NOTICE OF PRIVACY PRACTICES
EFFECTIVE: APRIL 14, 2003
This notice describes how
personal information about you may be used and
disclosed and how you can get access to this information.
Please review it carefully.
PRIVACY PROMISE
The Sandusky County Board of Mental Retardation and Developmental Disabilities (MR/DD) understands that your personal information needs to be kept private. Protecting your personal information is important. We follow strict federal and state laws that require us to keep your personal information confidential.
HOW WE USE YOUR PERSONAL INFORMATION
When you receive services from the Sandusky County Board of MR/DD, we may use your personal information for such activities as providing you with services, billing for services, and conducting our normal board business known as health care operations.
If you have chosen a personal representative and have agreed to let your personal representative obtain your personal information, we will provide the information to your personal representative. If you have a guardian we will provide the information to your guardian.
Examples of how we use your information include:
Treatment – We keep records of the care and services provided to you within the Sandusky County Board of MR/DD. For example, your service and support administrator keeps notes on all contacts made in coordinating and arranging for services. If you see a nurse working for the Sandusky County Board of MR/DD, the nurse will keep records of any care you receive. The Sandusky County Board of MR/DD staff may share your personal information while helping to develop your service plan.
If the Sandusky County Board of MR/DD staff wants to share your personal information with anyone who is not employed by the Sandusky County Board of MR/DD, you must give them written permission first.
Some personal records, including confidential communications with a mental health professional and substance abuse records, may have additional restrictions for use and disclosure under state and federal law.
Payment – We keep records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment to your services from Medicaid, insurance or other sources. For example, we may disclose personal information about the services provided to you to confirm your eligibility for Medicaid and to obtain payment from Medicaid. The Sandusky County Board of MR/DD may use your personal information to determine the amount and type of Medicaid services you need and send this information to the proper state department.
Health Care Operations – We use personal information to improve the quality of care, train staff, manage costs, conduct required business duties, and make plans to better serve you and other individuals enrolled in the Sandusky County Board of MR/DD. For example, we may use your personal information to evaluate the quality of treatment and services provided by our service staff.
OTHER SERVICES WE PROVIDE
We may also use your personal information to:
 |
Determine whether you are eligible for services from the Sandusky County Board of MR/DD. |
|
Recommend to you service alternatives and other possible benefits. |
|
Tell you about other service providers who may be able to help you. |
|
Remind you of an appointment unless you tell the Sandusky County Board of MR/DD staff that you do not wish to be reminded. |
|
To allow the Sandusky County Board of MR/DD to review direct service contracts. |
|
Allow local, state, federal agencies to monitor your services. |
|
To investigate incidents affecting health and safety, to report these kinds of incidents and to take steps to protect your health and safety. |
|
To allow the Sandusky County Board of MR/DD to prepare reports required by the Ohio Department of MR/DD and the Ohio Department of Job and Family Services. |
|
Contact you for assistance in passing levies, unless you notify the Sandusky County Board of MR/DD that you do not wish to be contacted for these purposes. |
MORE INFORMATION
For more information about the practices and rights described in this notice:
|
Visit our website at: www.sanmrdd.org |
|
Contact the Sandusky County Board of MR/DD at the phone number and address on the back of this notice. |
SHARING YOUR PERSONAL INFORMATION
There are limited situations when we are permitted or required to disclose personal information without your signed authorization. These situations are:
|
To protect victims of abuse, neglect, or domestic violence |
|
To reduce or prevent a serious threat to public health and safety |
|
For health oversight activities such as investigations, audits, and inspections |
|
For lawsuits and similar proceedings |
|
For public health purposes such as reporting communicable diseases, work-related illnesses, or other diseases and injuries permitted by law; reporting births and deaths, and reporting reactions to drugs and problems with medical devices. |
|
When required by law |
|
When requested by law enforcement as required by law or court order |
|
To coroners, medical examiners, and funeral directors |
|
For organ and tissue donation |
|
For workers’ compensation or other similar programs if you are injured at work and are covered by workers’ compensation or other similar programs |
|
For specialized government functions such as intelligence and national security |
All other uses and disclosures, not described in this notice, require your signed authorization. You may revoke your authorization at any time with a written statement.
OUR PRIVACY RESPONSIBILITIES
The MR/DD Board is required by law to:
|
Maintain the privacy of your personal information |
|
Provide this notice that describes the ways we may use and share your personal information. |
|
Follow the terms of the notice currently in effect. |
We reserve the right to make changes to this notice at any time and make the new privacy practices effective for all information we maintain.
Current notices will be posted in the Sandusky County Board MR/DD Board facilities and on our website, www.sanmrdd.org
You may also request a copy of any notice from the Sandusky County Board of MR/DD Privacy Office.
YOUR INDIVIDUAL RIGHTS
You have the right to:
|
Request restrictions on how we use and share your personal information. We will consider all requests for restrictions carefully but are not required to agree to any restriction.* |
|
Request that we use a specific telephone number or address to communicate with you. |
|
Inspect and copy your personal information, including service, medical and billing records. Fees may apply.* |
|
Request corrections or additions to your personal information. You must give the reasons for wanting the change.* |
|
Request an accounting of certain disclosures of your personal information made by us. Your request must state the period of time desired for the accounting, which must be within the six years prior to your request. The first accounting is free but a fee will apply if more than one request is made in a 12-month period.* |
|
Request a paper copy of this notice even if you agree to receive it electronically |
Requests marked with a star (*) must be made in writing. Contact the MR/DD Board Privacy Office for the appropriate form for your request.
OUR ORGANIZATION
This notice
describes the privacy practices of the Sandusky County board of MR/DD. This
notice also describes the privacy practices of persons or entities which
have signed a contract with the MR/DD Board and which are acting as business
associates, and have promised to follow the same rules of confidentiality.
The Sandusky County Board of MR/DD includes the School of Hope and Sandco Industries.
If you want to know about the privacy practices of service providers who are not employed by the Sandusky County Board of MR/DD and who are not business associates, you should contact them directly.
Contact Us
If you would like further information about
your privacy rights, are concerned that your privacy rights have been
violated, or disagree with a decision that we made about access to your
personal information, contact:
Cheryl Cotter, Superintendent
Sandusky County Board of MR/DD
1001 Castalia Street
Fremont, Ohio 43420 (419-332-9296 x 110)
OR
e-mail: ccotter@sanmrdd.org
We will investigate all complaints and will not retaliate against you for filing a complaint.
You also may file a written complaint with either:
· The Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue SW, Washington D.D., 20201 or call 1-877-696-6775 OR
The Office for Civil Rights, U.S. Department of Health and Human Services at 200 Independence Avenue SW., Room 509F, HHH Building, Washington D.C., 20201 or call CR’s hotline – voice at 1-800-368-1019, or e-mail at ocrmail@hhs.gov.