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Privacy Practice (Continued)
- Right to Inspect and Copy
You have the right to access the personal information we collect
upon request. Under certain circumstances, we may not share information
that we collected, for example, if the information is the subject
of a lawsuit or legal claim or if release of mental health information
may present a danger to you or someone else. Fees may apply to
copied information.*
- Right to Amend You have the right to request
corrections or additions to your personal information. You must
give the reasons for wanting the change.*
- Right to An Accounting of Disclosures
You have the right to request an accounting of disclosures made
of your personal information that were not related to our business
operations or your authorization. Under certain circumstances,
we may not share information that we collected, for example, if
the information is the subject of a lawsuit or legal claim or
if release of the information may present a danger to you or someone
else. Your request must state the period of time desired for the
accounting, which must be within the six years prior to your request.
The first accounting is free but a fee will apply if more than
one request is made in a 12-month period.*
- Right to a Paper Copy of Notice You have
the right to a paper copy of this Notice. Although this Notice
is available at our web site, www.geauga.org, you may obtain a
copy of the Notice by contacting the Board office.
Requests marked with a (*) must be made in writing.
Contact the Board Privacy Officer with your request. To exercise
any of your rights described in this paragraph, please contact the
Board Privacy Officer at the address or phone number listed below:
Bethany Matthews
13244 Ravenna Road, Chardon, OH 44024
(440)285-2282
CHANGES TO 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 at the
Board Office. The Notice will contain on the first page in the top
center, the effective date. In addition, each time there is a change
in the Notice, you will receive a copy by mail at the last known
address we have in our plan enrollment file.
COMPLAINTS If you have a complaint about our Privacy policies
and procedures or you believe your privacy rights have been violated,
you may file a complaint with the Board or with the Secretary of
the Department of Health and Human Services. To file a complaint
with the Board, contact the Privacy Officer at the address below.
We will investigate all complaints and will not retaliate against
you for filing a complaint. If you wish to file a complaint with
the Secretary you may send the complaint to: HIPAA Complaint, 7500
Security Blvd., C5-24-0 Baltimore, MD 21244.
OTHER USES OF PERSONAL HEALTH INFORMATION Other uses and
disclosures of your personal health information not covered by this
Notice or the laws that apply to us will be made only with your
written permission. If you provide us permission to use or disclose
health information about you, you may revoke that permission, in
writing, at any time. If you revoke your permission, we will no
longer use or disclose your health information for the reasons covered
by your written permission. You understand that we are unable to
take back any disclosures we have already made with your permission,
and that we are required to retain our records of the services that
we provided to you.
Board Privacy Officer: Bethany Matthews, 13244 Ravenna Road, Chardon,
OH 44024
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