Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
If you have any questions about this Notice, our policies, or practices please contact the Haven Behavioral Hospital of Dayton Privacy Officer at One Elizabeth Place, 9th Floor, Dayton, OH 45417 or (937) 234-0100.
H2: Who Will Follow This Notice
This Notice describes our organization’s practices and those of:
- Healthcare professionals who are members of our workforce authorized to access and/or enter information into your medical record or billing record.
- All departments and units of this facility.
- All employees, volunteers, and other facility personnel considered a part of our workforce.
Our Pledge Regarding Medical and Billing Information
We understand that information about you and your health is personal. We are committed to protecting medical and billing information about you. We create a record of the care and services you receive at our facility. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and charges or bills for services related to your care. These records are used 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 the facility, whether made by facility personnel or your personal care provider. Your personal care provider (for example, your primary care physician, etc.) may have different policies or Notices regarding the provider’s use and disclosure of your medical and billing information created in the practice office or clinic.
This Notice will tell you about the ways in which we may use and disclose medical and billing information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.
We are required by law to:
- Make sure that medical and billing information that identifies you is kept private,
- Give you this Notice of our legal duties and privacy practices with respect to medical and billing information about you; and
- Follow the terms of the Notice that is currently in effect.
How We May Use and Disclose Medical and Billing Information About You
The following categories describe different ways we use and disclose medical and billing information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or 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.
For Treatment. We may use your medical information to provide you with medical and behavioral health treatment or services. We may disclose your medical information to doctors, nurses, healthcare technicians, healthcare professional students, or other facility personnel who are involved in taking care of you at our facility. For example, a psychiatrist treating you may need to know if you have allergies to certain psychotropic medications. The psychiatrist may need to contact your primary care physician to obtain that information In addition, the doctor may need to tell the dietician if you have diabetes so we can arrange for appropriate meals. Different departments within the facility may also share your medical information in order to coordinate the services you need, such as prescriptions, lab work, x-rays and therapy. This information is shared on the basis of another healthcare staff “needing to know” the information to provide safe necessary treatment to you. We also may disclose medical information about you to people outside the facility who may be involved in your medical care after you leave the facility, such as family members, or other healthcare professionals we use to provide services that are a part of your care.
For Payment. We may use and disclose your medical information so that the treatment and services you receive may be billed and payment may be collected from you, an insurance company or other third party. For example, we may need to give your health plan information about therapy you received at our facility so your health plan will pay us or reimburse you for the therapy. 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 pay for the treatment. This does NOT mean that all information in your medical record will be shared to gain approval or seek payment, but only that information which is necessary. We may also provide information about you to another healthcare provider or facility for their payment activities. For example, we may provide information about you to your doctor’s office so they can bill you or your insurance company.
For Healthcare Operations. We may use and disclose your medical information about you for facility operations. These uses and disclosures are necessary to run the facility and make sure all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many facility patients to decide what additional services the facility should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, therapists, technicians, professional healthcare student, and other facility personnel for review and learning purposes. We may also combine medical information with medical information from other facilities to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study healthcare and healthcare delivery without learning who you or other patients are as individuals. We may provide information about you to other healthcare providers, health plans, or healthcare clearinghouses to perform activities such as quality assessment, case management, training, and studying groups of people for the purpose of improving health.
Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for tests, treatment, or medical care.
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you or offer you optional care alternatives.
Health-Related Products 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.
Business Associates. There are some services provided in our organization through contracts with business associates. Examples may include: contracted physical therapy and speech therapy. When these services are contracted, we may disclose your health information to our business associate so they can perform the job we’ve asked them to do, and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who receive one medication to those who received another, for the same condition. In certain circumstances, we are permitted to disclose medical information about you to preparing for research. For example, researchers may look for patients with specific treatment needs to develop a research protocol, but may not remove the medical information they review from the facility. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ needs for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We will almost always ask for your specific permission of the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the facility.
As Required By Law. We will disclose medical information about you when required to do so by federal, state or local laws.
To Avert a Serious Threat to Health or Safety. We may use or disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or other person. Any disclosure, however, would only be to someone able to help prevent the threat.
Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military Personnel. If you are a member of the armed forces, active or reserve, 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.
Workers’ Compensation. We may release medical information about you as necessary to comply with laws related to workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
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 births and deaths;
- To report child abuse or neglect;
- To report reactions to medications or problems with products;
- To notify people of recalls of products they may be using;
- To notify a person who may have been exposed to a disease, or who may be a risk for contracting or spreading a disease or condition; and
- To notify the appropriate government or law enforcement 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.
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 healthcare system, government programs, and compliance with civil rights laws.
Lawsuit 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.
Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
- In response to a 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;
- About criminal conduct at the facility; and
- 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.
Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about you as a patient of the facility to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protected Services for the President and Others. We may disclose medical information about you to an authorized federal official so they may provide protection to the President, other authorized persons, and foreign heads of state or to conduct special investigations.
Other uses of medical information: Authorization and Right to Revoke Authorization. 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 authorization. If you authorize us to use or disclose medical information about you, you may revoke that authorization, 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 authorization, and that we are required by State law to retain our records of the care that we provide to you.
H2: Your Rights Regarding Medical and Billing Information About You
You have the following rights regarding your medical and billing information we maintain.
Right to Inspect and Copy Your Medical and Billing Information. 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 obtain a copy of medical and billing information that may be used to make decisions about you, you must submit your request in writing to Haven Behavioral Hospital of Dayton, Record Custodian,One Elizabeth Place, 9th Floor, Dayton, OH 45417. 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 this information in certain limited circumstances. If you are denied access to medical or billing information, you may make a request, in writing to the Haven Behavioral Hospital of Dayton, Privacy Officer, that the denial be reviewed. Another licensed healthcare professional chosen by the facility 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 Medical and Billing Information. If you feel that medical and billing information we have about you is incorrect or incomplete, you may ask us to amend the information. You have a right to request an amendment for as long as the information is kept by or for the facility.
To request an amendment, your request must be made in writing and submitted to Haven Behavioral Hospital of Dayton, Record Custodian,One Elizabeth Place, 9th Floor, Dayton, OH 45417 or call (937) 234-0100. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing, or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical or billing information kept by or for the facility
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures of Your Medical and Billing Information.
You have the right to request an “accounting of disclosures”. This is a list of certain disclosures we made of medical and billing information about you, except for those disclosures to carry out treatment, payment, or healthcare operations; disclosures made to you; disclosures you have authorized; or certain other disclosures.
To request an accounting of disclosures, you must submit your request in writing to the Haven Behavioral Hospital of Dayton Privacy Officer. Your request must state a time period, which may not be longer than six years. This 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 costs involved and you may choose to withdraw or modify your request at the time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on the uses and disclosures of your medical or billing information for treatment, payment or healthcare operations. You also have the right to request a restriction on the medical or billing information we disclose about you to someone who is involved in your care or payment for your care, like a family member or friend. We are not required to agree to your request. If we cannot agree to your requested restriction, we will notify you. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. We may terminate our agreement for a restriction if we inform you and you agree.
To request restrictions, you must make your request in writing to the Privacy Officer for Haven Behavioral Hospital of Dayton.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical treatment and options in a certain way or at a certain location. For example, you can ask that we contact you at a different phone number or address.
To request confidential communications, you must make your request in writing to Haven Behavioral Hospital of Dayton Privacy Officer. 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 will be offered a paper copy of this Notice during the admission or registration process. You may ask us to give you a copy of this Notice at any time, or you may contact our Privacy Officer at (937) 234-0100.
Changes to This Notice. We reserve the right to change this Notice at any time. We reserve the right to make the revised or changed Notice effective for medical and billing information we already have about you as well as any information we receive in the future. The effective date of the revised Notice will be on the first page, in the top right-hand corner. As of the effective date, distribution of the revised Notice that is in effect will be the same as above in the section describing your rights to receive a paper copy of the Notice.
Complaints. If you believe your privacy rights have been violated, you may file a complaint with the Haven Behavioral Hospital of Dayton Record Custodian,One Elizabeth Place, 9th Floor, Dayton, OH 45417 or with the Secretary of Health and Human Services at 200 Independence Ave. S.W., Washington, D.C. 20201, or by phone 1-877-696-6775.
You will not be retaliated against or penalized for filing a complaint.