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

Privacy Practice (Continued)

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)285-2282CHANGES 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