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:

Marie Hall, 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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