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Member
Information Benefit Plan
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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.
Geauga County Board
of Mental Health and Recovery Services Notice of Privacy Practices
Effective: April 14, 2003
If you have any questions about
this Notice, please contact Bethany Matthews at (440)285-2282.
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION
At the Geauga County Board of Mental Health and Recovery Services
(Board) we understand that health information about you and your
health is personal. We are committed to protecting health information
about you and safeguarding that information against unauthorized
use or disclosure. We are required by law to: 1) assure health information
that identifies you is kept private; 2) give you notice of our legal
duties and privacy practices with respect to health information
about you; 3) follow the terms of the Notice that is currently in
effect. This Notice will tell you about the ways in which we may
use and disclose health information about you. We also describe
your rights and certain obligations we have regarding the use and
disclosure of your health information. The Notice applies to all
of the records that we have related to your care.
WHY WE COLLECT PERSONAL HEALTH INFORMATION?
We collect personal information to:
Determine eligibility for health care coverage
Provide benefits and pay claims
Conduct our service evaluation programs
Provide other information for planning and improving mental health
and substance abuse services in the community.
We may also be required to collect and keep certain information
so that we meet legal and regulatory requirements. We keep this
information after a client's health care coverage ends.
PERSONAL INFORMATION WE COLLECT
We ask people seeking benefits to provide certain information when
they complete an enrollment form. This information may include,
for example:
- Name, Address, Phone
- Date of Birth
- Marital Status
- Social Security Number
- Family Income
We may also receive personal information about you
from others, such as:
- Health care providers (doctors, clinics, hospitals)
- Other ADAMH Boards that provide coverage to our
clients
- Business partners (companies with whom we have
arrangements to assist us in providing products and services)
- Other government agencies (criminal justice system,
child welfare, juvenile justice, etc.)
The information we collect from others may include,
for example, eligibility, claims and payment information. We create
and maintain a record of your enrollment in the public mental health
and or drug addiction and substance abuse system of the State of
Ohio, and maintain records of payment for treatment you receive
in the public system. From time to time, we also receive information
from your treatment provider related to your diagnosis, treatment
and progress in recovery, and any major unexpected emergencies or
crises you may experience that help the Board to plan for and improve
the quality of services for the region's citizens.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.
When you receive services paid for in part or in full by the ADAMH
Board, we may use your personal information for such activities
as conducting our normal board business known as health care operations.
If the services we paid for were mental health services, we may
also use your personal information for billing for such services.
If you have a guardian or a power of attorney we will provide the
information to your guardian or attorney in fact. Examples of how
we use your information include:
Payment for Mental Health Services - We keep records that
include payment information and documentation of the services provided
to you. Your information may be used to obtain payment for your
services from Medicaid, insurance or other sources. For example,
we may disclose personal information about the services provided
to you to confirm your eligibility for Medicaid and to obtain payment
from Medicaid.
Health Care Operations - We use personal information to train
staff, manage costs, conduct required business duties, and make
plans to better serve you and other community residents who may
need mental health or substance abuse services.
Other Services We Provide
We may also use your personal information to:
- Review and evaluate the quality, effectiveness,
and efficiency of the services you have received;
- Conduct program and fiscal audits of programs
who have provided you with services;
- Investigate major unusual incidents, report these
kind of incidents and take steps to protect your health and safety;
- Services and the Ohio Department of Mental Health,
the Ohio Department of Alcohol and Drug Addiction Services and
the Ohio Department of Job and Family Services;
- Contact you for assistance in passing levies,
unless you notify the Board that you do not wish to be contacted
for these purposes.
Sharing Your Personal Information
There are limited situations when we are permitted or required to
disclose personal information without your signed authorization.
These situations are:
- To protect victims of abuse, neglect, or domestic
violence;
- To reduce or prevent a serious threat to public
health and safety;
- For health oversight activities such as investigations,
audits, and inspections;
- For local, state, federal agencies to monitor
your services;
- For lawsuits and similar proceedings;
- For public health purposes such as reporting
communicable diseases, work-related illnesses, or other diseases
and injuries permitted by law; reporting births and deaths, and
reporting reactions to drugs and problems with medical devices;
- When required by law;
- When requested by law enforcement as required
by law or court order, except as limited by laws regarding disclosure
of alcohol and other drug treatment;
- To coroners, medical examiners, and funeral directors;
- For organ and tissue donation;
- For workers' compensation or other similar programs
if your are injured at work and are covered by workers' compensation
or other similar programs;
- For specialized government functions such as
intelligence and national security;
All other uses and disclosures, not described in
this notice, require your signed authorization. You may revoke your
authorization at any time with a written statement.
SAFEGUARDING YOUR PERSONAL INFORMATION, We maintain physical,
electronic and procedural safeguards that comply with applicable
federal and state laws and regulation to guard your personal information
against unauthorized use or disclosure. Any third party processor
or consultant used by the Board has signed an agreement with us
requiring such entity to maintain the confidentiality of your personal
information. We also restrict access to your personal information
to those employees who need to know the information in order to
perform their job duties. The Board maintains policies and procedures
that prohibit employees and agents of the Board from using, disclosing,
transferring, providing access to or otherwise divulging client
health information to any person or entity other than to the individual
who is the subject of the information.
INDIVIDUAL CLIENT RIGHTS You have the following rights regarding
the health information we maintain about you:
- Right to Request Restrictions. You have
the right to request a restriction or limitation on the health
information we use or disclose about you for payment or health
care operations. We will consider all requests for restrictions
carefully but are not required to agree to any requested restrictions.*
You also have the right to request a limit on the health information
we disclose about you to a family member who is involved in your
care if you are receiving mental health services and have previously
agreed to limited disclosure to such a family member. We will
comply with any restrictions you request regarding disclosure
to such a family member.*
- Right to Request Confidential Communications
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.
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