GRANT-BLACKFORD
MENTAL HEALTH’S
NOTICE OF PRIVACY
PRACTICES
Effective Date: April 21, 2014
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Pledge To You. Your health
information -- which means any written or oral information that we create or
receive that describes your health condition, treatment or payments -- is
personal. Therefore, the Facility
pledges to protect your health information as required by law. We give you this Privacy Notice to tell you
(1) how we will use and disclose your "protected" health information,
or "PHI" and (2) how you can exercise certain individual rights
related to your PHI as a Client of our Facility. Please note that if any of your PHI qualifies
as mental health records, alcohol and drug treatment records, communicable
disease records or genetic test records, we will safeguard these records as
"Special PHI" which will be disclosed only with your prior express
written authorization, pursuant to a valid court order or as otherwise required
by law. We are required by law to
maintain the privacy of your PHI and to provide you with this notice of our
legal duties and privacy practices.
Who Will Follow This Notice:
This
notice describes our practices and that of:
A. All employees, professional staff and other
personnel including volunteers of Grant-Blackford Mental Health.
B. All these entities,
site and locations follow the terns of this notice. In addition, these entities, site and
locations may share PHI with each other for treatment, payment, or
Grant-Blackford Mental Health operations purposes described in this notice.
We are required by law to:
·
Make
sure that PHI that identifies you is kept private.
·
Give
you this notice of our legal duties and privacy practices with respect to PHI
about you.
·
Follow
the terms of the notice that is currently in effect.
I.
How We Will Use And
Disclose Your PHI
A. To Provide Treatment.
We may use and disclose your PHI to provide, coordinate, or manage your
health care and any related services. This includes the management or
coordination of your health status and care with another health care
Facility. For example, we may disclose
your PHI to a pharmacy to fill a prescription, or to a laboratory to order a
blood test. We may also disclose your PHI to another physician who may be
treating you or consulting with us regarding your care.
B. To Obtain Payment.
We
may also use and disclose your PHI, as needed, to obtain payment for services
that we provide to you. This may include
certain communications to your health insurer or health plan to confirm (1)
your eligibility for health benefits, (2) the medical necessity of a particular
service or procedure, or (3) any prior authorization or utilization review
requirements. We may also disclose your
PHI to another Facility involved in your care for the other Facility's payment
activities. For example, this may include disclosure of demographic information
to another physician practice that is involved in your care, or to a hospital
where you were recently hospitalized, for payment purposes.
C. To Perform Health Care Operations. We may also use or disclose your PHI, as
necessary, to carry on our day-to-day health care operations, and to provide
quality care to all of our clients, but only on a "need to know"
basis. These health care operations may include such activities as: quality
improvement; physician and employee reviews; health professional training
programs, including those in which students, trainees, or practitioners in
health care learn under supervision; accreditation; certification; licensing or
credentialing activities; compliance reviews and audits; defending a legal or
administrative claim; business management development; and other administrative
activities. In certain situations, we
may also disclose you PHI to another health care Facility or health plan to
conduct their own particular health care operation requirements.
D. To Contact You. To support our
treatment, payment and health care operations, we may also contact you at home,
either by telephone or mail, from time to time (1) to remind you of an upcoming
appointment date or (2) to ask you to return a call to the Facility unless you
ask us, in writing, to use alternative means to communicate with you regarding
these matters. We may also contact you
by telephone to inform you of specific test results or treatment plans, but
only with your prior written authorization.
E. To Be In Contact With Your Family or Friends. Additionally, we may also disclose certain of
your PHI to your family member or other relative, a close personal friend, or
any other person specified by you from time to time, but only if the PHI is
directly related (1) to the person's involvement in your treatment or related
payments, or (2) to notify the person of your physical location or a sudden
change in your condition, while receiving treatment at our office. Although you have a right to request
reasonable restrictions on these disclosures, we will only be able to grant
those restrictions that are reasonable and not too difficult to administer,
none of which would apply in the case of an emergency.
F.
According to Laws That Require or Permit Disclosure. We may disclose
your PHI
when we are required or permitted to do so by any federal, state or local law,
as follows:
1.
When There Are Risks to Public Health. We may disclose your PHI to (1) report
disease, injury or disability; (2) report vital events such as births and
deaths; (3) conduct public health activities; (4) collect and track FDA-related
events and defects; (5) notify appropriate persons regarding communicable
disease concerns; or (6) inform employers about particular workforce issues.
2.
To Report Suspected Abuse, Neglect Or Domestic Violence. We may notify government authorities if we
believe that a Client is the victim of abuse, neglect or domestic violence, but
only when specifically required or authorized by law or when the Client agrees
to the disclosure.
3.
To Conduct Health Oversight Activities. We may disclose your
PHI to a health oversight agency for activities including audits; civil,
administrative, or criminal investigations, proceedings, or actions;
inspections; licensure or disciplinary actions; or other activities necessary
for appropriate oversight, but we will not disclose your PHI if you are the
subject of an investigation and your PHI is not directly related to your
receipt of health care or public benefits.
4.
In Connection With Judicial and Administrative Proceedings. We may disclose your PHI in the course of any
judicial or administrative proceeding in response to an order of a court or
administrative tribunal. In certain
circumstances, we may disclose your PHI in response to a subpoena if we receive
satisfactory assurances that you have been notified of the request or that an
effort was made to secure a protective order.
5.
For Law Enforcement Purposes. We may disclose your
PHI to a law enforcement official to, among other things, (1) report certain
types of wounds or physical injuries, (2) identify or locate certain
individuals, (3) report limited information if you are the victim of a crime or
if your health care was the result of criminal activity, but only to the extent
required or permitted by law, (4) about criminal conduct at a Grant-Blackford
Mental Health facility, (5) in emergency circumstances to report a crime; the
location of the crime or victims; or the identity, description or location of
the person who committed the crime.
6.
To Coroners, Funeral Directors. We may disclose PHI to a coroner or medical
examiner for identification purposes, to determine cause of death or for the
coroner or medical examiner to perform other duties. We may also disclose PHI to a funeral
director in order to permit the funeral director to carry out their
duties.
7.
In the Event of a Serious Threat to Health or Safety, or
For Specific Government Functions. We may, consistent with applicable law
and ethical standards of conduct, use or disclose your PHI if we believe, in
good faith, that such use or disclosure is necessary to prevent or lessen a
serious and imminent threat to your health or safety or to the health and
safety of the public, or for certain other specified government functions
permitted by law.
8.
For Worker’s Compensation. We may disclose your
PHI to comply with worker‘s compensation laws or similar programs.
G.
With Your Prior
Express Written Authorization. Other than as stated above, we will not
disclose your PHI, or more importantly, your Special PHI, without first
obtaining your express written
authorization. We will not use or disclose your PHI in any of the following
situations without your written authorization:
1. Uses and disclosures of Special PHI (if recorded by us in the medical
record) except to carry out your treatment, payment or health care operations,
to the extent permitted or required by law;
2. Uses and disclosures of PHI to conduct certain marketing activities that
may encourage you to use or purchase a particular product or service for which
HIPAA requires your prior express written authorization;
3. Disclosures of PHI that constitutes a sale of your PHI under HIPAA;
4. Psychotherapy notes; and
5. Other uses and disclosures not described in this Notice.
II.
Your Individual
Rights Concerning Your PHI
a. The Right to Request
Restrictions on How We Use and Disclose Your PHI. You may ask us not to use or
disclose certain parts of your PHI but only if the request is reasonable. For example, if you pay for a particular
service in full, out-of-pocket, on the date of service, you may ask us not to
disclose any related PHI to your health plan.
(Medicaid will not allow you to pay out of pocket for a service, so this
option is not available to you if you have Medicaid.) You may also ask us not to disclose your PHI
to certain family members or friends who may be involved in your care or for
other notification purposes described in this Privacy Notice, or how you would
us to communicate with you regarding upcoming appointments, treatment
alternatives and the like by contacting you at a telephone number or address
other than at home. Please note that we are only required to agree to those
restrictions that are reasonable and which are not too difficult for us to
administer. We will notify you if we
deny any part of your request, but if we are able to agree to a particular
restriction, we will communicate and comply with your request, except in the
case of an emergency. Under certain circumstances, we may choose to terminate
our agreement to a restriction if it becomes too burdensome to carry out. Finally, please note that it is your
obligation to notify us if you wish to change or update these restrictions
after your visit by contacting the Privacy Officer directly.
b.
The Right to Receive
Confidential Communications of PHI. You
may request to receive communications of PHI from us by alternative means or at
alternative locations, and we will work with you to reasonably accommodate your
request. For example, if you prefer to receive communications of PHI from us
only at a certain address, phone number or other method, you may request such a
method.
c.
The Right to Inspect and Copy Your PHI. You may inspect and
obtain a copy of
your PHI that we have created or received as we provide your treatment or
obtain payment for your treatment. A
copy may be made available to you either in paper or electronic format if we
use an electronic health format. Under
federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in
reasonable anticipation of, or for use in, a civil, criminal, or administrative
action or proceeding; and PHI that is subject to a law prohibiting access. Depending on the circumstances, you may have
the right to request a second review if our Privacy Officer denies your request
to access your PHI. Please note that you
may not inspect or copy your PHI if your physician believes that the access
requested is likely to endanger your life or safety or that of another person,
or if it is likely to cause substantial harm to another person referenced
within the information. As before, you have the right to request a second
review of this decision. To inspect and
copy your PHI, you must submit a written request to the Privacy Officer. We may charge you a fee for the reasonable
costs that we incur in processing your request.
d. The Right to Request
Amendments To Your PHI. You may request that your PHI
be amended so long as it is a part of our official Client Record. All such requests must be in writing and
directed to our Privacy Officer. In
certain cases, we may deny your request for an amendment. If we deny your
request for amendment, you have the right to file a statement of disagreement
with us and we may respond to your statement in writing and provide you with a
copy.
e. The Right to Receive
an Accounting of Disclosures of PHI. You have the right
to request an accounting of those disclosures of your PHI that we have made for
reasons other than those for treatment, payment and health care operations,
which are specified in Section II (A-C) above.
The accounting is not required to report PHI disclosures (1) to
those family, friends and other persons
involved in your treatment or payment, (2) that you otherwise requested in
writing, (3) that you agreed to by signing an authorization form, or (4) that
we are otherwise required or permitted to make by law. As before, your request must be made in
writing to our Privacy Officer. The
request should specify the time period, but please note that we are not
required to provide an accounting for disclosures that take place prior to
f. The Right to Receive
Notice of a Breach. You have
the right to receive written notice in the event we learn of any unauthorized
acquisition, use or disclosure of your PHI that was not otherwise properly
secured as required by HIPAA. We will
notify you of the breach as soon as possible but no later than sixty (60) days
after the breach has been discovered.
g. The Right to File A
Complaint. You have the
right to contact our Privacy Officer at any time if you have questions,
comments or complaints about our privacy practices or if you believe we have
violated your privacy rights. You also
have the right to contact our Privacy Officer or the Department of Health and
Human Services’ Office for Civil Rights in
|
Ombudsman 505
Wabash Ave Marion,
IN 46952 765-662-3971 |
Please
note that we will not take any action, or otherwise retaliate, against you in
any way as a result of your communications to the Facility or to the Department
of Health and Human Services’ Office for Civil Rights. As always, please feel free contact us. We look forward to serving you as a Client.
h.
Your Right to Revoke
Authorization.
Any other uses and disclosures not described in this Notice will be made only
with your written authorization. Please note that you may revoke your
authorization in writing at any time except to the extent that we have taken
action in reliance upon the authorization.