“PRIVACY NOTICE”
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.
For over 35 years, the Poweshiek County Mental Health Center has provided confidential and private mental health services.
WHAT IS THIS DOCUMENT?
The following Privacy Notice provides for you specific standards that Center follows in collecting, storing, using, and disclosing PROTECTED HEALTH INFORMATION. This information may include information about your treatment, your payment, and our health care operations.
WHAT IS PROTECTED HEALTH INFORMATION?
A new federal law defines protected health information as “individually identifiable health information.” Protected health information can be as little as your name up to your entire treatment and billing record.
TREATMENT INFORMATION
We record general information about your treatment and other mental health services to meet state accreditation standards and the documentation requirements of various third party payers such as insurance, managed care, or government payment plans. This information is kept strictly confidential and secure, and it is not disclosed to anyone without your informed and written authorized consent. These same standards apply even after your death. Records are maintained for seven years following your last interaction with the Center. The records are then totally destroyed. There are a few exceptions which are listed in a later section.
Listed below are circumstances when we may use or disclose your protected information without your specific written consent:
1) For you as the individual to which it pertains;
2) To carry out treatment;
3) To handle emergency treatment;
4) When compelled by court order;
5) To protect the life and safety of yourself or others;
6) When required by the Secretary of Health and Human Services to investigate or determine the Center’s compliance with federal privacy rules;
7) When there is a legal personal representative to act for you;
8) For public health in controlling disease, injury, or disability, or in the event of medical examiner investigating your death;
9) For agencies authorized to receive reports of child or dependent adult abuse or neglect;
10) As subject to jurisdiction of the FDA in regard to biological products;
11) If accusations of unlawful or unethical disclosures of health information are made by others and are investigated by law enforcement or other oversight agency (i.e. Civil Rights Commission or the Secretary of Health & Human Services;
12) If you are an inmate of a correctional institution, and;
13) For specialized government functions such as protective services for the President or for national security purposes.
However, if information is disclosed in these circumstances, it is limited to only that information which is relevant to that purpose and you will be informed if possible and if this will not risk serious harm to you or others.
PAYMENT INFORMATION
We may use and disclose health information about you so that the treatment and services you receive at the Center may be billed to and payment collected from an insurance company, a third party, or you. The information provided will be the minimum required. On the Consents form you indicated a payment method and signed permission for us to bill for payment.
HEALTH OPERATIONS INFORMATION
We may use and disclose information about you for Center operations. These uses and disclosures are necessary to run the Center and make sure everyone receives quality care. For example, we may use health information to evaluate our performance and make changes. We may use health Information in consultation with other staff within the Center. Any staff or a consultant to the Center may have access to private health information in order to perform their function, i.e. billing clerk, insurance, clerk, filing clerk, transcriptionist, intake clerk, computer consultant. In all circumstances, the minimum amount of private health information to perform the function of their job will be disclosed.
WHEN WILL I BE REQUIRED TO GIVE MY WRITTEN PERMISSION TO HAVE PROTECTED HEALTH INFORMATION DISCLOSED?
All other uses and disclosures, other than those listed above, will be made only with you written authorization.
WHAT ABOUT APPOINTMENT REMINDERS?
We may contact you to provide treatment reminders, provide information regarding treatment alternatives, for fund raising, or other health-related benefits and services that may be of interest to you.
WHAT ARE MY RIGHTS REGARDING PROTECTED HEALTH INFORMATION WHICH YOU HAVE ABOUT ME AT THE CENTER?
You have several rights as the individual who has information gathered, stored, and used at the Center. These include the following:
• You have the right to request restrictions on certain uses and disclosures of protected health information, although we are not obligated to agree to the restriction if there is good reason.
• You have the right to receive protected health information in a confidential manner of communication.
• You have the right to inspect and copy protected health information unless this is judged to be of potential serious harm to someone in accordance with Center policy.
• You have the right to amend protected health information according to the Center policy.
• You have the right to receive an accounting of disclosures of protected health information.
• You have a right to have a paper copy of our privacy notice of information practices.
WHAT ARE THE DUTIES OF THE CLINIC IN REGARD TO PRIVACY ACCORDING TO THE FEDERAL LAW?
The Center is required to perform certain duties to protect you privacy including the following:
• We are required by law to protect the privacy of individually identifiable health information and provide this notice of our legal duties and privacy practices.
• We are required to abide by the terms of this notice while it remains in effect.
• We reserve the right to change the terms of this notice and policies and practices in regard to protected health information we maintain. These changes will also apply retroactively to information created or received prior to the notification of the public. This public notice will be provided by prominently posting the changed notice in our waiting room, available to all individuals as they attend appointments and to all new individuals receiving services.
• You may complain to the Center Privacy Officer, and to the Secretary of Health and Human Services, if you believe your privacy rights have been violated. These complaints may be registered by seeking a complaint form from the receptionist. No retaliation against anyone filing the complaint will occur.
WHO CAN I CONTACT FOR FURTHER INFORMATION OR TO MAKE COMPLAINTS?
The Executive Director of the Center serves as the Privacy Officer. The telephone contact number is 641-236-6137.
THIS IS THE FIRST EDITION OF THE PRIVACY NOTICE OF THE CENTER AND IS DATED AND BECOMES EFFECTIVE APRIL 1, 2003. WE RESERVE THE RIGHT TO CHANGE THIS NOTICE.
Privacy notice-pcmhc/cj/apr03
Poweshiek County Mental Health Center