Favette Countv Health Department
NOTICE
OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH
INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
THE
PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
OUR
LEGAL DUTY
We
are required by applicable federal and state law to maintain the privacy of your
health information. We are also required to give you this Notice about our
privacy practices, our legal duties, and your rights concerning your health
information. We must follow the privacy practices that are described in this
Notice while it is in effect. This Notice takes effect April 15, 2003 and will
remain in effect until we replace it.
We
reserve the right to change our privacy practices and the terms of this Notice
at any time, provided such changes are permitted by applicable law. We reserve
the right to make the changes in our privacy practices and the new terms of our
Notice effective for all health information that we maintain, including health
information we created or received before we made the changes. Before we make a
significant change in our privacy practices, we will change this Notice and make
the new Notice available upon request.
You
may request a copy of our Notice at any time. For more information about our
privacy practices, or for additional copies of this Notice, please contact us
using the information listed at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We
use and disclose health information about you for treatment, payment, and
healthcare operations. For example:
Treatment:
We may use or disclose your health information to a physician or other
healthcare provider providing treatment to you.
Payment:
We may use and disclose your health information to obtain payment for services
we provide to you.
Healthcare
Operations: We may use and disclose your health information in connection with
our healthcare operations. Healthcare operations include quality assessment and
improvement activities, reviewing the competence or qualifications of healthcare
professionals, evaluating practitioner and provider performance, conducting
training programs, accreditation, certification, licensing or credentialing
activities.
Your
Authorization: In addition to our use of your health information for treatment,
payment or healthcare operations, you may give us written authorization to use
your health information or to disclose it to anyone for any purpose. If you give
us an authorization, you may revoke it in writing at any time. Your revocation
will not affect any use or disclosures permitted by your authorization while it
was in effect. Unless you give us a written authorization, we cannot use or
disclose your health information for any reason except those described in this
Notice.
To
Your Family and Friends: We must disclose your health information to you, as
described in the Patient Rights section of this Notice. We may disclose your
health information to a family member, friend or other person to the extent
necessary to help with your healthcare or with payment for your healthcare, but
only if you agree that we may do so.
Persons
Involved In Care: We may use or disclose health information to notify, or assist
in the notification of (including identifying or locating) a family member, your
personal representative or another person responsible for your care, of your
location. your general condition, or death. If you are present, then prior to
use or disclosure of your health information, we will provide you with an
opportunity to object to such uses or disclosures. In the event of your
incapacity or emergency circumstances, we will disclose health information based
on a determination using our professional judgment disclosing only health
information that is directly relevant to the person's involvement in your
healthcare. We will also use our professional judgment and our experience with
common practice to make reasonable inferences of your best interest in allowing
a person to pick up filled prescriptions, medical supplies, x‑rays, or
other similar forms of health information.
Marketing
Health‑Related Services: We will not use your health information for
marketing communications without your written authorization.
Required
by Law: We may use or disclose your health information when we are required to
do so by law.
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. We may disclose your
health information to the extent necessary to avert a serious threat to your
health or safety or the health or safety of others.
National Security: We may disclose to military authorities the health information of Armed
Forces personnel under certain circumstances. We may disclose to authorized
federal officials health information required for lawful intelligence.
counterintelligence, and other national security activities. We may disclose to
correctional institution or law enforcement official having lawful custody of
protected health information of inmate or patient under certain circumstances.
Appointment Reminders: We may use or disclose your health information to
provide you with appointment reminders (such as voicemail messages, postcards,
or letters).
PATIENT RIGHTS
Access: You have the right to look at or get copies of your health information,
with limited exceptions. You may request that we provide copies in a format
other than photocopies. We will use the format you request unless we cannot
practicably do so. (You must make a request in writing to obtain access to your
health information. You may obtain a form to request access by using the contact
information listed at the end of this Notice. We will charge you a reasonable
cost‑based fee for expenses such as copies and staff time. You may also
request access by sending us a letter to the address at the end of this Notice.
If you request copies, we will charge you $0.50 for each page.
Fees: One copy, without charge, is available to the client per year. Additional copies may be charged per ORC 3701.74(A)(4) and (B) and 3701.741 as follows:
An initial fee of $15, which compensates for the records search;
One dollar per page for the first ten pages;
Fifty cents per page for pages 11-50;
Twenty cents per page for pages 51 and higher.
The actual cost of the postage if mailed.
Disclosure Accounting: You have the right to receive a list of instances in
which we or our business associates disclosed your health information for
purposes, other than treatment, payment, healthcare operations and certain other
activities, for the last 6 years. but not before April 14, 2003. If you request
this accounting more than once in a 12‑month period, we may charge you a
reasonable, cost‑based fee for responding to these additional requests.
Restriction: You have the right to request that we place additional restrictions on
our use or disclosure of your health information. We are not required to agree
to these additional restrictions. but if we do, we will abide
by our agreement (except in an emergency).
Alternative Communication: You have the right to request that we communicate
with you about your health information by alternative means or to alternative
locations. (You must make your request in writing.) Your request must specify
the alternative means or location, and provide satisfactory explanation how
payments will be handled under the
alternative means or location you request.
Amendment: You have the right to request that we amend your health information.
(Your request must be in writing, and it must explain why the information should
be amended.) We may deny your request under certain circumstances.
Electronic Notice: If you receive this Notice on our Web site or by electronic mail
(e‑mail), you are entitled to receive this Notice in written form.
QUESTIONS AND
COMPLAINTS
If you want more information about our privacy
practices or have questions or concerns, please contact us.
If
you are concerned that we may have violated your privacy rights, or you disagree
with a decision we made about access to your health information or in response
to a request you made to amend or restrict the use or disclosure of your health
information or to have us communicate with you by alternative means or at
alternative locations, you may complain to us using the contact information
listed at the end of this Notice. You also may submit a written complaint to the
U.S. Department of Health and Human Services. We will provide you with the
address to file your complaint with the U.S, Department of Health and Human
Services upon request.
We
support your right to the privacy of your health information. We will not
retaliate in any way if you choose to file a complaint with us or with the U.S.
Department of Health and Human Services.
Contact Officer: Karen Lowe
Telephone
740‑333-3590
Fax:
740‑636-1583
Email: fayecohd@odh.ohio.gov
Address:
317 S. Fayette Street, Washington Court House, OH 43160