Client Intake Packet
Revised August 2025

CLIENT RIGHTS

As a client of Center for Children and Families, Inc., you have the following rights:

You have the right to be treated with respect and without discrimination due to race, color, national origin, sex, religion, disability or age.
You have the right to refuse or consent to services.
You have the right to participate in goal setting and service planning for your family.
You have the right of privacy and confidentiality of services.
You have the right to access your records.
You have the right to request a change of provider, end services or receive information and referrals for other services.
You have the right to be free from abuse or any kind of mistreatment.
You have the right to consent or refuse to participate in research projects.
You have the right to complain about any matter that concerns you and receive a fair investigation and resolution of your concerns.

CCFI PRIVACY NOTICE

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Center for Children and Families, Inc. is required by law to protect the privacy of your health information. We are also required to provide you with this notice, which explains how we may use information about you and when we can give out or "disclose" that information to others. You also have rights regarding your health information that are described in this notice. We are required by law to abide by the terms of this notice.

The terms "information" or "health information" in this notice include any information we maintain that reasonably can be used to identify you and that relates to your physical or mental health condition, the provision of health care to you, or the payment for such health care.

We have the right to change our privacy practices and the terms of this notice. If we make a material change to our privacy practices, we will provide to you a revised notice by direct mail or electronically as permitted by applicable law. In all cases, we will post the revised notice on our website, ccfinorman.org. We reserve the right to make any revised or changed notice effective for information we already have and for information that we receive in the future.

HOW WE USE OR DISCLOSE INFORMATION

We must use and disclose your health information to provide that information:

To you or someone who has the legal right to act for you (your personal representative) in order to administer your rights as described in this notice; and
To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected.

We have the right by law to use and disclose health information for your treatment, to pay for your health care and to operate our business, without your written consent. For example, we may use or disclose your health information:

For Payment. We may disclose your health information to your insurance company or a government funder in order to be reimbursed for services provided to you.
For Treatment. We may use or disclose health information to aid in your treatment or the coordination of your care. For example, we may disclose information to your physicians or hospitals to help them provide medical care to you.
For Health Care Operations. We may use or disclose health information as necessary to operate and manage our business activities related to providing and managing your health care. For example, we may analyze data to determine how we can improve our services.

We may use or disclose your health information without your written consent for the following purposes under limited circumstances:

As Required by Law. We may disclose information when required to do so by law. There are certain state and federal law exceptions to disclosure of mental health and drug or alcohol treatment information without the written consent of the consumer or the consumers’ legally authorized representative and CCFI will release information as required by those laws.

For Public Health Activities such as reporting or preventing disease outbreaks.
For Reporting Victims of Abuse, Neglect or Domestic Violence to government authorities that are authorized by law to receive such information, including a social service or protective service agency.
For Health Oversight Activities to a health oversight agency for activities authorized by law, such as licensure, governmental audits and fraud and abuse investigations.
For Judicial or Administrative Proceedings such as in response to a court order, search warrant or subpoena.
To Avoid a Serious Threat to Health or Safety to you, another person, or the public, by, for example, disclosing information to public health agencies or law enforcement authorities, or in the event of an emergency or natural disaster.
For Research Purposes such as research related to the evaluation of certain treatments or the prevention of disease or disability, if the research study meets privacy law requirements.
To Provide Information Regarding Decedents. We may disclose information to a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law. We may also disclose information to funeral directors as necessary to carry out their duties.
To Correctional Institutions or Law Enforcement Officials if you are an inmate of a correctional institution or under the custody of a law enforcement official, but only if necessary

for the institution to provide you with health care;
to protect your health and safety or the health and safety of others; or
for the safety and security of the correctional institution.

To Business Associates that perform functions on our behalf or provide us with services if the information· is necessary for such functions or services. Our business associates are required, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Additional Restrictions on Use and Disclosure. Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you such as alcohol and drug abuse information, HIV/AIDS, etc.

If a use or disclosure of health information described above in this notice is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law.

Except for uses and disclosures described and limited as set forth in this notice, we will use and disclose your health information only with a written authorization from you. Once you give us authorization to release your health information, we cannot guarantee that the person to whom the information is provided will not disclose the information. You may take back or "revoke" your written authorization at any time in writing, except if we have already acted based on your authorization.

WHAT ARE YOUR RIGHTS

The following are your rights with respect to your health information:

You or your legally authorized representative has the right to ask to restrict uses or disclosures of your information for treatment, payment, or health care operations. You also have the right to ask to restrict disclosures to family members or to others who are involved in your health care or payment for your health care. Please note that while we will try to honor your request and will permit requests consistent with our policies, we are not required to agree to any restriction.
You or your legally authorized representative has the right to ask to receive confidential communications of information in a different manner or at a different place (for example, by sending information to a P.O. Box instead of your home address). We will accommodate reasonable requests where a disclosure of all or part of your health information otherwise could endanger you. We will accept verbal requests to receive confidential communications, but requests to modify or cancel a previous confidential communication request must be made in writing.
You or your legally authorized representative have the right to access health information about you. You must make a written request to access your health information. If you make a verbal request, CCFI staff will assist you in documenting the request in writing. In certain limited circumstances, we may deny your request to access your health information. We may charge a reasonable fee for any copies. If we deny your request, you have the right to have the denial reviewed. If we maintain an electronic health record containing your health information, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Additional Restrictions on Use and Disclosure. Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you such as alcohol and drug abuse information, HIV/AIDS, etc.

CLIENT COMPLAINT AND GRIEVANCE PROCEDURE

Center for Children and Families, Inc. is committed to providing quality client centered services and has established the following procedures to resolve client concerns in a timely manner. All client complaints are taken seriously, all individuals involved are treated with dignity and respect, and complaints are investigated with objectivity.

Wherever possible, clients are encouraged but not required to address concerns directly with the staff involved or their immediate supervisor. Staff are encouraged to make every effort to resolve concerns through this informal process and are expected to convey a decision within three business days.
Clients may choose to express their concerns directly to senior management or appeal a decision made by program staff orally or in writing to the Clinical Director or the Executive Director. Concerns submitted to the Clinical Director or the Executive Director are considered Grievances.
Clients receiving counseling services also have the right to complain directly to the State Department of Mental Health and Substance Abuse Services Consumer Advocacy Division at 1-866-699-6605. This may be done without contacting CCFI staff or management.
Clients may also choose to report discrimination due to race, color, national origin, sex, religion, disability or age directly to the Oklahoma District Attorneys Council or the US Department of Justice Office of Civil Rights.
Clients may request assistance from the Local Advocate. This is clinical director, Kathryn Morris-Scott who will serve as the client’s advocate to assist the client to explain and resolve the concern. Client communication with the Local Advocate shall be confidential if the client requests this.
Client grievances will be thoroughly investigated and resolved by the Clinical Director, Kathryn Morris- Scott who serves as the Grievance Coordinator and/or the Executive Director, Melissa Klink who serves as the final Decision Maker. The final decision is conveyed in writing within 10 business days.
Clients may appeal a decision made by the Chief Executive Officer to the President of the Board of Directors and the decision is conveyed in writing within five business days.

Contact Information for the Chief Executive Officer/Clinical Director:

210 S. Cockerel Ave Norman, OK 73071

(405) 364-1420

Clients receiving counseling services also have the right to complain directly to the State Department of Mental Health and Substance Abuse Services Consumer Advocacy Division at 1-866-699-6605

Availability of Mental Health Services

Regular Business Hours:

Monday- Friday 8:00 a.m. – 5:00 p.m.

Closed on holidays

After Hour Emergencies

Counseling Client after hours’ emergency CCFI number: (405) 881-2937

Others: Please go to your nearest Emergency Department

or call one of the following numbers:

988

405- 848-CARE (2273)

1-800- REACH OUT (522-9054)

Oklahoma Department of Mental Health and Substance Abuse Services CONSUMER RIGHTS

Each consumer has the right to be treated with respect and dignity.

Each consumer shall retain all rights, benefits, and privileges guaranteed by law except those lost through due process of law.

Each consumer has the right to receive services suited to his or her condition in a safe, sanitary and humane treatment environment regardless of race, religion, gender, ethnicity, age, degree of disability, handicapping condition or sexual orientation.
No consumer shall be neglected or sexually, physically, verbally, or otherwise abused.
Each consumer shall be provided with prompt, competent, and appropriate treatment; and an individualized treatment plan. A consumer shall participate in his or her treatment programs and may consent or refuse to consent to the proposed treatment. The right to consent or refuse to consent may be abridged for those consumers adjudged incompetent by a court of competent jurisdiction and in emergency situations as defined by law. Additionally, each consumer shall have the right to the following:
- Allow other individuals of the consumer's choice participate in the consumer's treatment and with the consumer's consent;
- To be free from unnecessary, inappropriate, or excessive treatment; To participate in consumer's own treatment planning;
- To receive treatment for co-occurring disorders if present;
- To not be subject to unnecessary, inappropriate, or unsafe termination from treatment; and To not be discharged for displaying symptoms of the consumer's disorder.
- Every consumer's record shall be treated in a confidential manner.
- No consumer shall be required to participate in any research project or medical experiment without his or her informed consent as defined by law. Refusal to participate shall not affect the services available to the consumer.
- A consumer shall have the right to assert grievances with respect to an alleged infringement on his or her rights.
- Each consumer has the right to request the opinion of an outside medical or psychiatric consultant at his or her own expense or a right to an internal consultation upon request at no expense.
- No consumer shall be retaliated against or subjected to any adverse change of conditions or treatment because the consumer asserted his or her rights.