NOTICE OF PRIVACY PRACTICES/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.
State and Federal law advise us to maintain the privacy of your health information and to inform you about our privacy practices by providing you with this Notice. We must follow the privacy practices as described below. This Notice will take effect on August 1, 2009, and will remain in effect until it is amended or replaced by us.
It is our right to change our privacy practices provided law permits the changes. Before we can make significant changes, this Notice will be amended to reflect the changes and we will make our Notice available upon request. We reserve the right to make any changes in our privacy practices and the new terms of our Notice effective for all health information maintained, created and/or received by us before the date changes were made.
You may request a copy of our Privacy Notice at any time by contacting our Women’s Center Managers, or our Director of Women’s Centers, Meg Carnahan. Information on contacting us can be found at the end of this Notice.
Typical uses and disclosures of health information
We will keep your health information confidential, using it only for the following purposes:
Treatment: We may use your health information to provide you with our professional services. We have established “minimum necessary or need to know” standards that limits various staff members’ access to your health information according to their primary job functions. Everyone on staff is required to sign a confidentiality agreement. We reserve the right to maintain, at a minimum, a copy of your Client Intake Sheet in order to document your written consent for care and the specific service(s) provided.
Disclosure: We may disclose and/or share your healthcare information with other health care professionals who provide treatment and/or services to you. These professionals will have a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family, friends and/or other person you choose to involve in your care, only if you agree that we may do so.
Emergencies: We may use or disclose your health information to notify you of a physician’s recommendations for urgent or emergency follow-up care via phone, text message and/or mail. We may also use or disclose your health information to assist in the notification of a family member or anyone responsible for your care, in case of urgent/emergency matter involving your care (as directed by a physician), including your location, your pregnancy status, general condition or death. If at all possible we will provide you with an opportunity to object to this use or disclosure. Under emergency conditions or if you are incapacitated we will use our professional judgment to disclose only that information directly relevant to your care. We will also use our professional judgment to make reasonable inferences of your best interest by allowing someone to pick up ultrasounds or other similar forms of health information and/or supplies unless you have advised us otherwise.
Healthcare Operations: We will use and disclose your health information to keep our services available. Examples of personnel who may have access to this information include, but are not limited to, our staff, outside health or management reviewers and individuals performing similar activities.
Required by Law: We may use or disclose your health information when we are required to do so by law. (Court or administrative orders, subpoena, discovery request or other lawful process.) (Results for HIV are confidential but law requires that positive results be reported to the Ohio Department of Health.) We will use and disclose your information when requested by national security, intelligence and other State and Federal officials and/or if you are an inmate or otherwise under the custody of law enforcement.
Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.
Public Health Responsibilities: We will disclose your health care information to report problems with products, reactions to medications, product recalls, disease/infection exposure and to prevent and control disease, injury and/or disability.
Marketing Health-Related Services: We will not use your health information for marketing purposes unless we have your written authorization to do so.
National Security: The health information of Armed Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence, counterintelligence or other national security activities, we may disclose it to authorized federal authorities.
Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders, including, but not limited to, voicemail messages, postcards and letters.
YOUR PRIVACY RIGHTS AS OUR CLIENT
Access: Upon written request, you have the right to inspect and get copies of your health information. There will be some limited exceptions. If you wish to examine your health information, you will need to complete and submit an appropriate request form. Contact our Women’s Center Manager for a copy of the Request Form. You may also request access by sending us a letter to the address at the end of this Notice. Once approved, an appointment can be made to review your records. Fees for copies, if requested, may be $15.00 for record retrieval, plus $1.00 per page. Staff time charged may be $12.00 per hour including the time required to locate and copy your health information. If you want copies mailed to you, postage will also be charged. If you prefer a summary or an explanation of your health information, we will provide it for a fee of $20.00 per hour.
Amendment: You have the right to request receipt of receive a list of non-routine disclosures we have made of your health care information. When we make a routine disclosure of your information to a professional for treatment, we do not keep a record of routine disclosures: therefore, these are not available. You have the right to a list of instances in which we disclose information for reasons other than treatment or healthcare operations. You can request non-routine disclosures going back 6 years starting on April 14, 2003. Information prior to that date would not have to be released. (Example: If you request information on August 1, 2009, the disclosure period would start on April 14, 2003 up to August 1, 2009. Disclosures prior to April 14, 2003 do not have to be made available.)
Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We do not have to agree to these additional restrictions, but if we do, we will abide by our agreement (except in emergencies.) Please contact our Women’s Center Manager if you want to further restrict access to your health care information. This request must be submitted in writing.
QUESTIONS AND COMPLAINTS
You may file a complaint if you believe your privacy rights have been violated or if you disagree with a decision we made regarding your access to your health information. Your complaint should be directed to our Women’s Center Manager or Director of Women’s Centers, at the address below. All complaints must be made in writing and should be submitted within 180 days of when you knew or should have known of the suspected violation. There will be no retaliation against you for filing a complaint.
Director of Women’s Centers: Meg Carnahan
Address: 359 Forest Ave, Dayton, OH 45405
If you are under 18 we may discuss serious health information with a parent or legal guardian. If you are 18 or older and want us to be able to discuss your health information with any other person, you will need to speak with a Women’s Center employee.
Please Sign below to acknowledge receipt of the Notice of Privacy Practices.