Thompkins is a contract agency of Mental Health & Recovery Services Board funded in part by state and local taxes.
“The Thompkins Treatment, Inc. is committed to Equal Opportunity Employment, excellence, and quality services through diversity.”
Thompkins Treatment, Inc. is accredited by the Commission on Accreditation of Rehabilitation Facilities
International (CARF), licensed and certified by Ohio Mental Health and Addiction Services.
Thompkins is also a proud member of the National and Ohio Alliance on Mental Illness.
Thompkins Treatment, Inc. Vision, Mission, and Values
Vision: It is the vision of Thompkins Treatment, Inc. that all citizens in our community live in a nurturing and violent free environment and are able to utilize their abilities to reach their full potential as individuals, family members, and citizens of our community.
Mission: It is the mission of Thompkins Treatment, Inc. to strengthen families and the community by providing quality mental health, residential, family centered support services, and advocacy to all clients and their families, in but not limited to, Muskingum, Noble, Perry, Guernsey, Coshocton, and Morgan Counties.
Values: Thompkins Treatment, Inc. is committed to integrating the values of Respect, Integrity, Dedication, Quality, and Professionalism into every activity and service provided.
Daniel E. Carpenetti, M.Ed., PCC-S Executive Director
1175 Newark Road
Zanesville, Ohio 43701
Human Resource/Client Rights Officer
211 Watson Avenue
Byesville, Ohio 43723
740-685-2000 ext. 208
Chief Compliance Officer/Privacy Officer
1175 Newark Road
Zanesville, Ohio 43701
Philosophy of Treatment
Is based on our premise that a range of reliable, evidence based, treatment approaches exist which are capable of reducing or remedying the great majority of issues identified by children and families referred to our agency. We require our staff to be adequately trained and supervised in those approaches specific to their area of service. It is our policy that all services begin with a thorough evaluation of the problem presented, to determine the most appropriate level and range of care. In cases where the determination is made that all, or some of the presenting problem resides outside our discipline or capability, every effort will be made to both clarify this issue to the parents and arrange the best referral possible to an appropriate alternative provider.
We believe that the initial assessment should designate the intent of treatment in expected outcomes which can be measured and clearly defined to the client and family. In general such outcomes will constitute (in order of priority) improvements in: safety, functioning and/or behavior. In the event that treatment is compulsory, required by an outside entity such as the court, it is our philosophy that we remain agents of the client and family, will provide services only with their agreement and will communicate information to any outside agent only with their permission, except in certain predefined areas required by law. We believe it is of crucial importance that the client and family are in agreement with the goals of treatment and that appropriate attention is paid to the process of planning and communication with them throughout.
Thompkins treatment philosophy is additionally based on our conviction that mental heath is relational especially in respect to one’s immediate home environment and therefore family members must be included in the process either indirectly or through family work to insure the changes their child makes maintain maximum stability. The relationship between client and therapist is professional but also relational and we believe treatment is optimized by developing interpersonal security and trust. We recognize that any relationship is potentially subject to intangible processes and misunderstanding. It is our policy therefore that the therapy relationship be protected through stringent confidentiality and also that there be recourse for the consumer if they have a complaint or feel their rights are at any time violated. Clients are informed of these rights and recourse at point of intake.
We believe that our services should be available to all persons in our designated region free of any discrimination. Where money is an issue, we’ll make every effort to negotiate a workable contract based on a sliding fee schedule. We believe that services should be minimal as possible to meet the required goals and at all times within the least restrictive setting of our continuum of care. We believe in accurate record keeping and lawful protection and disposal of records as required.
Finally we value and actively seek, utilize and respond to consumer and community feedback from several sources and venues. We systematically collect and analyze data related to treatment process and outcomes as a means of overseeing and improving services.
Outpatient services includes the areas of Diagnostic Services, Community Support Program Services, Counseling, and Psychotherapy Services. All of these services are designed to promote and preserve a healthy family unit.
1.Children 2-17 and Adults
2.Manifest emotional, psychological, behavioral, developmental, and/or social problems that are preventing the client from maximizing their full potential.
3.Client meets DSM IV diagnostic criteria (for those with Develomental Disability diagnosis must have an additional mental health diagnosis).
4.For those under 18 a parent and/or legal guardian must agree with admission to program.
This service offers a comprehensive Clinical Assessment for youth and adults including recommendations. This service may be used as an independent service available to other agencies or as a requirement for pre-admission to other services TCAS offers.
Community Support Program
This service offers case coordination through our Community Support Staff. These services may include assisting in developing treatment plans, working on goals, and linking the client and family with other available and appropriate commune resources.
Counseling and Psychotherapy Services
Individual Counseling and Psychotherapy with children and their families are provided by trained, licensed clinical staff at scheduled times in private, confidential settings. This is an essential service and often includes in home counseling and specialized group counseling depending on the individual needs of the youth and family.
Our medical staff works in conjunction with the clinical and administrative staff to provide comprehensive treatment. Medication/Somatic services are provided by a Psychiatrist or Nurse Practitioner and a Registered Nurse. Psychiatric Evaluations are completed to determine if clients have biological abnormalities causing symptoms of a mental health disorder requiring psychiatric intervention.
In almost all cases, we recommend initiating or continuing counseling in conjunction with medication and/or other somatic treatments to assist in making the desired changes. Medication may make change possible, but the changes are most effectively achieved when talk therapy is used to maximize your efforts.
Please note we do ask that you call in for medication refills 1-2 weeks ahead of when your prescriptions runs out.
Intensive Home-Based Treatment
Intensive Home-Based Treatment services is designed to prevent hospitalization/ out of home placement of emotionally and behaviorally challenged youth or assists in the reunification of families with youth previously placed out of home. This comprehensive treatment program consists of assessments, counseling, case management, school based services, nutritional and health services. Home-Based Services are available in Coshocton, Guernsey, Perry, Noble, and Muskingum counties.
Intensive Outpatient Services (ISO)
Thompkins Intensive Outpatient Services (IOS) program serves youth ages 7 - 17 who are at risk of hospitalization, out of home placement or who have recently been returned from out-of-home placement due to severe emotional and/ or behavioral challenges or family crisis.
All therapist are specially trained to provide therapy and services that focus around the youth's treatment care needs. Program hours are 8:30 - 2:30 Monday through Friday with educational time included.
211 Watson Avenue119 S 2nd Street
Byesville, Ohio 43723 Coshocton, Ohio 43812
Cambridge New Lexington
2007 Wheeling Avenue 205 W. Brown Street
Cambridge, Ohio 43725 New Lexington, Ohio 43764
1175 Newark Road 18003 Woodsfield Rd #2
Zanesville, Ohio 43701 Caldwell, Ohio 43724
121 N. 18th Street
Cambridge, Ohio 43725
1175 Newark Road
Zanesville, Ohio 43701
Billing and HR Office
211 Watson Ave.
Byesville, Ohio 432723
For additional information regarding locations and services please visit www.thompkintreatment.org or email us at [email protected]
Client Rights & Grievances Procedures
To protect and ensure the rights of persons seeking or receiving mental health services by guaranteeing specific rights of clients, with procedures for responsive and impartial resolution for all grievances either from the client themselves or on behalf of the client by the guardian, next-of-kin, or special representative.
It is the intention of this policy and procedure that our clients/consumers are free from abuse, financial or other exploitation, retaliation, humiliation, and neglect.
1.Client—an individual applying for or receiving mental health services from a qualified person from this agency. Includes the term “YOUTH” as used in SAFNet policies and procedures.
2.Client Rights Officer—the person designated by the Thompkins Treatment, Inc. with responsibility for assuring compliance with the Client Rights and Grievance Procedure rule as implemented.
3.Grievance—a written complaint initiated, either verbally or in writing, by the client or any other person or agency on behalf of the client regarding denial or abuse of the client’s rights.
4.Mental Health Services—any of the services, programs, or activities listed/defined in Rule 5122:2-1-01 of the Administrative Code. Mental health services include both direct client services and community services. Direct client services are listed and defined in paragraph (D)(1) to (D)(10) of Rule 5122:2-1-01. Community services are listed and defined in paragraph (D)(11) to (D)(15) of the same rule.
1.The right to be treated with kindness, consideration, and respect for personal dignity, autonomy, and privacy.
2.The right to receive service in a humane setting which is the least restrictive possible, as defined in the treatment plan.
3.The right to be told of one’s own condition, of planned or present services, treatment or therapies, and of the alternative of requesting an evaluation by an independent professional.
4.The right to agree to or refuse any service, treatment, or therapy upon full explanation of the expected consequences. A parent or legal guardian has the right to consent to or refuse any service, treatment or therapy on behalf of a minor child.
5.The right to a current, written treatment plan that addresses one’s own mental and physical health, social and economic needs, and that specifies the provision of appropriate and adequate services as available, either directly or indirectly.
6.The right to active and informed participation in the development, periodic review, and re-review of the treatment plan.
7.The right to freedom from unnecessary or excessive medication.
8.The right to freedom from unnecessary restraint or seclusion.
9.The right to participate in any appropriate and available Agency service regardless of refusal of one or more other services, treatment or therapies, or regardless of relapse from earlier treatment, unless there is a valid and specific necessity which precludes and/or requires the client’s participation in the other services. This will be explained to the client and will be recorded in the client’s treatment plan.
10.The right to be informed of, and to refuse, any unusual or hazardous treatment procedure.
11.The right to be told of and to refuse observation techniques such as one-way mirrors, tape-recording, television, movies, or photographs.
12.The right to request and have the opportunity to consult with independent treatment specialists or legal counsel at one’s own expense.
13.The right to confidentiality of communications and of all personally identifying data within the limitations and requirements for disclosure of various and/or certifying sources, State or federal statutes, unless release of information is specifically authorized by the Client, parent, or legal guardian of a minor client or court appointed guardian of the person of an adult client in accordance with Rule 5122:2-3-11 of the Administrative Code.
14.The right to have access to one’s own psychiatric, medical or other treatment records, unless access to particular identified items of information is specifically restricted for that individual client for clear treatment reasons, as cited in the service plan. “Clear Treatment Reasons” shall be understood to mean only severe emotional damage to the client and/or if dangerous or self-injurious actions are an imminent risk. This action must be explained in detail to the client and other persons authorized by the clients. The restriction must be renewed at least annually to remain valid. Any person authorized by the client has unrestricted access to all information. Clients will be informed in writ- ing of Agency policies and procedures for reviewing or obtaining cop- ies of all personal records.
15.The right to be told in advance of the reason (s) for termination of services and to be involved in planning for the consequences of that event.
16.The right to receive an explanation of the reason for denial of service.
17.The right not to be discriminated against in the delivery of services on the basis of religion, race, color, creed, sex, national origin, age, life-style, sexual orientation, physical or mental handicap, developmental disability, or inability to pay.
18.The right to know the cost of the services.
19.The right to be fully informed of all rights.
20.The right to exercise any and all rights without reprisal in any form, including continued, uncompromised access to service.
21.The right to file a grievance.
22.The right to have oral and written instruction for filing a grievance.
Those clients receiving Residential Services have the following additional rights:
1.The right to enjoy freedom of thought, conscience, and religion.
2.The right to reasonable enjoyment of privacy.
3.The right to have his or her opinions heard and be included, to the greatest extent possible, when any decisions are being made affecting his/her life.
4.The right to receive appropriate and reasonable adult guidance, support, and supervision.
5.The right to be free from physical abuse and inhumane treatment.
6.The right to be protected from all forms of sexual exploitation.
7.The right to receive adequate and appropriate medical care.
8.The right to receive adequate and appropriate food, clothing, and housing.
9.The right to his/her own personal property (including money) commensurate with the child’s developmental age and safety needs.
10.The right to live in clean, safe, surroundings.
11.The right to participate in an appropriate educational program.
12.The right to communicate with family, guardian, custodian, friends, and significant others, outside the facility in accordance with the child’s treatment plan.
13.The right to be taught to fulfill appropriate responsibilities to him/ herself and to others.
14.The right to reasonable access to the child’s own bedroom or sleeping area at anytime, commensurate with the child’s developmental age and safety needs.
15.The right to send or receive mail subject to the facilities rules regarding contraband and directives from the legal custodian, when such rules and directives do not conflict with federal postal regulations.
Client Rights Procedure
Thompkins Treatment, Inc. will offer and distribute, if requsted, to each applicant or client at the scheduled diagnostic evaluation, or following subsequent appointment, a copy of the Client Rights Policy & Procedure.
The Client Rights Officer is available upon request. It is the Client Rights Officers responsibility to accept and oversee the processing of any and all grievances filed by a client or other person or agency on behalf of a client, also to explain any and all aspects of client rights and grievance procedures.
1.In a crisis or emergency situation, the Clients Rights Officer shall advise the client of at least the immediate pertinent rights to consent to, or to refuse, the offered treatment and the consequences of that agreement or re-
fusal. Under these circumstances, the written copy and full verbal explanation of the clients rights policy may be delayed to a subsequent meeting.
2.All clients or recipients of the type of mental health services specified as "Community Services" (Information and referral, consultation services, mental health education service, training) may have a copy and explanation of the client rights policy upon request.
3.A copy of the client rights policy will be distributed to each applicant or client and will be posted in a conspicuous location at each building operated by Thompkins Treatment, Inc.
4.All staff persons at the Board, including both administrative and support staff, will be familiarized with all specific client rights and grievance policies and procedures.
To establish guidelines of the timely processing of client grievances as pertain to the agency’s Client Rights Policy.
Policy. It is the Thompkins Treatment, Inc. policy to insure that the program partici- pants have the right to file grievances concerning the services they receive while a program participant. However, participants are encouraged to try to rectify their complaints with the program coordinator, residential director, immediate staff or foster family to the filing of a formal grievance. All other avenues of alleviating the problems should be exhausted prior to filing a formal complaint.
It shall further be the policy of Thompkins Treatment, Inc. to fully support the appointed Client Rights Officer to take all necessary steps to assure compliance with the following procedures:
1.All clients will be offered and given, if requested, a copy of the Client Rights Grievance procedure at in- take. The procedure will be explained by a staff member and upon acceptance of the procedure will the sign the form to verify understanding of and receipt of the Client Grievance Procedure.
2.A grievance may be submitted in written form or can be communicated verbally. This may be done by phone or in person.
3.Upon receipt of the grievance, the Client Rights Officer shall collect pertinent information and document information for the Client Rights Grievance Log. The Client Rights Officer shall serve as representative for the griever. If resolved at this time, a written statement of results will be given to the client and the procedure shall end. The Client Rights Officer will respond to the grievance within five (5) working days.
4.If not resolved, the Client and Client Rights Officer will meet with the Executive Director. The Client Rights Officer shall serve as representative for the griever. If resolved at this time, a written statement of results will be given to the client and the procedure shall end. The Client Rights Officer will schedule the meeting with the Executive Director within ten (10) working days of when the grievance was received.
5.If not resolved, the Client Rights Officer will present to the griever the option to initiate a complaint with any of several outside entities. Specifically, the Ohio Department of Mental Health, the Ohio Legal Rights Services, The U.S. Department of Health and Human Services, and appropriate professional licensing or regulatory associations. The client’s relevant addresses and telephone numbers and copies of the presenting grievances and resolutions to any or all of the above agencies, if requested to do so, in writing by the griever.
In the event that a grievance is filed against the Client Rights Officer, the client will then be assisted through the entire grievance procedure by the Executive Director. All written documents relating to the grievance itself will remain confidential at the Administrative level and the resolution for, the grievance will only be shared with the Client Rights Officer with permission of the client.
This agency shall keep records of grievances it receives, the subject of the grievances, the resolution of each and shall ensure the availability of these records for review by the Department of Mental Health upon request. The agency will also summarize annually its records to include the number of grievances received, types of grievances and resolution status for each.
At all times, the grievances process shall be operate din accordance with Title VI: No person in the agency shall on the grounds of RACE, COLOR, RELIGION, SEX, AGE NATIONAL ORIGIN, OR HANDICAP be excluded from participation in, be denied the benefits of, or otherwise be subject to discrimination under any program or activity for which the applicant received federal financial assistance.
Client Rights Officer Cherri Tolliver
211 Watson Avenue
Byesville, Ohio 43723
Daniel E. Carpenetti, M.Ed., PCC-S
1175 Newark Road
Zanesville, Ohio 43701
(740) 454 0738
Mental Health and Recovery Services Board
1205 Newark Rd.
Zanesville, Ohio 43701
Ohio Mental Health and Addition Services
30 E. Broad St.
Columbus, Ohio 43215
U.S. Department of Human Services Office of Civil Rights
Washington, D.C. (202) 727-5940
Ohio Rights Service
50 W. Broad St. #1400
Columbus, Ohio 43215
Client information is confidential and normally cannot be released without the permission of the parent/legal guardian. Confidentiality of mental health information is protected under the Ohio Revised Code. There are a few exceptions to this that you should know. When you become a client at Thompkins Treatment, Inc. you will be asked to sign forms that allow us to receive payment for our services. These forms include releases that allow the local mental health board and Ohio Mental Health and Addiction Services to have knowledge of the services we have provided so that the agency can receive funds for your service. These forms also let us bill insurance and Medicaid. The exact fee for the services will be described in the Service Agreement.
There are four exceptions to the requirement of a release of information:
1.Under Ohio Revised Code if there is credible evidence that the client may be dangerous to themselves or others we are obligated to take steps to ensure safety.
2.Under Ohio Revised Code we are obligated to report suspected abuse or neglect of a child.
3.If we receive a subpoena or court order we may be obligated to share information covered under the subpoena or court order.
4.In an emergency situation where medical treatment is necessary our agency may release information to assist emergency care workers, law enforcement in dealing with the emergency.
If you have specific questions regarding the confidentiality of your information please talk with your service provider and they will be able to answer your questions and concerns.
Additional information regarding confidentiality and the Health Insurance Portability and Accountability Act is outlined in our privacy practices which is available to you at intake.
Clients, parents, legal guardians should also be aware of Ohio Law that gives certain rights to the biological non custodial parent. This law has been reprinted here for your review if applicable.
The agency highly values confidentiality and takes care to assure that information you provide us is kept confidential.
Statement of Access of Records by Non Custodial Parent
Subject to division (G) (2) of Section 2301.35 and division (F) of section
31319.321 of revised code, a parent of a child who is not the residential parent of the child is entitled to access, under the same terms and conditions under which access is provided to the residential parent, to any record that is related to the child and to which the residential parent of the child legally is provided access, unless the court determines that it would not be in the best interest of the child for the parent who is not the residential parent to have access to the records under those same terms and conditions. If the court determines that the parent of a child who is not the residential parent should not have access to records related to the child under the same terms and conditions as provided for the residential parent, the court shall specify the terms and conditions under whim the parent who is not the residential parent is to have access to those records, shall enter its written findings of facts and opinion in the journal and shall issue an order containing the terms and conditions to both the residential parent and the parent of the child who is not the residential parent. The court shall include in every order issued pursuant to this division notice that any keeper of a records who knowingly fails to comply with the order or division (H) of this section is in contempt of court.
In addition, subject to division (G)(2) of section 2301.35 and division (F) of section
33319.321 of the revised code subsequent to the insurance of an order under division (H)(I) of this section, the keeper of any record that is related to a particular child and to which the residential parent legally is provided access, shall permit the parent of the child who is not the residential parent to have access to the record under ~ same terms and conditions under which access is provided to the residential parent, unless residential parent has presented keeper of the record with a copy of an order issued under division (H)(I) of this section that limits the terms and con- ditions under which the parent who is not the residential parent is to have access to records pertaining to the child and the order pertains to the record in question. If the residential parent presents the keeper of the record with a copy of that type of order, the keeper of the record shall permit the parent who is not the residential parent to have access to the record only in accordance with the most recent order that has been issued pursuant to division (H)(I) of this section and presented to the keeper by the residential parent or the parent who is not the residential parent. Any keeper of any record who knowingly fails to comply with division (H) of this section or with any order issued pursuant of division (H)(I) of this section is in contempt of court.
Protected Health Information (PHI) is information that identifies you and relates to health care services, payment of health care services, or your physical or mental health or condition, in the past, present, or future. As stated above, the Thompkins Treatment, Inc. Notice of Privacy Practices (hereinafter referred to as Notice") describes:
(1)how Thompkins Treatment, Inc. (THOMPKINS) may use or disclose your PHI
(2)your rights to access, inspect, and control your PHI.
This notice is posted at and is available at all THOMPKINS facilities where services are provided. A copy of the notice will be provided to anyone upon request. For your convenience, the notice is also electronically available on our website at thompkinstreatment.org and you may print the notice from that site.
THOMPKINS is required by Federal Law to: (1) maintain the privacy of your PHI, (2) provide you with notice of THOMPKINS’, legal duties and privacy practices, and (3) notify you in the unlikely event of a breach of unsecured PHI. We are required to abide by the terms of this Notice so long as it is in effect. We do reserve the right to change the terms of this Notice and to make the new Notice effective for all PHI maintained by THOMPKINS. THOMPKINS will promptly revise and distribute a new Notice whenever there is a material change. Except when required by law, a material change will not be implemented before the effective date of the new Notice in which the change is reflected.
Please Note: For your convenience, all forms identified below may be obtained at any THOMPKINS office or by contacting the Clinical Records Manager at 740-454-0738.
USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION
Use and Disclosure with Your Authorization: Except as outlined below, THOMPKINS will not use or disclose your PHI unless you have signed a HIPAA compliant form authorizing the use or disclosure. You also have the right to revoke an authori- zation in writing unless THOMPKINS has already taken action in reliance on that authorization. You may complete a THOMPKINS form to revoke an authorization and may provide the completed form to the Site Manager at the office where you are seen, or you may provide it to the Clinical Records Manager at 1175 Newark Road, Zanesville, Ohio 43701. There are certain uses and disclosures of your PHI for which THOMPKINS will always obtain a prior authorization. These include:
1)most uses and disclosures of psychotherapy notes, as applicable, unless otherwise permitted or required by law;
2)subject to certain limited exceptions, use or disclosure of PHI for marketing purposes,
3)sale of your PHI.
Use and Disclosure for Treatment: THOMPKINS may use and disclose your PHI to coordinate or manage your care within THOMPKINS. For example, your THOMPKINS therapist may consult with a THOMPKINS doctor regarding your care.
THOMPKINS may also use and disclose your PHI to individuals or organizations outside of THOMPKINS who are involved in your care, such as your primary doctor, other healthcare providers, or contracted services. For example, a doctor/healthcare facility not affiliated with THOMPKINS, who is involved in your care, may request parts of your PHI to make decisions about your care.
Use and Disclosure to Obtain or Provide Payment: THOMPKINS may use and disclose your PHI to collect or make payment for your care. For example, THOMPKINS may: (1) transmit PHI regarding your treatment to entities paying for your services such as Medicaid, or Medicare/insurance companies; (2) disclose PHI to apply for pre-authorization for services; and/or (3) include PHI on invoices to collect payment from you, a person responsible for payment, or other third parties.
Use and Disclosure for Healthcare Operations: THOMPKINS may use and disclose your PHI for THOMPKINS Operations as necessary, and as permitted by law, to provide and improve services. Examples include but are not limited to: (1) quality assurance and improvement activities; (2) case management and care coordination;
(3) professional review and performance evaluation; (4) auditing, including compliance reviews ; (S) medical reviews; (6) legal services; and (7) business management and general administrative activities.
For example, THOMPKINS may: (1) use PHI to evaluate staff performance; (2) combine your PHI with other clients' PHI to evaluate how to better serve clients; (3) disclose PHI to contracted personnel for limited training purposes; or (4) disclose PHI to another healthcare facility, healthcare pro- fessional, or health plan for purposes such as quality assurance and case management, but only if that individual or entity also has or had a patient/client relationship with you. Family and Friends Involved in Your Care: With your approval, THOMPKINS may disclose your PHI to designated family, friends, and others who are involved in your care or in payment for your care. However, we may share limited PHI with such individuals without your approval if you are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest. We may also share limited PHI with such individuals if otherwise permitted or required by law.
Business Associates: Certain aspects and components of our services are performed through contracts/agreements with outside persons/organizations/businesses, such as auditing, accreditation, actuarial services, claims payment, data compilation, legal services, and others. At times, it may be necessary to provide certain parts of your PHI to one or more of these persons/organizations/businesses. In all cases, THOMPKINS requires that these Business Associates appropriately safeguard the privacy and security of your PHI.
Appointment Reminders: THOMPKINS may use and disclose your PHI to contact you to leave appointment reminders. If you wish to not have appointment reminders left on voicemail or do not want mail sent to a particular address, we will accommo- date reasonable requests and will not require an explanation. You may make the request by completing a THOMPKINS request for confidential communication form and providing it to the Site Manger at the office where you are seen or by providing it to the Clinical Records Manager at 1175 Newark Road, Zanesville, Ohio 43701.
Treatment Alternatives: THOMPKINS may use and disclose your PHI to advise you of or recommend services or treatment options that may be of interest to you. We will not use your PHI to communicate with you about products or services which are not health related without your written permission.
OTHER USES OR DISCLOSURES
THOMPKINS is permitted or required by law to make certain other additional uses and disclosures without your authorization. THOMPKINS will follow applicable law when making such disclosures.
Legally Required Disclosures: THOMPKINS will disclose your PHI for any purpose required by Federal, State, or local law.
Serious Threat to Life, Health, or Safety: THOMPKINS may disclose your PHI if it is believed, in good faith and consistent with applicable law and ethical standards, that it is necessary to prevent or decrease serious and imminent threat to your life, health, or safety or the life, health, or safety of another individual(s) or the public.
Risks to Public Health: THOMPKINS may disclose your PHI to a public health authority, as allowed or required by law to:
(1)prevent or control a disease, injury, or disability;
(2)report disease, injury, and vital events such as birth or death;
(3)conduct public surveillance, investigations, and interventions;
(4)notify a person(s) who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
Reports to the Food and Drug Administration: In accordance with applicable law, THOMPKINS may release your PHI to report adverse events and/or product defects to the Food and Drug Administration or to participate in product recalls initiated by the Food and Drug Administration.
Report of Abuse, Neglect, or Domestic Violence: In accordance with applicable law, THOMPKINS will disclose your PHI to fulfill legal obligations to report to legal authorities suspected child abuse or neglect. We may also release your PHI, as required by law, if we have reasonable belief that you are a victim of abuse, neglect, or domestic violence.
Health Oversight: THOMPKINS may disclose your PHI if required by law to a health oversight agency conducting: audits, civil administrative or criminal inves- tigations, inspections, or licensure or action. However, we may not disclose your PHI if you are the subject of an investigation that does not fall under health oversight activities. For example, if your PHI is not directly related to your receipt of health care or public benefits.
Judicial and Administrative Proceeding: THOMPKINS may disclose your PHI if required by law to do so by a court or administrative ordered subpoena or discovery request (in most cases you will have notice of such a request).
Law Enforcement: THOMPKINS may disclose specific and limited PHI about you for certain law enforcement reasons as required by law, including but not limited to reporting wounds, injuries, and crimes.
Research: THOMPKINS may, under limited circumstances, use and disclose your PHI for research. For example, a researcher might want to review the outcomes of clients who received a particular medication or other treatment. Before PHI which could identify you would be released for such research purposes, the project will be subject to an extensive THOMPKINS review and approval process including strict confidentiality requirements. In all cases where
your specific prior authorization is not requested, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board or privacy board which oversees the research or by representations of the re-searchers that limit their use and disclosure of PHI information.
Specialized Government Functions: THOMPKINS may be required or author- ized by Federal regulations to use or disclose your PHI to facilitate specified government functions. For example, THOMPKINS may be required by law to release your PHI if you are a member of the military as required by armed forces services; we may also release your PHI for national security and intelligence activities and protective services for the President and others.
Correctional Institution: We may release your PHI to a correctional institution or to law enforcement officials under certain circumstances, if you are an inmate or under the custody of a law enforcement official.
Worker's Compensation: THOMPKINS may use or disclose your PHI to com- ply with worker's compensation law or similar programs established by law that provide benefits for work related injuries or illness.
Transfer of Information at Death: In accordance with applicable law, THOMPKINS may disclose PHI to funeral directors, medical examiners, and coroners.
Organ Procurement: In accordance with applicable law, THOMPKINS may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs if necessary to arrange an organ, eye, or tissue donation by you or a transplant for you.
YOUR RIGHTS WITH REGARD TO PHI
Right to a Personal Representative: You may identify a person(s) to serve as your authorized personal representative, such as a court-appointed guardian, a properly executed and specific power-of-attorney granting such authority, or a Durable Power of Attorney for Health Care, if it allows such person to act when you are able to communicate on your own, or other method recognized by applicable law. THOMPKINS may, however, reject a representative if, in our professional judgment, we determine that it is not in your best interest.
Right to Request Restrictions: You may request restrictions on certain uses and disclosures of your PHI for treatment, payment, or healthcare operations by notifying THOMPKINS in writing of the request. THOMPKINS will consider the request, but is under no obligation to accept it or abide by it unless the request concerns disclosure of PHI to a health plan for purposes of carrying out payment or health care operations and the PHI pertains solely to a health care ser- vice for which the provider has been paid out of pocket in full by you or some- one else.
You may request a restriction by completing a THOMPKINS disclosure restriction form and providing it to the Clinical Records Manager at 1175 Newark Road, Zanesville, Ohio 43701. THOMPKINS has the right to terminate a restriction (except as described above) if we believe it is not appropriate, and THOMPKINS will notify you of such termination. You also have the right to terminate orally or in writing a previous restriction. Oral terminations will be documented by THOMPKINS personnel. For your convenience, written termination may be communicated by com- pleting a THOMPKINS termination of restrictions form and providing it to the Clinical Records Manager at 1175 Newark Road, Zanesville, Ohio 43701.
Right to Receive Confidential Communications: You have the right to request that we communicate with you in a confidential manner. For example, you may wish to not have messages left on your voicemail or sent to a particular address. You may request that we communicate regarding your PHI using alternative means or a different location.
We may not require that you provide an explanation for your request. The request must be made in writing and signed by you/your authorized representative. You may make a request by completing a THOMPKINS request for confidential communication form and providing it to the Site Manager where you are seen or providing it to the Clinical Records Manager at 1175 Newark Road, Zanesville, Ohio 43701. We will attempt to honor any reasonable request.
Right to Access, Inspect, and Copy Your PHI: You have the right to copy and/or inspect much of the PHI that we retain on your behalf. The request must be made in writing and signed by you/your authorized representative. Certain restrictions may apply as permitted or required by law. You may make a written request by completing a THOMPKINS form to request access/inspection/copying of your PHI and providing it to the Site Manager where you are seen or providing it to the Clinical Records Manager at 1175 Newark Road, Zanesville, Ohio 43701. If you request a copy of health information, we may charge reasonable coping, processing and personnel fees. You may request an electronic copy of your health information that exists in an electronic format, and you may direct that the copy be transmitted directly to an entity or person designated by you, providing the designation are clear and specific with complete name and mailing address or other identifying information. Under special circumstances as required or permitted by law, we may decide not to share information. You may request a review of the denial by com- pleting a THOMPKINS request for review of denial form and providing it to the Clinical Records Manager at 1175 Newark Road, Zanesville, Ohio 43701.
Right to Amend Your PHI: You have the right to request an amendment of your records if you believe that your PHI is incorrect or incomplete. That request may be made as long as we maintain the information. The request must be made in writing and signed by you/your authorized representative. You may make a request for an amendment by completing a THOMPKINS request for amendment form and providing it to the Clinical Records Manager at 1175 Newark Road, Zanesville, Ohio 43701. THOMPKINS may deny the request if it is not in writing or if it does
not include a reason for the request. The request may also be denied if: (1) your health information records were not created by us; (2) the records you are requesting to amend: a) are not part of our records, or b) are not part of the health information you are permitted to inspect and copy; or (3) if, in our opinion, the records containing your health information are accurate and complete. Amendments may take the form of including a written statement from you and may not include changing, defacing, or destroying any necessary information related to your
Right to Accounting of Disclosure: You have the right to request an accounting of disclosures of your PHI made by THOMPKINS for certain reasons, including reasons related to public purposes authorized by law, and certain research. The re- quest must be made in writing and must be signed by you/your authorized repre- sentative. You may make a request by completing an THOMPKINS accounting of disclosures form and providing it to the Clinical Records Manager at 1175 Newark Road, Zanesville, Ohio 43701. The request must specify the time period for the accounting starting on or after June 6, 2006. Accounting requests may not be made for periods of time beyond six (6) years prior to the date on which the accounting is requested.
Right to a Paper Copy of this Notice: You have a right to receive a paper copy of this Notice at any time, even if you have received this Notice previously or have previously agreed to receive it electronically. To obtain a paper copy, please contact the Site Manager at any of our offices or contact the Clinical Records Manager at 740-454-0738.
lf you believe that your privacy rights have been violated, you may file a written complaint with the Thompkins Treatment, Inc. Chief Compliance Officer at 1175 Newark Road, Zanesville, Ohio 43701. You may receive a form for your convenience by contacting the Clinical Records Manager at 740-454-0738. You will not be retaliated against in any way for filing a complaint.
You may also file a written complaint within 180 days of a violation of your rights with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C., 20201 or call toll-free (877) 696- 6775, by email to [email protected], or to Region V, Office for Civil Rights, U.S. Department of Health and Human Services, 233 N. Michigan Ave ., Suite 240, Chicago, Ill. 60601, Voice Phone (312) 886-2359, FAX (312) 886-1807, or TDD (312) 353-5693.
FOR FURTHER INFORMATION
If you have any questions regarding this Notice of Privacy Practices, please contact the Thompkins Treatment, Inc. Chief Compliance Officer at 740-454-0738.
EFFECTIVE DATE: November 15, 2013
It’s the philosophy of Thompkins Treatment, Inc. to never use seclusion in any form and to only use physical interventions within the residential program when there is danger to the client due to them harming themselves or eminent danger of harming others. Staff may physically intervene in order to protect the client or others.
For the safety of all clients, staff and visitors, all Thompkins locations are equip- ment with fire suppression equipment and first aid kits along with emergency exit maps.
It is the policy at Thompkins that for the safety of all staff and visitors that all tobacco use be done in designated areas outside of each agency location.
Illicit drugs are not permitted on any Thompkins property. Licit drugs are to remain with the prescribed user or guardian of user while the drug is on Thompkins outpatient or office properties.
No weapons of any type are allowed on Thompkins property unless weapon is the property of an officer of the law.
Code of Ethics
Purpose: To establish guidelines for employees and the agency that assures adherence to a Code of Ethics that will guide staff and the agency to fulfill their obligations in an ethical manner.
Policy: Thompkins Child and Adolescent Services, Inc. is dedicated to the indi- vidual employee and the organization to adhere to sound ethical practices in all aspects of administration, business, marketing, direct service delivery, and fiscal management. It is the policy of Thompkins Child and Adolescent Treatment Services, Inc. that procedures be in place for reporting any unethical behaviors, including but not limited to, waste, fraud, abuse, and other questionable activi- ties, with no reprisals against staff which may so report. Such reports will be communicated to the Executive Director or his designee (Chief Compliance Officer) and a timely response and action will be taken regarding such reports with the consent and involvement of the Executive Director.
The Thompkins Treatment, Inc. will adhere to the following Code of Ethics:
1.Will not represent to the public or referring sources services that are not or cannot be provided.
2.Will handle employees in a fair and consistent manner.
3.Will use accepted and standard practices of the accrual accounting method in reporting and maintaining fiscal records and budgets.
4.Will not use deceptive practices in marketing it's services.
5.Will use the guiding principle of "Doing unto others as you would have them do unto you" in conducting its business and marketing strategies.
Procedure: All employees will review at least annually the Policy regarding Code of Ethics and documentation of such review will be kept. Violations of the Code of Ethics will be reported to either a Supervisor, Executive Director, or the Chief Compliance Officer. There will be no reprisals to any employee for such reporting. A timely investigation of such complaints will be made by the Executive Director or his designee (s). Sanctions may include dismissal for any employee violating either the Employee or Organization Code of Ethics and such sanctions if any will be the responsibility of the Executive Director and/or the Board of Directors.
No Show Cancellation Policy
Policy: It is the policy of Thompkins Treatment, Inc. that the following will occur when a client fails to attend scheduled appointments:
1.Two “no shows” in a row; or three missed appointments in a row (any combination of “no shows” or cancellations); or five failed appointments in one year, will result in no further advance scheduling for one year. Clients may call at 8:00 a.m. on any given business day to see if the office can work an appoint- ment in for that day.
2.No contact with any TCAS provider for 90 days will result in a discharge. Clients may still re-open services at any time provided the client has not exceeded Section 1 of this policy.
Cancellations and rescheduling with at least twenty-four hours’ notice are not considered failed appointments. This policy includes all types of service appointments: group or individual provided by: therapist, CPST, nurse, nurse practitioner, or physician
Client’s receiving psychiatric services have the option of coming in on the physician’s days and waiting for an opening to occur in order to receive prescription renewals.
After Hours Information
Thompkins Treatment, Inc. office’s are 8 a.m. to 5 p.m.
If there is an EMERGENCY, call 9-1-1 or the Six County, Inc. Crisis Hotline at 1-800-344-5818.
If there is an urgent need to contact your therapist or during the hours that we are closed, you may call 1-740-541-5484 for assistance. If this is not an urgent need, you may also leave a message at our site offices and we will get back with you on the next business day.
All Policies and Procedures may be viewed at all locations.
For additional information: www.thompkintreatment.org