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  • The Children & Family Wellness Center is committed to providing safe, child-focused, and professionally supervised home-based visitation services. The primary responsibility of the Supervised Visitation Monitor is to protect the safety, well-being, and best interests of the child(ren).

    All participants are expected to comply with the following rules. Failure to comply may result in the visit being modified, suspended, terminated, or discontinued.

    1. Home Approval

    • The residence must be approved by the Children & Family Wellness Center before any home-based supervised visitation occurs.

    • The home must provide a safe, clean, sanitary, and appropriate environment for children.

    • The Supervised Visitation Monitor may inspect the visitation area before the visit begins.

    • If the home is determined to be unsafe, unsanitary, or otherwise inappropriate, the visit may be canceled or relocated.

    2. Safe Home Environment

    The home must be free from hazards, including but not limited to:

    • Illegal drugs or drug paraphernalia

    • Alcohol being consumed during the visit

    • Weapons or firearms that are unsecured

    • Aggressive animals

    • Unsafe living conditions

    • Excessive clutter that creates safety hazards

    • Individuals who appear to be under the influence of drugs or alcohol

    The Supervised Visitation Monitor may end the visit if safety concerns are identified.

    3. Continuous Line-of-Sight Supervision

    • The Supervised Visitation Monitor must maintain continuous visual supervision of the child(ren) throughout the visit.

    • The visiting (non-custodial) parent and child(ren) must remain within the monitor's sight whenever possible.

    • Closed doors are not permitted during supervised visitation unless approved by the monitor for privacy related to the child's care.

    4. No Unsupervised Contact with the Visiting (Non-Custodial) Parent

    The visiting parent may not:

    • Be alone with the child(ren).

    • Ask the monitor to leave the room or residence.

    • Take the child(ren) to another room outside the monitor's supervision.

    • Take the child(ren) outside the home or into a vehicle without prior approval.

    • Leave the residence with the child(ren).

    • Ask the child(ren) to keep secrets.

    5. Household Members and Visitors

    • Only individuals approved by the supervising agency and authorized by the court order or visitation agreement may be present.

    • Friends, neighbors, romantic partners, extended family members, or visitors may not participate unless approved in advance.

    • The Supervised Visitation Monitor may require unauthorized individuals to leave before the visit begins.

    6. Pets

    • Pets must be secured before the visit begins if requested by the monitor.

    • Animals that create a safety concern or interfere with supervision may result in the visit being suspended or terminated.

    7. Arrival and Late Arrival

    • Participants should be prepared before the scheduled start time.

    • Late arrivals may shorten the visit.

    • Repeated lateness or failure to appear may result in cancellation of future visits.

    8. Safety and Behavioral Expectations

    The visiting parent agrees to:

    • Follow all directions provided by the Supervised Visitation Monitor.

    • Use respectful language and behavior.

    • Maintain appropriate physical boundaries.

    • Use positive parenting skills.

    • Avoid discussing court proceedings, custody disputes, child support, or adult conflicts.

    • Avoid questioning the child(ren) about the custodial parent or legal matters.

    • Refrain from yelling, threatening, intimidating, or using physical discipline.

    • Refrain from using alcohol, marijuana, illegal drugs, or any impairing substances before or during the visit.

    9. Child's Needs

    • The child's physical safety and emotional well-being always take priority.

    • The Supervised Visitation Monitor may redirect activities that are not in the child's best interests.

    • A child will never be forced to participate in visitation. The monitor will make reasonable efforts to encourage participation while considering the child's age, developmental level, and emotional well-being.

    10. Personal Belongings

    The Supervised Visitation Monitor may inspect:

    • Bags

    • Purses

    • Gifts

    • Food

    • Drinks

    • Medications

    • Toys

    • Electronic devices

    Only approved items may be given to the child(ren).

    11. Prohibited Items

    The following items are prohibited:

    • Weapons or firearms that are unsecured

    • Alcohol

    • Marijuana

    • Illegal drugs

    • Drug paraphernalia

    • Tobacco or vaping products used during the visit

    • Fireworks

    • Hazardous chemicals

    • Any item determined to present a safety risk

    12. Electronic Devices

    • Cell phones should be silenced during the visit.

    • Audio or video recording is prohibited unless specifically authorized.

    • Live streaming or posting on social media is prohibited.

    13. Photography and Social Media

    • Photographs may only be taken with prior approval from the supervising agency and when consistent with the court order.

    • Posting photographs, videos, or information regarding the child(ren) or visitation on social media is prohibited unless specifically authorized.

    14. Illness

    Participants should not attend visitation if they have:

    • A fever

    • A contagious illness

    • Vomiting or diarrhea

    • Any condition that may place the child(ren) or others at risk

    The agency should be notified as soon as possible if illness prevents attendance.

    15. Emergency Procedures

    The Supervised Visitation Monitor may:

    • Contact emergency medical services.

    • Contact law enforcement.

    • End the visit immediately if necessary to protect the child(ren) or any participant.

    Participants must immediately report any illness, injury, accident, or emergency.

    16. Confidentiality

    • The Supervised Visitation Monitor will document observations during each visit.

    • Reports may be released only as authorized by court order, signed authorization, or applicable law.

    • Participants are expected to maintain the confidentiality of the visitation process.

    17. Authority of the Supervised Visitation Monitor

    The Supervised Visitation Monitor has the authority to:

    • Redirect conversations and activities.

    • Stop unsafe or inappropriate behavior.

    • Modify the visitation plan when necessary.

    • End the visit if safety concerns arise or these rules are violated.

    • Contact emergency responders when necessary.

    The monitor's decisions regarding safety during the visit are final.

  • The Children & Family Wellness Center is committed to providing safe, professional, and child-focused supervised visitation services. This Fee Agreement outlines the fees, payment policies, cancellation procedures, and financial responsibilities associated with our services.

    FEE SCHEDULE

    Intake & Orientation Assessment
    Initial intake meeting, assessment, orientation, review of policies and procedures, safety planning, required paperwork, and service planning. Required once unless services have been inactive for two (2) months or longer, at which time a new intake is required.
    $80.00

    Additional Child Fee
    Fee for each additional child participating in supervised visitation services.
    $15.00 per child

    Supervised Visitation
    Two (2) hour supervised visitation session at $80.00 per hour.
    $160.00

    Monitored Child Exchange
    Neutral, structured, and safe exchange of the child(ren) between parents or caregivers.
    $70.00 per exchange

    Additional Approved Participant
    Fee for each court-approved or agency-approved support person attending the supervised visitation session.
    $15.00 per person

    Travel Fee
    Mileage for travel to and from the approved visitation location.
    $0.70 per mile

    By signing this agreement, all participants acknowledge that they have read, understand, and agree to comply with the policies contained in this document.

    Payment Policy

    • ALL PAYMENTS MUST BE PAID IN FULL IN ADVANCE OF THE SCHEDULED VISIT OR SERVICE.

    • Payment is required before any supervised visitation session, monitored child exchange, intake appointment, travel service, or other service provided by the Children & Family Wellness Center.

    • Services will not begin until payment has been received in full, unless other arrangements have been approved in writing by the Children & Family Wellness Center.

    • Payments may be made using approved payment methods accepted by the Children & Family Wellness Center.

    • Outstanding balances must be paid in full before any additional services will be scheduled.

    • The Children & Family Wellness Center reserves the right to postpone, cancel, or suspend services until all required payments have been received.

    Cancellation, Rescheduling, Refund, and No-Show Policy

    • ALL PAYMENTS ARE NON-REFUNDABLE.

    • ALL PAYMENTS MUST BE PAID IN ADVANCE OF THE SCHEDULED VISIT OR SERVICE.

    • If you need to cancel your appointment, you must notify the Children & Family Wellness Center as soon as possible.

    • No refunds will be issued for canceled appointments.

    • A canceled appointment may be rescheduled one (1) time using the original payment, provided the request to reschedule is made before the scheduled appointment time and the new appointment is scheduled within 30 calendar days, subject to staff availability.

    • If a client fails to appear for a scheduled appointment without prior notice ("No-Show"), the appointment will be considered completed for billing purposes. The payment will be forfeited, and a new payment will be required before another appointment can be scheduled.

    • Clients who repeatedly cancel appointments, fail to appear, or arrive excessively late may be required to prepay for all future services and may be denied future scheduling at the discretion of the Children & Family Wellness Center.

    • If the Children & Family Wellness Center cancels a scheduled service due to staff illness, weather, safety concerns, facility closure, or other unforeseen circumstances, the client may reschedule the appointment at no additional charge. If the Center is unable to provide the service within a reasonable period, the client may request a refund.

    Court-Ordered Services

    If supervised visitation services are ordered by the court:

    • All participants remain financially responsible for payment unless the court order specifically states otherwise.

    • Court-ordered allocations of fees between the parties are the responsibility of the parties to follow.

    • The Children & Family Wellness Center is not responsible for collecting reimbursement from another party.

    • Court reports, court testimony, consultation, document preparation, and additional services requested by the court may be subject to separate fees.

    Travel Fees

    Travel fees apply when services are provided outside the Children & Family Wellness Center or another approved visitation location.

    Mileage is calculated at $0.70 per mile, based on the total distance traveled to and from the approved visitation location.

    Travel fees are due with the payment for the scheduled visit.

    Outstanding Balances

    • Outstanding balances must be paid in full before additional services may be scheduled.

    • Failure to maintain a current account may result in suspension or termination of services.

    • Returned checks, declined payments, or unpaid balances may delay or prevent future scheduling until the account has been brought current.

    Agreement

    By signing below, I acknowledge that I have received, read, understand, and agree to the Children & Family Wellness Center Supervised Visitation Fee Agreement and Financial Responsibility Policy, including the Fee Schedule, Payment Policy, Cancellation, Rescheduling, Refund, and No-Show Policy, and all applicable service fees.

    I understand and agree that:

    • ALL PAYMENTS MUST BE PAID IN FULL PRIOR TO THE SCHEDULED VISIT OR SERVICE.

    • No supervised visitation, monitored child exchange, intake appointment, or other service will be provided until payment has been received in full unless otherwise approved in writing by the Children & Family Wellness Center.

    • All fees are my financial responsibility unless otherwise ordered by the court.

    • ALL PAYMENTS ARE NON-REFUNDABLE.

    • If I cancel my appointment, I may reschedule one (1) appointment using the original payment, provided I notify the Children & Family Wellness Center before my scheduled appointment time and schedule the new appointment within 30 calendar days, subject to staff availability.

    • If I fail to appear for my scheduled appointment without prior notice, my payment will be forfeited and a new payment will be required before another appointment can be scheduled.

    • Outstanding balances must be paid in full before additional services may be scheduled.

    • Failure to comply with this agreement or to make timely payments may delay, suspend, or terminate services.

    I have had the opportunity to ask questions regarding this agreement, and all of my questions have been answered to my satisfaction.

  • Welcome to Children & Family Wellness Center. We appreciate the opportunity to serve you and your family. To ensure that appointments are available for all families and that professional services are delivered efficiently, the following policy applies to all scheduled services.

    Appointment Scheduling

    Appointments are reserved specifically for you and your family. Professional supervised visitation, co-parenting coaching, monitored exchanges, parenting education, reunification services, consultations, and court-related services require advance scheduling and dedicated staff time.

    Cancellation & Rescheduling

    • Appointments canceled or rescheduled 48 hours or more before the scheduled appointment may be rescheduled without penalty.

    • Appointments canceled 24 to 47 hours before the scheduled appointment will be charged 50% of the scheduled service fee.

    • Appointments canceled less than 24 hours before the scheduled appointment will be charged 100% of the scheduled service fee.

    No-Show Policy

    If a client fails to appear for a scheduled appointment without prior notice, the appointment will be considered a No-Show, and 100% of the scheduled service fee will be charged.

    Late Arrivals

    Clients are expected to arrive on time.

    Late arrivals do not extend the scheduled appointment time. Services will conclude at the originally scheduled end time, and the full scheduled fee will apply.

    Court-Ordered Services

    Professional supervised visitation, monitored exchanges, co-parenting coaching, parenting education, reunification services, and other court-related appointments reserve dedicated time with a Professional Service Provider. Because these appointments generally cannot be filled on short notice, the applicable cancellation or no-show fee will be charged when adequate notice is not provided.

    Court Reports & Professional Services

    Fees for court reports, declarations, affidavits, consultations, record reviews, case preparation, court appearances, and other professional services are based on work completed. Once preparation has begun, these fees are non-refundable, even if a hearing or appointment is later canceled.

    Emergencies

    Children & Family Wellness Center understands that unexpected emergencies may occur.

    Cancellation fees may be waived at the sole discretion of Children & Family Wellness Center for documented emergencies, including:

    • Hospitalization

    • Serious illness

    • Death of an immediate family member

    • Court cancellation or court closure

    • Severe weather or natural disaster

    • Other extraordinary circumstances approved by the Professional Service Provider

    Documentation may be requested.

    Outstanding Balances

    All outstanding balances, including cancellation fees, no-show fees, court report fees, and other service fees, must be paid in full before additional services are scheduled, unless other written payment arrangements have been approved by Children & Family Wellness Center.

    Acknowledgment

    By scheduling services with Children & Family Wellness Center, you acknowledge that you have read, understand, and agree to comply with this Cancellation, Rescheduling, and No-Show Policy. You understand that appointment times are reserved exclusively for you and your family and that failure to comply with this policy may result in additional fees, suspension of services, or discontinuation of services.

  • General Expectations For All Participants 
    All participants are expected to:

    • Treat others with respect, dignity, and kindness 

    • Use appropriate language and communication 

    • Follow staff directions and program rules 

    • Maintain a safe and non-threatening environment 

    • Respect personal space and boundaries 

    • Participate honestly and cooperatively 

    • Respect program property, supplies, and facilities 

    • Arrive on time for scheduled services 

    • Notify staff of cancellations or emergencies when possible 

    • Support a child-centered and emotionally safe environment 

    Parent & Caregiver Behavior Expectations
    Parents, caregivers, and adult participants are expected to:

    • Speak respectfully to children, staff, and other participants

    • Avoid yelling, threats, intimidation, or aggressive behavior

    • Refrain from discussing court matters, custody disputes, or adult conflicts in front of children

    • Avoid negative comments about the other parent, caregiver, or family members during services

    • Follow visitation guidelines and staff instructions at all times

    • Maintain appropriate supervision and interactions with children

    • Refrain from physical discipline, verbal abuse, or inappropriate punishment

    • Participate in services free from alcohol, drugs, or impairment

    • Maintain confidentiality regarding other participants and families

    • Respect arrival, departure, and scheduling procedures

    • Follow all transportation and safety procedures when applicable

    Youth & Child Behavior Expectations
    Children and youth participating in services are expected to:

    • Use respectful language and behavior

    • Follow staff instructions and safety rules

    • Keep hands, feet, and objects to themselves

    • Respect others’ personal space and belongings

    • Participate safely in activities and services

    • Avoid bullying, threats, fighting, or disruptive behavior

    • Use program equipment and supplies appropriately

    • Ask for help from staff when upset, frustrated, or needing support

    • Remain in designated program areas unless approved by staff

    Staff understand that children and youth may experience emotional distress, behavioral challenges, trauma responses, or difficulty with transitions. Program staff will respond using trauma-informed, supportive, and de-escalation approaches whenever possible.

    Prohibited Behaviors
    The following behaviors are not permitted during participation in services:

    • Physical aggression or fighting

    • Threats, intimidation, or harassment

    • Possession of weapons or dangerous objects

    • Use of alcohol, drugs, vaping devices, or smoking on program property

    • Destruction of property or vandalism

    • Inappropriate sexual behavior or comments

    • Profanity directed toward staff or participants

    • Recording, photographing, or sharing confidential information without permission

    • Refusal to follow safety instructions

    • Any behavior that places children, staff, or others at risk

    Visitation-Specific Rules
    During supervised visitation services:

    • Children may not be left alone with unauthorized individuals

    • Parents/caregivers must follow all visitation schedules and visitation rules

    • Gifts, food, outings, or activities must be approved by staff

    • Discussions regarding court cases, legal matters, custody disputes, or placement issues areprohibited during visits unless approved by staff

    • Participants may not coach children regarding court or investigations

    • Staff observations and directions must be respected at all times

    • Visits may be stopped if safety concerns arise

    Virtual & Telephone Service Expectations
    For virtual or phone services:

    • Participants must be in a safe and appropriate environment

    • Appropriate clothing and respectful behavior are required

    • Unauthorized persons may not participate unless approved

    • Recording sessions is prohibited without written authorization

    • Staff may end sessions if safety or confidentiality concerns arise

    Consequences For Policy Violations
    Failure to follow program rules and behavior expectations may result in:

    • Verbal reminders or redirection

    • Temporary pause or interruption of services

    • Parent/caregiver conference

    • Modification of visitation or service arrangements

    • Suspension of services

    • Termination of services

    • Notification to referral agencies, courts, social workers, probation officers, or law enforcement when required

    Program staff will attempt to address concerns using supportive, trauma-informed, and restorative approaches whenever possible.

 

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Comprehensive Intake & Agency Referral Form

Medical Questionnaire & Emergency Information Form

For your protection and privacy, please refer to our HIPPA Privacy Policy:

  • 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.

    Protected Health Information

    Information about your health is private. And it should remain private. That is why this healthcare institution is required by federal and state law to protect and maintain the privacy of your health information. We call it “Protected Health Information” (PHI).

    The basis for federal privacy protection is the Health Insurance Portability and Accountability Act (HIPAA) and its regulations, known as the “Privacy Rule” and “Security Rule” and other federal and state privacy laws.

    The basis for federal privacy protection is the Health Insurance Portability and Accountability Act (HIPAA) and its regulations, known as the “Privacy Rule” and “Security Rule” and other federal and state privacy laws.

    Who Will Follow This Notice

    This Notice describes the information privacy practices followed by our hospital employees, volunteers, and related personnel.

    The practices described in this Notice may also be followed by health care providers, who are members of our Medical Staff, if they have opted to abide by its contents. Many of our doctors follow the practices contained within this Notice. Other physicians have created their own Notice. Those members of the Medical Staff who opt not to abide by this Notice are required to give you a separate Notice that will explain their privacy practices.

    Each participant who joins in this joint Notice of Privacy Practices serves as their own agent for all aspects of HIPAA Compliance, other than the delivery of this Joint Notice. For physician specific issues or questions, please feel free to contact your physician directly.

    Hospital employees, volunteers, and related personnel, including those members of the Medical Staff who have opted to abide by its contents, must follow this Notice with respect to:

    • How we use your PHI

    • Disclosing your PHI to others

    • Your privacy rights

    • Our privacy duties

    • Hospital contacts for more information or, if necessary, a complaint

    Your personal doctor may have different policies regarding the use and disclosure of PHI created in their offices.

    Using or Disclosing Your PHI

    For Treatment
    During the course of your treatment, we use and disclose your PHI. For example, if we test your blood in our laboratory, a technician will share the report with your doctor. Or, we will use your PHI to follow the doctor’s orders for an x-ray, surgical procedure or other types of treatment related procedures.

    For Payment
    After providing treatment, we will ask your insurer to pay us. Some of your PHI may be entered into our computers in order to send a claim to your insurer. This may include a description of your health problem, the treatment we provided and your membership number in your employer’s health plan.

    Or, your insurer may want to review your medical record to determine whether your care was necessary. Also, we may disclose to a collection agency some of your PHI for collecting a bill that you have not paid.

    For Healthcare Operations
    Your medical record and PHI could be used in periodic assessments by physicians about the hospital’s quality of care. Or we might use the PHI from real patients in education sessions with medical students training in our hospital. Other uses of your PHI may include business planning for our hospital or the resolution of a complaint.

    Special Uses
    Your relationship to us as a patient might require using or disclosing your PHI in order to

    • Remind you of an appointment for treatment

    • Tell you about treatment alternatives and options

    • Tell you about our other health benefits and services

    • Ask you to contribute to our charitable activities, unless you tell us not to ask. You have a right to opt out of receiving such communications.

    Your Authorization May Be Required
    In many cases, we may use or disclose your PHI, as summarized above, for treatment, payment or healthcare operations or as required or permitted by law. In other cases, we must ask for your written authorization with specific instructions and limits on our use or disclosure of your PHI. This includes, for example, uses or disclosures of psychotherapy notes, uses or disclosures for marketing purposes, or for any disclosure which is a sale of your PHI.  You may revoke your authorization if you change your mind later.

    Certain Uses and disclosures of your PHI required or permitted by law
    As a hospital or healthcare facility, we must abide by many laws and regulations that either require us or permit us to use or disclose your PHI.

    Required or Permitted Uses and Disclosures

    • If you do not verbally object, we may include information identifying you in a visitors’ directory of patients while you are an inpatient in our hospital. This information may include your name, general condition and religious affiliation, if any.

    • If you do not verbally object, we may share some of your PHI with a family member or friend involved in your care.

    • We may use your PHI in an emergency when you are not able to express yourself.

    • We may use or disclose your PHI for research if we receive certain assurances which protect your privacy.

    We may also use or disclose your PHI

    • When required by law, for example when ordered by a court.

    • For public health activities including reporting a communicable disease or adverse drug reaction to the Food and Drug Administration.

    • To report neglect, abuse or domestic violence.

    • To government regulators or agents to determine compliance with applicable rules and regulations.

    • In judicial or administrative proceedings as in response to a valid subpoena.

    • To a coroner for purposes of identifying a deceased person or determining cause of death, or to a funeral director for making funeral arrangements.

    • For purposes of research when a research oversight committee, called an institutional review board, has determined that there is a minimal risk to the privacy of your PHI.

    • For creating special types of health information that eliminate all legally required identifying information or information that would directly identify the subject of the information.

    • In accordance with the legal requirements of a workers compensation program.

    • When properly requested by law enforcement officials, for instance in reporting gun shot wounds, reporting a suspicious death or for other legal requirements.

    • If we reasonably believe that use or disclosure will avert a health hazard or to respond to a threat to public safety including an imminent crime against another person.

    • For national security purposes including to the Secret Service or if you are Armed Forces personnel and it is deemed necessary by appropriate military command authorities.

    • In connection with certain types of organ donor programs.

    • For surveys, including patient satisfaction surveys.

    Your Privacy Rights and How to Exercise Them

    Under the federally required privacy program, patients have specific rights.

    Your Right to Request Limited Use or Disclosure
    You have the right to request that we do not use or disclose your PHI in a particular way. We must abide by your request to restrict disclosures to your health plan (insurer) if:

    • the disclosure is for the purpose of carrying out payment or health care operations and is not required by law; and

    • the PHI pertains solely to a healthcare item or service that you, or someone else other than the health plan (insurer) has paid us for in full.

    In other situations, we are not required to abide by your request. If we do agree to your request, we must abide by the agreement.

    Your Right to Confidential Communication
    You have the right to receive confidential communications of PHI from the hospital at a location that you provide. Your request must be in writing, provide us with the other address and explain if the request will interfere with your method of payment.

    Your Right to Revoke Your Authorization
    You may revoke, in writing, the authorization you granted us for use or disclosure of your PHI. However, if we have relied on your consent or authorization, we may use or disclose your PHI up to the time you revoke your consent.

    Your Right to Inspect and Copy
    You have the right to inspect and copy your PHI (or to an electronic copy if the PHI is in an electronic medical record), if requested in writing. We may refuse to give you access to your PHI if we think it may cause you harm, but we must explain why and provide you with someone to contact for a review of our refusal.

    Your Right to Amend Your PHI
    If you disagree with your PHI within our records, you have the right to request, in writing, that we amend your PHI when it is a record that we created or have maintained for us. We may refuse to make the amendment and you have a right to disagree in writing. If we still disagree, we may prepare a counter-statement. Your statement and our counter-statement must be made part of our record about you.

    Your Right to Know Who Else Sees Your PHI
    You have the right to request an accounting of certain disclosures we have made of your PHI over the past six years, but not before April 14, 2003. We are not required to account for all disclosures, including those made to you, authorized by you or those involving treatment, payment and healthcare operations as described above. There is no charge for an annual accounting, but there may be charges for additional accountings. We will inform you if there is a charge and you have the right to withdraw your request, or pay to proceed.

    Your Right to be Notified of a Breach
    You have the right to be notified following a breach of unsecured PHI.

    Your Right to Obtain a Paper Copy of This Notice
    You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically.

    What if I have a complaint?
    If you believe that your privacy has been violated, you may file a complaint with us or with the Secretary of Health and Human Services in Washington, D.C. We will not retaliate or penalize you for filing a complaint with us or the Secretary.

    • To file a complaint with us, please contact our Risk Management Department or call the UHS Compliance Hotline at 1-800-852-3449. Your complaint should provide specific details to help us in investigating a potential problem.

    • To file a complaint with the Secretary of Health and Human Services, write to: 200 Independence Ave., S.E., Washington, D.C. 20201 or call 1-877-696-6775.

    Contact for additional information
    If you have questions about this Notice or need additional information, you can contact our Risk Management Department (or the UHS Compliance Hotline at 1-800-852-3449).

    Some of Our Privacy Obligations and How We Fulfill Them

    Federal health information privacy rules require us to give you notice of our legal duties and privacy practices with respect to PHI and to notify you following a breach of unsecured PHI. This document is our notice. We will abide by the privacy practices set forth in this Notice. We are required to abide by the terms of the Notice currently in effect. However, we reserve the right to change this Notice and our privacy practices when permitted or as required by law. If we change our Notice of Privacy Practices, we will provide you with a copy to take with you upon request and we will post the new notice.

    Compliance with Certain State Laws
    When we use or disclose your PHI as described in this Notice, or when you exercise certain of your rights set forth in this Notice, we may apply state laws about the confidentiality of health information in place of federal privacy regulations. We do this when these state laws provide you with greater rights or protection for your PHI. For example, some state laws dealing with mental health records may require your express consent before your PHI could be disclosed in response to a subpoena. Another state law prohibits us from disclosing a copy of your record to you until you have been discharged from our hospital. When state laws are not in conflict or if these laws do not offer you better rights or more protection, we will continue to protect your privacy by applying the federal regulations.

    EFFECTIVE DATE: This notice takes effect on September 1, 2026 Version # 1