This notice describes how personal/private information (PPI) about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Your RightsWhen it comes to your personal 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 Case Management file
• You can ask to see or get a copy of your Case Management file and other personal information we have about you.
• We will provide a copy or a summary of your personal information, usually within 30 days of your written request.
Ask us to correct your Case Management file
•You can ask us to correct personal information about you that you think is incorrect or incomplete.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone). We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• All information will remain confidential except in the following circumstances: danger of one acting on suicidal or homicidal thoughts, suspected child or vulnerable adult abuse or neglect, or court subpoena.
•You can ask us not to use or share certain personal information for our referral services or our operations.
•JJAB is required to share specific information with organizations, grantors, and contractors that provide funding for our programs. You will be provided the choice as to data that is shared and to which agency it is provided.
Choose someone to act for you
•If you have given someone power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your service referral.
•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
•If you feel your rights have been violated, you can make a complaint by contacting us directly.
•You may 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 www.hhs.gov/ocr/privacy/.
•We will not retaliate against you for filing a complaint.
Your ChoicesYou have a right and a choice regarding the sharing of any of your information. For certain information, you can tell us your choices about what we may share. If you have a clear preference for how we share your information in the situations described below, talk to us.
•For JJAB to share any information with any person or organization, except in the circumstances defined above, you must sign a Consent of Service and/or a Release of Information.
•A Release of Information is a document signed by you, where you explicitly state with whom we can share case related information about you. This may allow us to share case information with your family, close friends, your school, or others involved in your care.
Our Uses and DisclosuresHow do we typically use or share your personal information?
We can use your personal information and share it with other professionals for referral purposes. Example: A Resource Specialist may refer you to a medical provider if you identify a need for services.
Run our organization
We can use and share your personal information to improve your care and contact you when necessary.
•The organization is the owner of all official JJAB documents which are kept confidential as directed by privacy rules.
Obtain funding for the programs used to aid and support you
With your permission, JJAB may share your information with Los Alamos County and the administrative grant unit of the New Mexico Children, Youth, and Families Department (CYFD) to provide funding to our programs.
•This information can include full name, full address, date of birth, gender, ethnicity, race, and tribal affiliation.
JJAB shares de-identified information with other organizations/grantors that provide funding for our programs.
•This can include aggregate information by age, gender, ethnicity, race, tribal affiliation and/or zip code/city of residence.
We can share personal information about you under certain situations such as:
•Reporting suspected abuse or neglect.
•Preventing or reducing a serious threat to health or safety.
Do research or for program development
We can use or share de-identified information for program development.
Example: The JJAB coordinator may report compiled data such as - 24 Youth expressed a need for walk-in mental health services.
Comply with the law
We will share information about you if state or federal laws requires this. It may include, but not be limited to:
•Sharing information with the Department of Health and Human Services in order for the agency to verify that we are compliant with federal privacy law.
•For law enforcement purposes or with a law enforcement official.
•With oversight agencies for activities authorized by law.
Respond to lawsuits and legal actions
We can share information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities• We are required by law to maintain the privacy and security of your protected personal information.
•We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
I understand that the One Circle program requires a weekly commitment and that all program costs are covered by the Los Alamos JJAB. I understand that I may contact the JJAB facilitator associated with my child's group with questions or comments about the Boys Council/Girls Circle/Group. I understand that One Circle encourages creative and verbal expression and that the council/circle guidelines provide the foundation for circle communication. For the purpose of effective program facilitation, I authorize the mutual exchange of information regarding my child’s participation in One Circle between the JJAB One Circle Facilitator, JJAB One Circle Coordinator, myself as the parent/guardian of the undersigned child, and if applicable the site school’s counselor and/or Teen Court coordinator. All information will remain confidential per the JJAB Privacy Practices, unless I have authorized its exchange, except in the following circumstances: danger of one action on suicidal or homicidal thoughts, danger or injury to oneself or authors, suspected child or vulnerable adult abuse or neglect, or court subpoena. I have received the Notice of JJAB Privacy Practices.
I hereby authorize the Los Alamos JJAB to publish the photographs taken of myself and/or the undersigned minor children, for use in JJAB's printed publications, website, and social media for the purpose of promoting their programs.
I attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize JJAB to use their photographs.
I acknowledge that since participation in publications, websites, and social media produced by JJAB is voluntary, neither the minor children nor I will receive financial compensation.
I further agree that participation in any publication, website, or social media produced by JJAB confers no rights of ownership whatsoever. I release JJAB, its contractors, and its employees from liability for any claims by me or any third party in connections with my participation or the participation of the undersigned minor children.