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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. This notice became effective on 14 July 2006.
MHS uses and discloses information about you to carry out treatment, payment, and health care operations. Both Federal and State laws govern how information is used and stored, what information is disclosed, and who gets this information. We will only disclose information about you that we are permitted to disclose. For treatment purposes, we will not disclose information about you without your written authorization, except in circumstances that we reasonably believe are emergencies. For example, we may disclose information about you if you are in a hospital emergency room, and hospital staff request information to help them evaluate or treat you.
To receive payment for services, we disclose information about you to the Cuyahoga County Community Mental Health Board. It determines your eligibility, enrolls you in the County Behavioral Healthcare Plan, and pays us for services through the MACSIS computer system which connects the Board to the Ohio Department of Mental Health, the Ohio Department of Alcohol and Drug Addiction Services, and the Ohio Department of Job and Family Services. Health care operations refers to quality assurance, audit, accreditation, licensing, and other activities that are required to meet our professional and legal obligations. For example, an auditor may see information about you, but we require that auditors agree to our privacy policies. Or, if you receive homeless assistance services, we disclose information about you to the Cleveland and Cuyahoga County Office of Homeless Services.
All information will be kept confidential, consistent with state and federal laws. Name identifying information will be used only to obtain payment for services provided to you. Demographic information will be kept without your name attached, and reported to the state departments and the Ohio Health Care Data Center. This information will not be available to other sources, or used for other purposes. Billing information will only be kept for up to seven (7) years after you have received services, and only demographic information will be kept after that time.
We maintain an electronic database of health information, for billing, planning, and quality assurance purposes. Your information may be seen by those who install and service our computer equipment. All business associates who provide us with services that help us operate are notified that information they see must be protected, and not disclosed.
In some circumstances, we may disclose health information about you, without your authorization. For example, we are sometimes required to disclose health information to authorized public health authorities for the prevention or control of disease, injury, or disability. We may disclose health information to a government office authorized by law to receive reports of suspected child abuse or neglect. If we believe that you may be a victim of abuse, neglect, or domestic violence, we may disclose information about you to a government authority, social service agency, or protective service agency authorized by law to receive reports of this kind. We may disclose information if we believe that disclosure is necessary to prevent serious harm to yourself or others. We may disclose information in response to a court order, subpoena, law enforcement official's request, coroner's request, or other lawful process in which disclosure is authorized. We may make telephone calls or send letters to you to reschedule or remind you about appointments, make arrangements for follow-up services, or provide you with information about treatment alternatives, benefits, or services. Please tell us if you wish to receive communications from us through another means, or at another location. We will accommodate reasonable requests.
You have the right to request that we restrict how protected health information is used or disclosed. We are not required to agree to these restrictions. If we agree to a restriction that you have requested, we will provide you with a written description of the restriction, and that restriction will be binding on us. You have the right to inspect and copy certain health information, to request that we amend health information about you that you believe is inaccurate or incomplete, and to receive an accounting of certain disclosures of your health information. To exercise these rights, contact the Client Rights Officer, as described below.
All other uses and disclosures of health information about you will be made only with your written authorization. We are required by law to maintain the privacy of protected health information, and to provide you with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this notice, but we reserve the right to change the terms of this notice, and to make the new notice provisions effective for all protected health information we maintain. If we change this notice, a revised notice will be available to you by coming to this office.
If you believe your privacy rights have been violated, you may complain to Lorraine Meyer, Client Rights Officer, by calling 216-623-6555, extension 196. She is available Monday – Friday, 9:00 a.m. to 4:00 p.m. The Alternate Client Rights Officer is LaTonya Murray. You may also file a complaint in writing or electronically to the U.S. Department of Justice, Civil Rights Division, Office of the Assistant Attorney General, 950 Pennsylvania Avenue, N.W., Washington, D.C. 20530. Your complaint must be filed within 180 days of when you knew or should have known of the occurrence of the act or omission that is the subject of your complaint. You will not be retaliated against for filing a complaint.
Please take and keep this Notice of Privacy Practices for Protected Health Information. You have the right to review this Notice before signing the Consent for Treatment, and for Use and Disclosure of Protected Health Information document. You always have the right to withdraw your Consent by submitting a written request to the Client Rights Officer.
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