Gratiot County Community Mental Health (GCCMH)
NOTICE OF PRIVACY PRACTICES
This notice describes how personal and medical information about you may be used
and disclosed and how you can access this information. GCCMH is required to give
you this notice of our legal duties and privacy practices with respect to information
about you. You may ask us to give you a copy of this notice at any time.
WHO WILL FOLLOW THIS NOTICE:
Any authorized individual who may have access to your
medical information such as mental health professionals, other CMH staff, business
associates, student interns, and volunteers within GCCMH will follow the terms of
the privacy notice that is in effect.
OUR PRIVACY COMMITMENT TO YOU:
Information about you is personal, private and confidential. We are committed to
protecting your information. A paper and electronic record may be created of the
care and services you receive from us and information received from other providers
who are involved in your care. We are required by law to keep these records and
to ensure that this information is kept private and secure. Unless your permission
is given, disclosure of your information will only be given for the purposes of
treatment, payment, health care operations, or when required by law to do so.
Treatment:
Information may be disclosed to coordinate your services. This may include
sharing information with your doctor, treatment team, supervisory personnel, support
staff, students or other health care professionals who are involved in providing
your care.
Payment for Services:
Information may be disclosed so that
we may bill and receive payment for services you receive. This may include health
plans, the Department of Community Health, an insurance company, a third party,
or payment may be collected from you.
Health Care Operations:
Information may be disclosed for the agency’s business operations
to occur. This may include activities such as services provided through business
associates and contract providers, to avoid a serious health or safety threat, appointment
reminders, satisfaction surveys, staff performance evaluation, demographic studies,
required reporting, clinical review, health professional education, approved research
projects, training purposes, public health risks, and as required by law.
Alcohol and Drug Records:
Information about alcohol or drug use will not be disclosed
unless you give written consent; or the disclosure is allowed by court order; or
the disclosure is made to emergency personnel for an emergency or to a qualifying
person for research, audit or program evaluation.
With Your Permission:
Information may be disclosed in other situations not covered
by this notice with your written permission. If you give your permission, you have
the right to change your mind.
YOUR RIGHTS REGARDING YOUR INFORMATION (requests for actions listed must be in writing):
- You have the right to inspect and copy information from your record. This includes
medical and billing records, but may not include psychotherapy notes. If you request
a copy, we may charge a small fee for this service.
- If you feel that information
we have about you is incorrect or incomplete, you may ask us to amend your record.
We may deny your request if there is just cause for such an action.
- You have the
right to request an accounting of disclosures of your information that are not covered
by the scope of this notice.
- You have the right to request a restriction on how
your information is used or disclosed. We are not required to agree to your request
if there is cause for such action.
- You have the right to request the method of
communication we use with you. All reasonable requests will be followed.
CHANGES TO THIS NOTICE: We reserve the right to revise this notice. A revised
notice is effective for information we already possess. We are required by law to
comply with the notice that is currently in effect. A copy of the current notice
will be posted at all Agency locations.
COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint
in writing with the Agency’s Privacy Officer, Gratiot County CMH, P.O. Box 69, Alma,
Michigan, 48801-0069. You may also contact the Secretary of the Department of Health
and Human Services.
You will not be penalized for filing a complaint.
You may obtain a copy of this notice at our website, www.gccmha.org
If you have questions about this notice, please contact the Privacy Officer, 608
Wright Avenue, Alma, MI 48801, (989) 463-4971.
Revised: January 2009