Notice of Privacy Practices (download by clicking here)
(Effective 5/1/04) 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. The terms of this Notice of Privacy Practices apply to Catholic Charities a HYBRID entity under the federal HIPAA privacy regulations as a result of the provision of health care services through one or more programs, including Behavioral Health services (Mental Health and Chemical Dependency services), Adult Day services and Foster Care services. (Hereinafter referred to as “Covered Programs”.) Catholic Charities also has programs which do not provide health care services and are not covered under HIPAA. The members of the Covered Programs providing work and practice are located in the eight counties of the Diocese of Cleveland: Ashland, Cuyahoga, Geauga, Lake, Lorain, Medina, Summit, and Wayne Counties. All of the Covered Programs entities and persons listed will share personal health information of our clients as necessary to carry out treatment, payment, and health care operations as permitted by law. We are required by law to maintain the privacy of our clients’ personal health information and to provide persons served with notice of our legal duties and privacy practices with respect to your personal health information and to notify you in the unlikely event of a breach or unauthorized disclosure of your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices at Catholic Charities Administrative Location at 7911 Detroit Avenue, Cleveland, OH 44102 or a copy may be obtained by mailing a request to Catholic Charities Privacy Officer at 6753 State Road, Parma, OH 44134. You can also download a copy from our website at www.ccocle.org. USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION Your Authorization. Except as outlined below, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization. There are certain uses and disclosures of your personal health information for which we will always obtain a prior authorization and these include:
- Marketing communications unless the communication is made directly to you in person, is simply a promotional gift of nominal value, is a prescription refill reminder, general health or wellness information, or a communication about health related products or services that we offer or that are directly related to your treatment.
- Psychotherapy notes unless otherwise permitted or required by law.
- Uses and Disclosures for Treatment. We will make uses and disclosures of your personal health information as necessary for your treatment. For instance, clinicians, nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, tests, etc. We may also release your personal health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you.
- Uses and Disclosures for Payment. We will make uses and disclosures of your personal health information as necessary for the payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your health care services and treatment to your insurance company to arrange payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your payment.
- Uses and Disclosures for Health Care Operations. We will use and disclose your personal health information as necessary, and as permitted by law, for our health care operations which include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your personal health information for purposes of improving the clinical treatment and care of our patients. We may also disclose your personal health information to another health care facility, health care professional, or health plan for such things as quality assurance and case management, but only if that facility, professional, or plan also has or had a client relationship with you.
- Business Associates. Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain of your personal health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information. Appointments and Services. We may contact you to provide appointment reminders or test results. You have the right to request and we will accommodate reasonable requests by you to receive communications regarding your personal health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. You may request such confidential communication to your assigned worker.
- Research. In limited circumstances, we may use and disclose your personal health information for research purposes. For example, a research organization may wish to compare outcomes of all clients that received a particular drug and will need to review a series of medical records. In all cases where your specific authorization has not been obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board or privacy board which oversees the research or by representations of the researchers that limit their use and disclosure of client information.
- Confidentiality of Alcohol and Drug Abuse Client Records. The confidentiality of alcohol and drug abuse client records maintained by Catholic Charities Covered Programs is protected by federal law and regulations. Generally, the Covered Program may not say to a person outside the program that you attend a drug or alcohol program, or disclose any information identifying you as an alcohol or drug abuser unless: (1) you consent in writing: (2) the disclosure is allowed by law; or (3) the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation. Federal law and regulations do not protect any information about a crime committed by you either at our Covered Programs or against any person who works for the Covered Program or about any threat to commit such a crime. Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.
- Other Uses and Disclosures. We are permitted or required by law to make certain other uses and disclosures of your personal health information without your consent or authorization. We may release your personal health information for any purpose required by law; We may release your personal health information for public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations; We may release your personal health information as required by law if we suspect child abuse or neglect; we may also release your personal health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence; We many release immunization records to a student’s school but only if parents or guardians (or the student if not a minor) agree in writing; We may release your personal health information to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls; We may release your personal health information to your employer when we have provided health care to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer; We may release your personal health information if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings; We may release your personal health information if required to do so by subpoena or discovery request; in some cases you will have notice of such release; We may release your personal health information to law enforcement officials as required by law to report wounds and injuries and crimes; We may release your personal health information to coroners and/or funeral directors consistent with law; We may release your personal health information for certain research purposes when such research is approved by an institutional review board with established rules to ensure privacy; We may release your personal health information in limited instances if we suspect a serious threat to health or safety; We may release your personal health information if you are a member of the military as required by armed forces services; we may also release your personal health information if necessary for national security or intelligence activities; and We may release your personal health information to workers’ compensation agencies if necessary for your workers’ compensation benefit determination. Ohio law requires that we obtain a consent from you in many instances before disclosing the performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition; before disclosing information about drug or alcohol treatment you have received in a drug or alcohol treatment program; and before disclosing information about mental health services you may have received.
RIGHTS THAT YOU HAVE
- Access to Your Personal Health Information. You have the right to copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. We may charge you 10 cents per page if you request a copy of the information, but may be waived at the discretion of the site Director, depending on circumstances. We will also charge for postage if you request a mailed copy and will charge for preparing a summary of the requested information if you request such summary. You may obtain an access request form from your assigned worker or your site Director or Client & Civil Rights Liaison.
- You have the right to obtain an electronic copy of your health information that exists in an electronic format and you may direct that the copy be transmitted directly to an entity or person designated by you, provided that any such designation is clear, conspicuous, and specific with complete name and mailing address or other identifying information. We may charge you a fee for our labor and supplies in preparing your copy of the electronic health information.
- Amendments to Your Personal Health Information. You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from your assigned worker and/or your site Director or Client & Civil Rights Liaison.
- Accounting for Disclosures of Your Personal Health Information. You have the right to receive an accounting of certain disclosures made by us of your personal health information for six years prior to the date of your request. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from your assigned worker or your site Director or Client & Civil Rights Liaison. The first accounting in any 12-month period is free. You may be charged a fee of $15.00 for each subsequent accounting you request within the same 12-month period, but may be waived at the discretion of the site Director, depending on circumstances. When you request an accounting of disclosures of your electronic health record, the accounting will be for three years prior to the date of the request for the accounting and will include, in addition to all types of disclosures listed in the general policy, disclosures for treatment, payment and health care operations. For electronic health records acquired by us as of January 1, 2009, these requirements will apply to disclosures made by the organization from such a record on and after January 1, 2014. For electronic health records acquired after January 1, 2009, these requirements will apply to disclosures made by the organization from such a record on and after the later of January 1, 2011.
- Restrictions on Use and Disclosure of Your Personal Health Information. You have the right to request restrictions on certain of our uses and disclosures of your personal health information for treatment, payment, or health care operations. A restriction request form can be obtained from your assigned worker and/or your site Director or Client & Civil Rights Liaison. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing, any agreed-to restriction by sending such termination notice to your assigned worker and/or your site Director or Client & Civil Rights Liaison. We will honor any request to restrict disclosures to your health plan if the information to be disclosed pertains solely to a health care item or service for which a Catholic Charities Covered Program has been paid in full.
- Breach Notification: In the unlikely event that there is a breach, or unauthorized release of your personal health information, you will receive notice and information on steps you may take to protect yourself from harm.
- Complaints. If you believe your privacy rights have been violated, you can file a complaint in writing with your site Client & Civil Rights Liaison and or Catholic Charities Privacy Officer. An optional Complaint Form to initiate the complaint/grievance procedure is available in each behavioral health site and at Catholic Charities Administration location between the hours of 8:30 AM to 5:00 PM, Monday through Friday. Any Covered Program staff member that you elect may assist you with filing a complaint/grievance and explaining the process, if needed. You may mail or give the written complaint/grievance to your site’s Client & Civil Rights Liaison, Catholic Charities Client Rights & Privacy Officer or any staff member you trust. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services at 233 North Michigan Avenue, Suite 240, Chicago, IL 60601 or email OCRComplaint@hhs.gov in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.
- Acknowledgment of Receipt of Notice. You will be asked to sign an acknowledgment form that you received this Notice of Practice Practices. Behavioral Health services (Mental Health and Chemical Dependency services) and Foster Care services incorporate the Notice of Privacy Practices in the Client/Persons Served Guidebook and you will be asked to sign the Persons Served/Client Orientation Checklist acknowledging receipt of this information.
FOR FURTHER INFORMATION If you have questions or need further assistance regarding this Notice, you may contact Michele Adams, Catholic Charities Client Rights & Privacy Officer at 6753 State Road, Parma, OH 44134, telephone 440.843.5578, email email@example.com. As a client you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.