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.

 

If you have any questions about this notice, please contact

 Compliance Officer(s) at 301-739-2490.

 

 

 

WHO WILL FOLLOW THIS NOTICE.

 

This notice describes our agency practices and that of:

 

Ø      All Washington County Mental Health Authority (WCMHA) staff authorized to enter information into your chart.

 

Ø      All organization involved in the continuity of your care.

 

Ø      All of these entities, sites and locations follow the terms of this notice.  In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations purposes described in this notice.

 

OUR PLEDGE REGARDING MEDICAL INFORMATION:

 

We understand that medical information about you and your health is personal.

We are committed to protecting medical information about you.  We may create a record of the care and services you receive in the community.  We need this record to provide you with quality care and to comply with certain legal requirements.  This notice applies to all of the information that we receive or disseminate.  Other organizations may have different policies or notices regarding use and disclosure of your medical information.

 

This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

 

Law to requires us to:

 

 

 

 

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.

 

The following categories describe different ways that we use and disclose medical information.  For each category of uses of disclosures we will explain what we mean and try to give some examples.  Not every use of disclosure in a category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

 

Ø      For Treatment.  We may use information about you to provide you with treatment or services.  We may disclose information about you to health care providers, or others we use to provide services as part of your care that are involved in your treatment.

 

Ø      For Payment.  We may use and disclose medical information about you so that the treatment and services you receive by a treatment provider may be billed to and payment may be collected from you, an insurance company or a third party.  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.

 

Ø      Health-Related Benefits and Services.  We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

 

Ø      Individuals Involved in Your Care or Payment for Your Care.   We may release medical information about you to someone who is involved in your medical care.  We may also give information to someone who helps pay for your care.  In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

 

Ø      As Required By Law.  We will disclose medical information about you when required to do so by federal, state or local law.

 

Ø      To Avert a Serious Threat to Health or Safety.   We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety to the public or another person.  Any disclosure, however, would only be to someone able to help prevent the threat.

 

SPECIAL SITUATIONS

 

Ø      Military and Veterans.  If you are a member of the armed forces, we may release medical information about you as required by military command authorities.  We may also release medical information about foreign military personnel to the appropriate foreign military authority.

 

Ø      Workers’ Compensation.  We may release medical information about you for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

 

Ø      Public Health Risks.  We may disclose medical information about you for public health activities.  These activities generally include the following:

·        To prevent or control disease, injury or disability;

·        To report child abuse or neglect;

·        To notify the appropriate government authority if we believe a patient 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.

 

Ø      Health Oversight Activities.  We may disclose medical 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.

 

Ø      Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order.  We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

 

Ø      Law Enforcement.  We may release medical information if asked to do so by a law enforcement official:

·        In response to court order, subpoena, warrant, summons or similar process;

·        To identify or locate a suspect, fugitive, material witness, or missing person;

·        About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;

·        About a death we believe may be the result of criminal conduct;

·        In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

 

Ø      National Security and Intelligence Activities.  We may release medical information about you to authorized federal official for intelligence, counterintelligence, and other national security activities authorized by law.

 

Ø      Protective Services for the President and Others.  We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

 

Ø      Inmates.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical 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.

 

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.

 

You have the following rights regarding medical information we maintain about you:

 

Ø      Right to Inspect and Copy.  You have the right to inspect and copy medical information that may be used to make decisions about your care.  Usually, this includes medical and billing records, but does not include psychotherapy notes.

 

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Executive Director of WCMHA.  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 a 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 the hospital 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.

 

Ø      Right to an Accounting of Disclosures.  You have the right to request an “accounting of disclosures.”  This is a list of the disclosures we made of medical information about you.

 

To request this list of accounting of disclosures, you must submit your request in writing to the Executive Director of WCMHA.  Your request must state a time period, which may not be longer than six years and may not include dates before February 26, 2003.  Your request should indicate in what form you want the list (for example, on paper, electronically).  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.

 

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 you emergency treatment.

 

To request restrictions, you must make your request in writing to the Executive Director of WCMHA.  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.

 

Ø      Right to Request Confidential Communications.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail.

 

To request confidential communications, you must make your request in writing to the Executive Director of WCMHA.  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.

 

Ø      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.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

 

You may obtain a copy of this notice at our website, www.wcmha.org

 

To obtain a paper copy of this notice, contact the Compliance Officer of the WCMHA.

 

 

CHANGES TO THIS NOTICE

 

Ø      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 in our office.  The notice will contain on the first page, in the top right-hand corner, the effective date.

 

COMPLAINTS

 

If you believe your privacy rights have been violated, you may file a compliant with the WCMHA or with the Secretary of the Department of Health and Human Services.  To file a compliant with the WCMHA, contact Compliance Officer(s) at 301-739-2490.  All complaints must be submitted in writing.

 

You will not be penalized for filing a compliant.

 

OTHER USES OF MEDICAL INFORMATION.

 

Other uses and disclosures of medical 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 medical 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 medical 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.