Catholic Charities Community Services/Summit County NOTICE OF PRIVACY PRACTICES
IMPORTANT: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY AND ACKNOWLEDGE RECEIPT BY YOUR SIGNATURE ON THE FORM PROVIDED.
The terms of this Notice of Privacy Practices applies to Catholic Charities Community Services/Summit County and are effective April 14, 2003. This organization and its employees will share individual health information of clients as necessary to provide quality services and receive reimbursement for those services as permitted by law. This office is required by law to maintain the privacy of our clients’ individual health information according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the state of Ohio laws governing the protection of individually identifiable information and to provide clients with notice of privacy practices with respect to your individual personal/health information. We are required to abide by the terms of this Notice so long as it remains in effect, and we reserve the right to change the terms of this Notice of Privacy Practices as necessary. A copy of any revised notices will be available in this office or upon request to the HIPAA Privacy Officer at Catholic Charities Community Services/Summit County : 812 Biruta St. , Akron, Ohio 44307, telephone 330.762.2961. A copy may be mailed to your address that we have maintained on file.
Please contact Community Services and ask to speak to a staff representative of the HIPAA committee with any questions of concerns that you may have about this Notice of Privacy Practices of Catholic Charities Community Services/Summit County.
USES AND DISCLOSURES OF YOUR PERSONAL INFORMATION
Except as described below, this office will maintain the confidentiality of your individual health information. Your individual health information may be used and disclosed as customary and reasonable for purposes of treatment, payment, and daily agency operations. Other reasons requested by you, your representative or another entity will require you or your representative’s signature on the AUTHORIZATION TO RELEASE INFORMATION. You have the right to revoke that authorization in writing unless any action has been taken in reliance on the authorization.
Services/Treatment, Payment, Business and Daily Operations
Except as otherwise provided, or with your signed consent, Catholic Charities Community Services/Summit County will use and disclose your individual health information as necessary for purposes of your receiving services, payment, and as necessary and permitted by law, for our business and daily agency operations which include adult day care, health care, recreation, individual care plans, athletics, camping, professional peer review, business management, record keeping, auditing, accreditation and licensing, etc.
Family and Friends
With your approval and using our best judgment, individual health information may be disclosed to designated family, friends, and others who are involved in your care or in payment for your care. If you are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share limited personal information with such individuals without your approval.
Appointments and Service
This office may contact you to schedule appointments, provide appointment reminders, follow up on program participants, or inform you about service alternatives, special events, or other related information that may be of interest to you. You have the right to request and we will accommodate reasonable requests by you to receive communications regarding you individual health information from us by alternative means or at alternative locations. You may request such confidential communication in writing and may send your request to the Privacy Officer at Catholic Charities Community Services/Summit County . You also have the right to request that we not send you any future materials and we will use our best efforts to honor such request. You may make the request by sending your name and address to the Privacy Officer at Catholic Charities Community Services/Summit County .
At times it may be necessary for us to provide your individual health information to certain outside persons or organizations that assist us with the operations of our agency, such as auditing, accreditation, legal services, information technology services, etc. These Business Associates are required to properly safeguard the privacy of your information.
Other uses and disclosures of your individual health information, permitted or required by law, may be made without your consent or authorization.
- The release of your health information for any purpose required by law.
- The release of your individual health information for public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations.
- The release of your individual health information as required by law if we believe you to be involved in abuse, neglect, or domestic violence.
- The release of your health information to the Food and Drug Administration, if necessary, to report adverse events, product defects, or to participate in product recalls.
- The release of individual health information to your employer when we have provided services to you at the request of your employer; in most cases you will receive notice that information is disclosed to your employer.
- The release of your individual health information if required by law to a government oversight agency conducting audits, investigations, or civil/criminal proceedings.
- The release of your individual health information if required to do so by a court or administrative ordered subpoena or discovery request; in most cases you will have notice of such release.
- The release of your individual health information to law enforcement officials as required by law to report wounds, injuries, and crimes.
- The release of your individual health information to coroners and/or funeral directors consistent with law.
- The release of your individual health information if you are a member of the military as required by armed forces services; we may also release your individual health information if necessary for national security or intelligence activities.
- The release of your individual health information to workers’ compensation agencies if necessary for a workers’ compensation benefit determination.
Access to Individual Health Information. You have the right to copy and/or inspect much of the individual health information that we retain on your behalf. All requests for access must be in writing and signed by you or your designated/legal representative. We will process your request within 30 days. We will charge you a FEE of $1.00 per page if you request a copy of the information. 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 also obtain an Authorization to Release Information form from the Privacy Officer at Catholic Charities Community Services/Summit County.
Amendments to Individual Health Information, You have the right to request in writing that individual 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 the Privacy Officer at Catholic Charities Community Services/Summit County .
Accounting for Disclosures of Personal Health Information You have the right to receive an accounting of certain disclosures made by us of your individual health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Identification is required. Your request will be processed within 30 days or receipt. An Accounting of Disclosure request form are available from the Privacy Officer at Catholic Charities Community Services/Summit County . The first accounting in any 12-month period is free; you will be charged a FEE of $10.00 for each subsequent accounting you request within the same 12-month period.
Restrictions on Use and Disclosure of Personal Health Information You have the right to request restrictions on certain of our uses and disclosures of your individual health information. We are not required to agree to your restriction request, but will attempt to accommodate 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 or orally, any agreed-to restriction by communicating such termination notice to the Privacy Officer at Catholic Charities Community Services/Summit County .
Right to Request Confidential Communication You have the right to request that we communicate with you about PERSONAL HEALTH INFORMATION in a certain way or at a certain location if you tell us that communication in any other manner may endanger you. For example, you may ask that we contact you at work or by mail. You must make such a request in writing at the time of the intake process or by mail at any other time. Specify how or where you wish to be contacted.
Right to File a Complaint If you believe your privacy rights have been violated, you can contact the Privacy Officer to find out how to file a complaint, i.e., in writing, etc. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights at 330 Independence Avenue Southwest, Washington, DC 20237. There will be no retaliation for filing a complaint.
ADDITIONAL INFORMATION Changes to this notice. We reserve the right to change the terms of this notice at any time. The effective date of this notice and any revised or changed notice is located on the last page on the bottom left hand corner of the notice. A copy of any revised notices will be available at 812 Biruta St. Akron, Ohio 44307, telephone 330.762.2961.
If you have questions or need additional assistance regarding this Notice, you may contact the Privacy Officer at 812 Biruta St., Akron, OH 44307, telephone 330.762.2961.
April 7, 2003.
policy on confidentiality is in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the state of Ohio laws governing the protection of individually identifiable information.