Effective
NOTICE OF PRIVACY PRACTICES
This notice will tell you about the ways in
which we may use and disclose mental health and/or medical information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of mental health and/or medical
information.
PLEASE READ THIS
NOTICE CAREFULLY
If you have
questions about this notice, please contact the Privacy Officer at Gratiot County
Community Mental Health (GCCMH),
989 463-4971.
We are required by
law to:
§
make sure that information that identifies you
is kept private;
§
give you this notice of our legal duties and
privacy practices with respect to mental health and/or medical information about you; and
§
follow the terms of the notice that is
currently in effect.
WHO WILL FOLLOW
THIS NOTICE:
This notice
describes GCCMH’s practices and that of:
§
Any mental health professional authorized to
enter information into your record.
§
Staff and students of all departments and units
of GCCMH.
§
Any member of a volunteer group we allow to
help you while you are receiving services at GCCMH.
OUR PLEDGE
REGARDING MENTAL HEALTH INFORMATION:
We understand that
information about you and your mental health treatment is personal. We are committed to protecting mental health
information about you. We create a record,
paper and electronic, of the care and services you receive from us. We need this record to provide you with quality
care and to comply with certain legal requirements. This
notice applies to all of the records of your care generated by GCCMH or GCCMH personnel.
HOW WE MAY USE
AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The following
categories describe different ways that we use and disclose medical information:
For Treatment. We may use information about you to provide you
with mental health treatment or related services, or disclose information about you to any
doctors, treatment team and their supervisors, support staff or students who are involved
in taking care of you or your records while you receive services from GCCMH. For example, a doctor treating you for depression
may need to know if you are taking medication for seizures before prescribing medication
for the depression.
For Payment. We may use and disclose information about you so
that the treatment and services you receive at GCCMH may be billed and payment may be
collected from you, an insurance company or a third party.
For example, we may need to give your health plan information about the
treatment you receive at GCCMH so that your health plan will pay us or reimburse you for
treatment. We may also tell your health plan
about a treatment you are going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
For Business
Health Care Operations. We may use and disclose information about you for
GCCMH’s operations. These uses and
disclosures are necessary to run GCCMH, and make sure that all our consumers receive
quality care. For example, we may use
information to review our treatment and services, to evaluate the performance of our
staff, or assess your satisfaction. We may
also combine information about many consumers to decide what additional services GCCMH
should offer, what services are not needed and whether certain new treatments are
effective. We may also disclose information to
clinicians, doctors, nurses, students and other personnel for review and learning
purposes.
Business Associates. There
are some services provided in our organization through contacts with business associates. When any services are contracted, we may disclose
your health information so they may perform the job we’ve asked them to do and bill
you or your health plan. To protect your
health information, however, we require the business associate to appropriately safeguard
your information.
Health-Related Benefits and Services. We
may use and disclose information to tell you about health-related benefits or services
that may be of interest to you.
Individuals Involved in Your Care or Payment
for Your Care. With your
consent, we may, notify or release information about you to a friend or family member who
is involved in your care. We may also, with
your consent, give information to someone who helps pay for your care.
Research. Under certain circumstances, we may use and
disclose information about you for research purposes.
For example, a research project may involve comparing the health and
recovery of all clients who received one medication to those who received another, for the
same condition. All research projects,
involving individuals not employed by GCCMH, are subject to a special approval process. We will ask for your specific
permission if the researcher will have access to your name, address or other information
that reveals who you are, or if they will be involved in your care at GCCMH.
As Required By Law. We will disclose information about you when
required to do so by federal, state or local law. For instance, the State of
To Avert a Serious Threat to Health or Safety. We may use and disclose information about you
when necessary to prevent a serious threat to your health and safety or the health and
safety of the public or another person. Any
disclosure, however, would only be to someone able to help prevent the threat.
Public Health Risks. We may disclose information about you for
public health activities. These activities
generally include the following: 1) to prevent
or control disease, injury or disability; 2) to report births and deaths; 3) to report
child abuse or neglect; 4) to report reactions to medications or problems with products;
5) to notify people of recalls of products they may be using; 6) to notify a person who
may have been exposed to a disease or may be at risk for contracting or spreading a
disease or condition; 7) to notify the appropriate government authority if we believe a
person has been the victim of abuse, neglect or domestic violence.
We will only make this disclosure if you agree
or when required or authorized by law.
Health Oversight Activities. We may disclose information to a health
oversight agency for activities authorized by law. These
oversight activities include, for example, audits, investigations, inspections, and
licensure. These activities are necessary for
the government to monitor the health care system, government programs, and compliance with
civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or dispute,
we may disclose information about you in response to a court or administrative order.
Law Enforcement. We may release information to a law enforcement
official: 1) in response to a court order; 2) to identify or locate missing person; 3) if
we believe that there is a duty to warn an individual of risk or harm by another
individual.
Coroners, and Medical Examiners. We
may release information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person or
determine the cause of death.
Protective Services for the President and
Others. We may disclose information about you to authorized
federal officials so they may provide protection to the President, other authorized
persons or foreign head of state or to conduct special investigations.
Inmates. If
you are an inmate of a correctional institution or under the custody of a law enforcement
official, we may release information about you to the correctional institution or law
enforcement official. This release would be
necessary: 1) for the institution to provide you with health care; 2) to protect your
health and safety or the health and safety of others; or 3) for the safety and security of
the correctional institution.
Confidentiality of Alcohol and Drug Records. The
confidentiality of alcohol and drug abuse records maintained by GCCMH is protected by
federal law and regulations. Generally, the program may not say to a person outside the
program that you attend the program, or disclose any information identifying you as an
alcohol or drug abuser unless one of the following conditions is met: 1) you consent in writing; 2) the disclosure is
allowed by court order; or 3) the disclosure is made to emergency personnel for an
emergency or to a qualified person for research, audit or program evaluation.
Violation of the
federal law and regulations by GCCMH is a crime. Suspected violations may be reported to
appropriate authorities in accordance with federal regulations. Federal law and
regulations do not protect any information about a crime committed by you either at the
program or against any person who works for the 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.
YOUR RIGHTS REGARDING MENTAL HEALTH/MEDICAL
INFORMATION ABOUT YOU.
Right to Inspect and Copy. You
have the right to inspect and copy information, from your record, that may be used to make
decisions about your care. Usually, this
includes medical and billing records, but may not include psychotherapy notes. To inspect and copy information that may be used to
make decisions about you, you must submit your request in writing to your primary
therapist, case manager or supports coordinator. If
you request a copy of the information, we may charge a fee for the costs of copying,
mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to
medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by
GCCMH will review your request and the denial. The
person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend Your Record: If you believe that your personal health
information or treatment record is incorrect or that an important part of it is missing,
you have the right to ask us to amend your treatment record. You must provide your request
and your reason for the request in writing, and submit it to your primary therapist, case
manager, or supports coordinator. We may deny your request if it is not in writing
or does not include a reason that supports the request. In addition, we may deny your
request if you ask us to amend personal health information that: 1) is accurate and
complete; 2) was not created by GCCMH, unless the person or entity that created the
Personal Health Information is no longer available to make the amendment; 3) is not part
of the Personal Health Information kept by or for GCCMH; or 4) is not part of the Personal
Health Information which you would be permitted to inspect and copy.
Right to an Accounting of Disclosures.
You have the right to request an “accounting of disclosures.” This is a list of the disclosures that we made of
information about you. To request this list or
accounting of disclosures, you must submit your request in writing to your primary
therapist, case manager or supports coordinator. Your
request must state a time period for which you are requesting the information. The first list you request within a 12 month period
will be free. For additional lists, we may
charge you for the costs of providing the list. We
will notify you of the cost involved and you may choose to withdraw or modify your request
at that time before any costs are incurred.
Right to Request Restrictions.
You or your parent, if you are a minor, or your guardian must provide written
authorization to have information about your mental health treatment shared with others. However, you have the right to request a
restriction or limitation on the information we use or disclose about you for treatment,
payment or health care operations. You also
have the right to request a limit on the information we disclose about you to someone who
is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or
disclose information to your spouse about a particular drug you are taking. We are not required to agree to your request. If we do agree, we will comply with your request
unless the information is needed to provide emergency treatment to you. To request restrictions, you must make your request
in writing to your primary therapist, case manager or supports coordinator. In your request, you must tell us: 1) what information you want to limit; 2) whether
you want to limit our use, disclosure or both; and 3) to whom you want the limits to
apply, for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we
communicate with you in a certain way or at a certain location. For example, you can ask that we contact you only
at work or only by mail. To request
confidential communications, you must make your request in writing to your primary
therapist, case manager or supports coordinator. We
will not ask you the reason for your request. We
will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice.
You have the right to a paper copy of this notice.
You may ask us to give you a copy of this notice at any time. You may also obtain a copy of this notice at our
website, www.gccmha.org. To obtain a
paper copy of this notice, contact your primary therapist, case manager or supports
coordinator.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We
reserve the right to make the revised or changed notice effective for medical information
we already have about you as well as any information we receive in the future. We will post a copy of the current notice at all
GCCMH locations. This notice will contain, on
the first page, in the top right-hand corner, the effective date. In addition, when you register to begin treatment
at GCCMH, we will offer you a copy of the current notice in effect.
COMPLAINTS ABOUT PRIVACY PRACTICES
If you believe your privacy rights have been violated, you may file a written
complaint with GCCMH or with the Secretary of the Department of Health and Human Services. To file a written complaint with GCCMH, contact the
Privacy Officer,
OTHER USES OF MENTAL HEALTH/MEDICAL
INFORMATION.
Other uses and disclosures of information not covered by this notice or the laws
that apply to us will be made only with your written permission. If you provide us permission to use or disclose
information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer
use or disclose information about you for the reasons covered by your written
authorization. You understand that we are
unable to take back any disclosures we have already made with your permission and that we
are required to retain our records of the care that we provided to you.
This notice is available upon request in other
languages and alternate formats that meet legal requirements for the Americans with
Disabilities Act (ADA).
Esta notificación está disponible en otras
lenguas y formatos diferentes que satisfacen las normas