Geauga County Board of Mental Health & Recovery Services
13244 Ravenna Road
Chardon, Ohio 44024
Phone 440-285-2282
Fax: 440-285-9617
Hearing Impaired 1-800-750-0750
email: gbmhadas@lightstream.net

Hours Monday-Friday 8:30 a.m. to 4:30 p.m.

Jim Adams, Executive Director, CEO

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:

We may also receive personal information about you from others, such as:

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:

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:

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: