CENTRAL
COMMUNITY HEALTH BOARD, INC
Effective:
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU
MAY GAIN ACCESS TO THIS INFORMATION.
PLEASE READ CAREFULLY.
I. CCHB’s DUTY TO SAFEGUARD YOUR PROTECTED
HEALTH INFORMATION
Personal
health information about your past present, or future
health or condition, the provision of health care to you, or payment for health
care is considered “Protected Health Information” (PHI). CCHB is required by law to maintain the
privacy of your personal health information and to give you this Notice about
CCHB’s privacy practices that explains how, when and why we may use or disclose
your PHI. Except in
special circumstances, we must use or disclose only the minimum necessary PHI
to accomplish the intended purpose of the use or disclosure.
The following privacy
practices described in this Notice represent CCHB’s
current practices. CCHB reserves the
right to change these privacy practices and the terms of this Notice at any time. You may
request a copy of the new notice from CCHB’s Privacy Officer, Client Rights
Officer or any other staff.
II. HOW CCHB USES AND DISCLOSES YOUR
PERSONAL HEALTH INFORMATION
CCHB uses and discloses your
Protected Health Information (PHI) for a number of reasons. We have a restricted right to use and/or
disclose your PHI for treatment, payment and for CCHB’s health care operations. Beyond those uses, CCHB must have your
written authorization unless the law permits or requires CCHB to make the use
or disclosure without your authorization.
The law provides that CCHB is permitted to make some uses/disclosures
without your consent or authorization.
The following describes and provides examples of our potential
uses/disclosures of your PHI.
Treatment: CCHB may disclose your PHI
to doctors, nurses, social workers, counselors and other health care providers
who are involved in providing your health care.
For example your PHI will be shared among members of your treatment
team, various pharmacies and community support personnel. Your PHI may be shared with pharmacies, and
other community mental health agencies involved in the provision or
coordination of your care.
Payment: CCHB may use/disclose your PHI in order to
bill and collect payment for services provided.
For example, we may release portions of your PHI to Medicaid, Medicare,
the Ohio Department of Mental Health, the Ohio Department of Job and Family
Services, the local Community Mental Health Board through the MACSIS, and/or a
private insurer to get paid for services that CCHB delivers to you.
Health Care Operations: CCHB may use/disclose your
PHI in the course of operating CCHB. For
example CCHB may also release your PHI to the MACISIS and /or state agencies,
Job and Family Services to determine your eligibility for publicly funded
services.
Appointment
reminders: Unless you provide us with alternative
instructions, we may send appointment reminders and other similar materials to
your home or place of residence.
For
uses and disclosures beyond treatment, payment and operations purposes CCHB is
required to have your written authorization unless the use falls within one of
the following
exceptions. Your
authorization may be revoked at any time to stop future uses/disclosures except
to the extent that CCHB’s staff has already taken an action in reliance upon your
authorization.
Exceptions:
1) When required by law. For example child abuse reporting laws,
abuse, domestic violence, or relating to suspected criminal activity, or in
response to a court order. We must also
disclose PHI to authorities that monitor compliance with these privacy
requirements.
1)
Public Health Activities:
2)
Health oversight activities:
3)
Relating to decedents: CCHB may disclose PHI related to death to
coroners, medical examiners or funeral directors.
4)
Research: Presently, CCHB does
not participate in any research program.
5)
To stop a threat to health or safety: CCHB may disclose PHI to law
enforcement or other persons to prevent or reduce the threat of harm.
6)
For specific government functions: CCHB may disclose PHI to military
personnel and veterans in certain situations, to correctional facilities in
certain situations, to government benefit programs relating to eligibility and
enrollment, and for national security reasons.
IV. USES AND
DISCLOSURES REQUIRING YOU TO HAVE AN
To families, friends or
others involved in your care. CCHB may share with these
people information to assist in your care, or to payment for your care such as
group home operators. CCHB may also
share PHI with these people to notify them about your location, general
condition, or death. Generally this
information would be limited to diagnosis and prognosis, list of services and
personnel available to assist you and your family or group home operator.
V.
YOUR RIGHTS
TO REQUEST RESTRICTIONS ON
USES/ DISCLOSURES: You have the right to ask that CCHB limit how it uses or discloses
your PHI. CCHB will consider your
request, but is not legally bound to agree to your requested restriction. CCHB cannot
limit uses/disclosures that are required by law.
TO CHOOSE HOW CCHB CONTACTS
YOU: You
have the right to ask CCHB to send you information at an alternative address or
by another means. CCHB will agree to
your request as long as it is reasonably easy or possible for CCHB to do so.
TO INSPECT AND REQUEST A COPY
OF YOUR PHI:
You may have access to your records, by your written request, unless a licensed
health care professional has determined that the access requested is reasonably
likely to endanger the life or physical safety of you or another person. CCHB will respond to your request in 30
days. You have a right to choose what portions of your information you want
copied and to have prior information on the cost of copying.
TO REQUEST AMENDMENT OF YOUR
PHI:
If
you believe that there is a mistake or missing information in CCHB’s record of
you, you may request, in writing, that CCHB correct or add to the record. CCHB will respond within 60 days of receiving
your request. CCHB may deny the request
if it determines that the PHI is (1) correct and complete; (2) not created by
us and/or not part of our records, or; (3) not permitted to be disclosed.
TO FIND OUT WHAT DISCLOSURES
HAVE BEEN MADE:
You have a right to obtain a list of when, to whom, for what purpose, and what
content of your PHI has been released other than instances of disclosure for
treatment, payment and operations; to you, your family, or the pursuant to your
written authorization. This accounting
will not apply to disclosures for national security purposes, to law
enforcement officials or correctional facilities, or disclosures made before
VI. USES AND DISCLOSURES OF PHI FROM ALCOHOL AND
OTHER DRUG RECORDS NOT REQUIRING CONSENT OR AUTHORIZATION
The
law grants CCHB the right to use/disclose your PHI from alcohol and other drug
records without consent or authorization in the following circumstances:
1)
When required by law:
2)
Relating to decedents
3)
For research, audit or evaluation purposes
4)
To stop a threat to health or
safety:
If
you think CCHB may have violated your privacy rights, or you disagree with a
decision CCHB made about access to your PHI, you may file a complaint with
CCHB's Privacy Officer or Client Rights Officer:
Ms.
Charlene Davis, CRO
Central
Community Health Board
(513)
559-2015
(513)
559-2013
You
may also file a written complaint with the Secretary of the U.S. Department of
Health and Human Services at