NOTICE OF PRIVACY PRACTICES
Our Pledge Regarding Your Health Information
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY.
We understand that health information about you is personal. We are committed to protecting your health information. We need to create a record of the care and services you receive in order to provide you with quality care and to comply with certain legal requirements. This Notice applies to all medical records of your care generated by this department, whether made by health department personnel or contracted professionals. It also outlines your rights and certain obligations we have regarding the use and disclosure of health information.
USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION:
1. FOR TREATMENT - MCHD (Morrow County Health Department) may use your personal health information to provide you with medical treatment or services. We may disclose your medical information to doctors, nurses, nursing students, or other professionals who are involved in taking care of you; or disclose your health information to people outside the health department who may be involved in your care after you leave the health department, such as family members or others we use to provide services that are part of your care. We may also release your personal health information to another health care agency or professional who is not affiliated with our organization but who is, or will be, providing treatment to you.
2. FOR PAYMENT – MCHD may use and disclose health information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party responsible for your payments. Common payment activities may include, but are not limited to:
Determining eligibility or coverage under a plan; Billing and collection activities; Reviewing health care services for medical necessity, coverage, justification of charges, and the like; Utilization review activities; and Disclosures to consumer reporting agencies (limited to specified identifying information about you, your payment history, and identifying information about the MCHD)
3. FOR HEALTH CARE OPERATIONS - Health Care Operations are certain administrative, financial, legal, and quality improvement activities of the MCHD that are necessary to run its business and to support the core function of treatment and payment. These uses and disclosures are necessary to run our facility and make sure that all of our clients receive quality care. These activities may include, but are not limited to: Use of health information to review our services and to evaluate performance of our staff in caring for you; Combining information about many health department clients to decide what additional services MCHD should offer, what services are not needed, and whether certain new treatments are effective; Disclosure of information to doctors, nurses, nursing students, and other health department personnel for review and learning purposes; Combining the health information we have with health information from other health departments to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific clients are; and Disclosure of information for accreditation, licensing, and case management
4. FOR APPOINTMENT REMINDERS – MCHD may use and disclose health information to contact you as a reminder that you have an appointment for treatment or other care at the health department.
5. FOR PHONE CONTACTS – MCHD may contact you by phone to provide you with test results, return your call, answer questions, obtain additional information on billing, or other related issues. For confidentiality reasons, if you are not in, we will only leave our name, the name of the health department, and our phone number.
6. FOR E-MAIL – MCHD may respond or contact you with email if you have consented to such (contacting us first by email is implied consent).
7. FOR TREATMENT ALTERNATIVES – MCHD may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
8. FOR HEALTH-RELATED BENEFITS AND SERVICES – MCHD may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.
9. FOR RESEARCH – Under certain circumstances, MCHD may use and disclose health information about a client for research purposes. For example, a research project may involve comparing the health and recovery of all clients who received one vaccine to those who received another, for the same condition. All research projects, however, are subject to a special approval process. Before we use or disclose health information for research purposes, we will almost always ask for a client's specific permission if the researcher will have access to a client's name, address, or other information that reveals who a client is.
10. FOR FAMILY AND FRIENDS INVOLVED IN YOUR CARE OR PAYMENT OF YOUR CARE – MCHD may release health information about you to a friend or family member who is involved in your care, or to someone who helps pay for your care. We may also tell your family or friends your condition and that you are receiving services from the health department. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so your family can be notified about your condition, status and location.
11. FOR BUSINESS ASSOCIATES – Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain personal health information to one ore more of these outside persons or organizations who assist us with our healthcare operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
12. FOR AVERTING A SERIOUS THREAT TO HEALTH OR SAFETY – MCHD may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to prevent the threat.
13. FOR OTHER USES AND DISCLOSURES – MCHD is permitted to make certain uses and disclosures of your personal health information without your consent or authorization, which includes: for any purpose required by law; for public health activities, such as required reporting of communicable disease, injury, and birth and death, and for required public health investigations; as required by law if we suspect child abuse or neglect; we may also release your personal health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence; to the Food and Drug Administration, if necessary, to report adverse events, product defects, or to participate in product recalls; to your employer when we have provided healthcare to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer; if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings; if required to do so by subpoena or discovery request; in some cases you will have notice of such release; to law enforcement officials as required by law to report wounds and injuries and crimes; to coroners and/or funeral directors consistent with law; if you are a member of the military as required by armed forces services; we may also release your personal health information if necessary for national security or intelligence activities; to workers' compensation agencies if necessary for your workers' compensation benefit determination; and for eligibility or enrollment in the health plan of an agency administering a government program providing public benefits to you (i.e. Ohio Job Family Services)
YOUR RIGHTS REGARDING YOUR PERSONAL MEDICAL INFORMATION
1. RIGHT TO INSPECT AND COPY – This usually includes billing and health records. You must submit your request in writing to the MCHD Privacy Officer/Administrator. We may charge a fee, set by
2. RIGHT TO AMEND – If you feel that health information MCHD has about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by our facility. To request an amendment, your request must be made in writing and submitted to the MCHD Privacy Officer/Administrator on our designated forms. In addition, you must provide a reason that supports your request. This request may be denied if not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend information that: was not created by MCHD, unless the person or entity that created the information is no longer available to make the amendment; is not part of the health information kept by or for MCHD; is not part of the information which you would be permitted to inspect and copy; and is considered accurate and complete
3. RIGHT TO AN ACCOUNTING OF DISCLOSURES – To request a list or accounting of disclosures we have made of your health information, you must submit your request in writing to the MCHD Privacy Officer/Administrator. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (on paper, electronic, etc). The first list you request within a 12 month period will be free. There may be a fee for additional lists provided. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
4. RIGHT TO REQUEST RESTRICTIONS – You have the right to request a restriction or limitation on the use or disclosure of your health information for treatment, payment, or health care operations; and the right to request a limit of disclosure to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions you must make your request in writing to the MCHD Privacy Officer/Administrator on our designated forms. Your request must include: a) what information you want to limit; b) whether you want to limit use, disclosure, or both; and c) to whom you want the limits to apply (i.e., disclosures to your spouse).
5. RIGHT TO REASONABLE ACCOMMODATIONS – You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the MCHD staff person providing services to you (on the back of your Authorization form) or to the MCHD Privacy Officer/Administrator. We will not ask you the reason for your request. We will accommodate all reasonable requests, but your request must specify how or where you wish to be contacted.
6. RIGHT TO A PAPER COPY OF THIS NOTICE – You may ask for a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy. To obtain a copy, contact the MCHD Privacy Officer/Administrator, or ask an employee who has assisted you in the past.
COMPLAINTS - If you believe your privacy rights have been violated, you may file a complaint with MCHD or with the Secretary of the Department of Health and Human Services. To file a complaint with MCHD, contact the Office of the Health Commissioner at 419-947-1545. All complaints must be submitted in writing.
CURRENT NOTICE, CHANGE TO THIS NOTICE - The MCHD is required to and will abide by the terms of this Notice. We reserve the right to change this Notice at any time. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our facility. The Notice will contain the effective date. In addition, each time you register or are seen for services at MCHD, a copy of the current Notice will be available to you.
FOR FURTHER INFORMATION - If you have questions or need further assistance regarding this Notice, you may contact us at:
Morrow County Health Department
(419) 947-1545 or email:email@example.com
EFFECTIVE DATE - This Notice of Privacy Practices is effective
RESTRICTION OF PERSONAL HEALTH INFORMATION REQUEST - If you would like the Morrow County Health Department to abide by specific restrictions regarding the disclosure of any or all of your personal health information please request a form for that purpose from our staff.