contact information is:
Name: Tresha Lafon
Title: Chief Quality Officer
Agency Name: enCircle
Address: 2609 McVitty Road,
City, State Zipcode: Roanoke, VA 24018
Telephone Number: 540-774-7100
Email address: email@example.com
Notice under the Americans with Disabilities Act (ADA)
In accordance with the requirements of Title II of the Americans with Disabilities Act of 1990 (ADA), enCircle Virginia will not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs or activities.
Employment: EnCircle does not discriminate on the basis of disability in its hiring or employment practices and complies with all regulations promulgated by the U.S. Equal Employment Opportunity Commission under Title I of the ADA.
Effective Communication: EnCircle will generally, upon request, provide appropriate aids and services leading to effective communication for persons with disabilities so they can participate equally in DRPT’s programs, services, and activities, including qualified sign language interpreter, documents in Braille, and other ways of making information and communications accessible to people with speech, hearing or vision impairments.
Modifications to Policies and Procedures: EnCircle will make all reasonable modifications to policies and programs to ensure that people with disabilities have an equal opportunity to enjoy all of its programs, services, activities.
Anyone who requires auxiliary aid or service for effective communication, or a modification of policies or procedures to participate in enCircle’s programs, services, or activities, should contact Tresha Lafon, tlafon@enCircleAll.org, as soon as possible, but no later than 48 hours before the scheduled event.
The ADA does not require enCircle to take any action that would fundamentally alter the nature of the programs or services or impose any undue financial or administrative burden.
Complaints that an enCircle program, service, or activity is not accessible to persons with disabilities should be directed to Tresha Lafon at tlafon@enCircleAll.org.
enCircle will not place a surcharge on a particular individual with a disability or any group of individuals with disabilities to cover the cost of providing aids/services or reasonable modifications of policy.
Client Privacy Notice
This section describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this
We may say “no” to your request, but we’ll tell you why in writing within 60 days
Request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address
We will say “yes” to all reasonable requests
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations.
We are not required to agree to your request and may say “no” if it would affect your care
Any requests to limit shared information should be submitted in writing and should include what information should not be shared and with whom it should not be shared
If you pay for a service out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer
We will say “yes” unless a law requires us to share that information
Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information
We will make sure the person has this authority and can act for you before we take any action
File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us using the information on page 1
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting HIPPA complaints
We will not retaliate against you for filing a complaint
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions
In these cases, this is what you have both the right and choice to tell us
Share information with your family, close friends, or others involved in your care. We may contact or assist in contacting a family member, personal representative, or other person responsible for your care to advise them of your location and general condition. Depending on that person’s involvement in your care and payment related to your care, additional information might be disclosed as deemed necessary
Share information in a disaster relief situation
Contact you for fundraising efforts
If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety
Cases in which we never share your information unless you give us written permission
Sale of your information
Most sharing of psychotherapy notes
Fundraising cases: We may contact you for fundraising efforts, but you can tell us not to contact you again
Our Uses and Disclosures
How do we typically use or share your health information? We typically use or share your health information in the following ways
Treat you: We can use your health information and share it with other professionals who are treating you
Example: A doctor treating you for an injury asks another doctor about your overall health condition
Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary
Example: We use health information about you to manage your treatment and services
Bill you for services: We can use and share your health information to bill and get payment from health plans or other entities
Example: We give information about you to your health insurance plan so it will pay for your services
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see: Your rights under HIPAA
Help with public health and safety issues
We can share health information about you for certain situations such as:
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety
Do research Under certain circumstances, we may use and disclose information about you for research purposes. All research projects, are subject to a special approval process. This process evaluates a proposed research project and its use of information, trying to balance the research needs with the consumer’s need for privacy of their information. This will never occur without your knowledge and consent
Comply with the law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law
Work with a medical examiner or funeral director: We can share health information with a coroner, medical examiner, or funeral director when an individual dies
Address workers’ compensation, law enforcement, and other government requests: We can use or share health information about you:
For workers’ compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order, or in response to a subpoena
We are required by law to maintain the privacy and security of your protected health information
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information
We must follow the duties and privacy practices described in this notice and give you a copy of it
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind
For more information see: Notice of Privacy Practices
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.