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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.
Our Duty to
Safeguard Your Protected Health Information.
Individually
identifiable information about your past, present, or future Health
or condition, the provision of health care to you, or payment for
the health care is considered “Protected Health Information”
(“PHI”). We are required to extend certain protections to your PHI,
and to give you this Notice about our privacy practices that
explains how, when, and why we may use or disclose your PHI. Except
in specified circumstances, we must use or disclose only the minimum
necessary PHI to accomplish the intended purpose of the use or
disclosure.
We are required
to follow the privacy practices described in this Notice, though
we reserve the right to change our privacy practices and the terms
of this Notice at any time. If we do so, you may request a copy
of the new notice from Allen County Health Department HIPPA
Coordinator, 219 East market, Lima, OH, 45802-1503 or print a copy
by clicking here.
How We May Use
and Disclose Your Protected Health Information.
We use and
disclose PHI for a variety of reasons. We have a limited right to
use and/or disclose your PHI for purposes of treatment, payment, or
our health care operations. For uses beyond that, we must have your
written authorization unless the law permits or requires us to make
such use or disclosure without your authorization. If we disclose
your PHI to an outside entity in order for that entity to perform a
function on our behalf, we must have in place an agreement from the
outside entity that it will extend the same degree of privacy
protection to your information that we must apply to your
PHI. However, the law provides that we are permitted to make some
uses/disclosures without your consent or authorization. The
following offers more description and some examples of our potential
uses/disclosures of your PHI.
Uses and
Disclosures Relating to Treatment, Payment, or Health Care
Operations.
We may use or disclose your PHI as follows:
For Service:
We may disclose your PHI to doctors, nurses, and other health care
personnel, who are involved in providing you health care services in
one of the programs, offered at the Allen County Health Department.
Your PHI may also be shared with outside entities performing
ancillary services relating to your treatment, such as lab work,
x-rays, or for consultation purposes.
To obtain
payment:
We may
use/disclose your PHI in order to process bills for your services
received at one of the clinics provided at the Allen County Health
Department.
Appointment
Reminders:
Unless you provide us with alternative instructions, we may
send appointment reminders and other similar materials to your home.
Uses and
Disclosures Requiring Authorization:
For uses and disclosures beyond treatment, payment, and health care
operations purposes, we are required to have your written
authorization, unless the use or disclosure falls within one of the
exceptions described below. Authorizations can be revoked at any
time to stop future uses/disclosures except to the extent that we
have already undertaken an action in reliance upon your
authorization.
Uses and
Disclosures of PHI from Allen County Health Department Not Requiring
Consent or Authorization:
The law provides
that we may use/disclose your PHI from your records without consent
or authorization in the following circumstances:
When required by
law:
We may disclose PHI when a law requires us to do so. We are required
to report information about suspected abuse, neglect or domestic
violence, or relating to suspected criminal activity, or in response
to a court order. We must also disclose PHI to authorities that
monitor compliance with these privacy requirements.
For Public Health
Activities:
We may disclose PHI when we are required to collect information
about diseases or injury, or to report vital statistics to the
public health authorities.
For Health
Oversight Activities:
We may disclose PHI to our State Health Department, or other agency
responsible for monitoring the health care system for such purposes
as reporting or investigation of unusual incidents.
Relating to
decedents:
We may disclose PHI relating to an individual’s death to coroners,
medical examiners, or funeral directors, and to organ procurement
organizations relating to organ, eye, or tissue donations or
transplants.
For research
purposes:
In certain circumstances, and under supervision of a privacy board,
we may disclose PHI to our State Health Department Research Staff
and their designees in order to assist medical research.
To avert threat
to health or safety:
In order to avoid a serious threat to health or safety, we may
disclose PHI as necessary to law enforcement or other persons who
can reasonably prevent or lessen the threat of harm.
For specific
government functions:
We may disclose PHI of military personnel and veterans in certain
situations to correctional facilities in certain situations, to
government benefit programs relating to eligibility and enrollment,
and for national security reasons, such as protection of the
President.
Uses and
Disclosures requiring you to have an Opportunity to Object:
In the following situations, we may disclose a limited amount of
your PHI if we inform you about the disclosure in advance and you do
not object, as long as the disclosure is not otherwise prohibited by
law. However, if there is an emergency situation and you cannot be
given your opportunity to object, disclosure may be made if it is
consistent with any prior expressed wishes and disclosure is
determined to be in your best interests. You must be informed and
given an opportunity to object to further disclosure as soon as you
are able to do so.
To families,
friends, or others involved in your care:
We may share with
these people information directly related to their involvement in
your care, or payment for your care. We may also share PHI with
these people to notify them about your location, general condition,
or death.
Your Rights
Regarding Your Protected Health Information.
To request
restrictions on uses/disclosures:
You have the
right to ask that we limit how we use or disclose your PHI. We will
consider your request, but we are not legally bound to agree to the
restriction. To the extent that we do agree to any restrictions on
our use/disclosure of your PHI, we will put the agreement in writing
and abide by it except in emergency situations. We cannot agree to
limit uses/disclosures that are required by law.
To choose how we
contact you:
You have the right to ask that we send you information at an
alternative address or by an alternative means. We must agree to
your request as long as it is reasonably easy for us to do so.
To inspect and
copy your PHI:
Unless your access is restricted for clear and documented treatment
reasons, you have a right to see your protected health information
upon your written request. We will respond to your request within 30
days. If we deny your access, we will give you a written reason for
the denial and explain any right to have the denial reviewed. If you
want copies of your PHI, a charge for copying may be imposed,
depending on your circumstances. You have a right to choose what
portions of your information you want copied and to have prior
information on the cost of copying.
To request
amendment of your PHI:
If you believe that there is a mistake or missing information in our
record of your PHI, you may request, in writing, that we correct or
add to the record. We will respond within 60 days of receiving your
request. We may deny the request, if we determine that the PHI is:
(1) correct and complete; (2) not created by us and or not part of
our records, or (3) not permitted to be disclosed. Any denial will
state the reasons for denial and explain your rights to have the
request and denial, along with any statement in response that you
provide, appended to your PHI. If we approve the request for
amendment, we will change the PHI and so inform you, and tell others
that need to know about the change in the PHI.
To find out what
disclosures have been made:
You have a right to get a list of when, to whom, for what purpose,
and what content of your PHI has been released other than instances
of disclosure: for treatment, payment, and operations; to you and
your family; or pursuant to your written authorization. The list
also will not include any disclosures made for national security
purposes, to law enforcement officials or correctional facilities,
or disclosures made before April 14, 2003. We will respond to your
written request for such a list within 60 days of receiving it. Your
request can relate to disclosures going as far back as six years but
not earlier than April 14, 2003. There will be no charge for up to
one such list each year. There may be a charge for more frequent
requests.
To receive this
notice:
You have a right to receive a paper copy of this Notice and/or an
electronic copy by email upon request.
How to Complain
about our Privacy Practices
If you think we
may have violated your privacy rights, or you disagree with a
decision we made about access to your PHI, you may file a complaint
with the person listed in Section VI below. You also may file a
written complaint with the Secretary of the U.S. Department of
Health and Human Services, c/o HHS Privacy Advocate John Fanning,
HHH Bldg, Room 440-D, Washington, DC 20201; Phone: 202-690-5896. We
will take no retaliatory action against you if you make such
complaints.
Contact Person
for Information, or to Submit a Complaint.
If you have
questions about this Notice or any complaints about our privacy
practices, please contact: Health Commissioner, Allen County Health
Department, 219 East Market St., Lima, OH 45802-1503.
Effective Date
The effective
date for this document is April 14, 2003.
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