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NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
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.
This notice of Privacy Practices is provided to you as a requirement
of the Health Insurance Portability and Accountability Act (HIPAA).
It describes how we may use or disclose your protected health information,
with whom that information may be shared, and the safeguards we
have in place to protect it. This notice also describes your rights
to access and amend your protected health information. You have
the right to approve or refuse the release of specific information
outside of our system except when the release is required or authorized
by law or regulation.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE
You will be asked to provide a signed acknowledgment of receipt
of this notice. Our intent is to make you aware of the possible
uses and disclosures of your protected health information and your
privacy rights. The delivery of your health care services will in
no way be conditioned upon your signed acknowledgment. If you decline
to provide a signed acknowledgment, we will continue to provide
your treatment, and will use and disclose your protected health
information for treatment, payment, and health care operations when
necessary.
WHO WILL FOLLOW THIS NOTICE
This notice describes Gulf Coast Mental Health Center (GCMHC) practices
regarding your protected health information. This notice includes
all facilities, programs, and services operated/conducted under
the auspices of Gulf Coast Mental Health Center.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION
"Protected health information" is individually identifiable
health information. This information includes demographics, for
example, age, address, and relates to your past, present, or future
mental health or condition and related health care services. GCMHC
is required by law to do the following:
- Make sure that your protected health information is kept private.
- Give you this notice of our legal duties and privacy practices
related to the use and disclosure of your protected health information.
- Follow the terms of the notice currently in effect.
- Communicate any changes in the notice to you.
We reserve the right to change this notice. Its effective date
is at the top of the first page and at the bottom of the last page.
We reserve the right to make the revised or changed notice effective
for health information we already have about you as well as any
information we receive in the future. You may obtain a Notice of
Privacy Practices by asking for a copy at your next appointment
or by calling the Privacy Officer and requesting a copy be mailed
to you.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Following are examples of permitted uses and disclosures of your
protected health information. These examples are not exhaustive.
Required Uses and Disclosures
By law, we must disclose your health information to you unless it
has been determined by a competent authority that it would be harmful
to you. We must also disclose health information to the Secretary
of the Department of Health and Human Services (DHHS) for investigations
or determinations of our compliance with laws on the protection
of your health information.
Treatment
We will use and disclose your protected health information to provide,
coordinate or manage your health care and any related services.
We may disclose your protected health information to other GCMHC
clinical staff to coordinate your treatment or other services requested.
Your protected health information may be disclosed to GCMHC physicians
who will review services provided to you for medical necessity,
for medication approval or medication monitoring. We may disclose
your protected health information to health care providers. For
example, pharmacists or laboratories who, at the request of your
physician, have become involved in your care by providing assistance
with your health care diagnosis or treatment. This includes pharmacists
who may be provided information on the other drugs you have been
prescribed to identify potential interactions.
In emergencies, we will use and disclose your protected health
information to provide the treatment you require.
Payment
Your protected health information will be used, as needed, to obtain
payment for your health care services. For example, we may send
a bill to you or to a third-party payer, such as a health insurer.
The information on or accompanying the bill may include information
that identifies you, your diagnosis, services received and dates
of service.
Health Care Operations
We may use or disclose, as needed, your protected health information
to support the daily activities related to health care. These activities
include, but are not limited to, quality assurance activities, investigations,
oversight or staff performance reviews, training of students, licensing,
communications about a product or service, and conducting or arranging
for other health care related activities.
For example, we may disclose your protected health information
to interns (students) seeing individuals at GCMHC. We may call you
by name in the waiting room when GCMHC staff is ready to see you.
We may use or disclose your protected health information, as necessary,
to contact you to remind you of your appointment.
We will share your protected health information with third-party
"business associates" who perform various activities (for
example, transportation or audit services) for GCMHC. The business
associate will also be required to protect your health information.
We may use or disclose your protected health information, as necessary,
to provide you with information about treatment alternatives or
other health-related benefits and services that might interest you.
For example, we may send you information about community resources
for services that GCMHC does not provide that we believe might benefit
you.
Required by Law
We may use or disclose your protected health information if law
or regulation requires the use or disclosure.
Public Health
We may disclose your protected health information to a public health
authority that is permitted by law to collect or receive the information.
The disclosure may be necessary to do the following:
- Prevent or control disease, injury, or disability.
- Report child abuse or neglect.
- Report reactions to medications or problems with products.
- Notify a person who may have been exposed to a disease or may
be at risk for contracting or spreading a disease or condition.
Communicable Diseases
We may disclose your protected health information, if authorized
by law, to a person who might have been exposed to a communicable
disease or might otherwise be at risk of contracting or spreading
the disease or condition.
Health Oversight
We may disclose protected health information to a health oversight
agency for activities authorized by law, such as audits, investigations,
and inspections. These health oversight agencies might include government
agencies that oversee the health care system, government benefit
programs, other government regulatory programs, and civil rights
laws.
Food and Drug Administration
We may disclose your protected health information to a person or
company required by the Food and Drug Administration to do the following:
- Report adverse events or product defects.
- Track products.
- Enable product recalls.
- Make repairs or replacements.
- Conduct post-marketing surveillance as required.
Legal Proceedings
We may disclose protected health information during any judicial
or administrative proceeding, in response to a court order or administrative
tribunal (if such a disclosure is expressly authorized), and in
certain conditions in response to a subpoena, discovery request,
or other lawful process.
Law Enforcement
We may disclose protected health information for law enforcement
purposes, including the following:
- Responses to legal proceedings
- Information requests for identification and location
- Circumstances pertaining to victims of a crime
- Deaths suspected from criminal conduct
- Crimes occurring at a GCMHC site
- Medical emergencies (not on GCMHC premises) believed to result
from criminal conduct
Coroners, Funeral Directors, and Organ Donations
We may disclose protected health information to coroners or medical
examiners for identification to determine the cause of death or
for the performance of other duties authorized by law. We may also
disclose protected health information to funeral directors as authorized
by law.
Research
We may disclose your protected health information to researchers
when authorized by law, for example, if their research has been
approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy
of your protected health information.
Criminal Activity
Under applicable Federal and state laws, we may disclose your protected
health information if we believe that its use or disclosure is necessary
to prevent or lessen a serious and imminent threat to the health
or safety of a person or the public. We may also disclose protected
health information if it is necessary for law enforcement authorities
to identify or apprehend an individual.
Workers' Compensation
We may disclose your protected health information to comply with
workers' compensation laws and other similar legally established
programs.
Inmates
We may use or disclose your protected health information if you
are an inmate of a correctional facility, and GCMHC created or received
your protected health information while providing care to you. This
disclosure would be necessary (l) for the institution to provide
you with health care, (2) for your health and safety or the health
and safety of others, or (3) for the safety and security of the
correctional institution.
Parental Access
Some state laws concerning minors permit or require disclosure of
protected health information to parents, guardians, and persons
acting in a similar legal status. We will act consistently with
the law of the state where the treatment is provided and will make
disclosures following such laws.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING
YOUR PERMISSION
In some circumstances, you have the opportunity to agree or object
to the use or disclosure of all or part of your protected health
information. Following are examples in which your agreement or objection
is required.
Individuals Involved in Your Health Care
With your consent, we may disclose to a member of your family, a
relative, a close friend, or any other person you identify, your
protected health information that directly relates to that person's
involvement in your health care. In an emergency, we may use or
disclose protected health information to notify or assist in notifying
a family member, legal personal representative, or any other person
who is responsible for your care, of your location, general condition,
or death. Finally, we may use or disclose your protected health
information to an authorized public or private entity to assist
in disaster relief efforts and coordinate uses and disclosures to
family or other individuals involved in your health care.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You may exercise the following rights by submitting a written request
to the GCMHC Privacy Officer. Depending on your request, you may
also have rights under the Privacy Act of 1974. Your GCMHC Privacy
Officer can guide you in pursuing these options. Please be aware
that GCMHC might deny your request; however, you may seek a review
of the denial.
Right to Inspect and Copy
You may inspect and obtain a copy of your protected health information
that is contained in a "designated record set" for as
long as we maintain the protected health information. A designated
record set contains medical and billing records and any other records
that GCMHC uses for making decisions about you.
This right does not include inspection and copying of the following
records: psychotherapy notes; information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative
action or proceeding; and protected health information that is subject
to law that prohibits access to protected health information.
Right to Request Restrictions
You may ask us not to use or disclose any part of your protected
health information for treatment, payment, or health care operations.
Your request must be made in writing to the GCMHC Privacy Officer
where you wish the restriction instituted. In your request, you
must tell us (1) what information you want restricted; (2) whether
you want to restrict our use, disclosure, or both; (3) to whom you
want the restriction to apply, for example, disclosures to your
spouse; and (4) an expiration date.
If GCMHC believes that the restriction is not in the best interest
of either party, or GCMHC cannot reasonably accommodate the request,
GCMHC is not required to agree. If the restriction is mutually agreed
upon, we will not use or disclose your protected health information
in violation of that restriction, unless it is needed to provide
emergency treatment. You may revoke a previously agreed upon restriction,
at any time, in writing.
Right to Request Confidential Communications
You may request that we communicate with you using alternative means
or at an alternative location. We will not ask you the reason for
your request. We will accommodate reasonable requests, when possible.
Right to Request Amendment
If you believe that the information we have about you is incorrect
or incomplete, you may request an amendment to your protected health
information as long as we maintain this information. While we will
accept requests for amendment, we are not required to agree to the
amendment.
Right to an Accounting of Disclosures
You may request that we provide you with an accounting of the disclosures
we have made of your protected health information. This right applies
to disclosures made for purposes other than treatment, payment,
or health care operations as described in this Notice of Privacy
Practices. The disclosure must have been made after April 14, 2003,
and no more than six years from the date of request. This right
excludes disclosures made to you, to family members or friends involved
in your care (where your consent was given), or for notification.
The right to receive this information is subject to additional exceptions,
restrictions, and limitations as described earlier in the notice.
Right to Obtain a Copy of this Notice
You may obtain a paper copy of this notice from any GCMHC facility
or from the GCMHC Privacy Officer.
FEDERAL PRIVACY LAWS
This GCMHC Notice of Privacy Practices is provided to you as a requirement
of the Health Insurance Portability and Accountability Act (HIPAA).
There are several other privacy laws that also apply including the
Freedom of Information Act, the Privacy Act and the Alcohol, Drug
Abuse, and Mental Health Administration Reorganization Act. These
laws have not been superseded and have been taken into consideration
in developing our policies and this notice of how we will use and
disclose your protected health information.
COMPLAINTS
If you believe that your health information privacy rights have
been violated, you may contact:
Sandra Fox, Privacy Officer
Gulf Coast Mental Health Center
1600 Broad Avenue
Gulfport, MS 39501
Phone: (228) 863-1132
Or, you may contact:
OCR Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Atlanta Federal Center, Suite 3B70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
Or
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 515F HHH Bldg.
Washington, D.C. 20201
You will not be retaliated against for filing a complaint.
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