Privacy

Fairfield County Board of Mental Retardation and Developmental Disabilities

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.

Our Organization

This notice describes the privacy practices of the Fairfield County Board of MRDD (the FCBMRDD). This notice also describes the privacy practices of persons or entities which have signed a contract with the FCBMRDD and which are acting as business associates, and have promised to follow the same rules of confidentiality.

The FCBMRDD includes Board employees and volunteers at those facilities. If you want to know about the privacy practices of services providers who are not employed by the FCBMRDD and who are not business associates, you should contact them directly. For further information on the FCBMRDD visit our website at

www.fairfieldmrdd.com

How We Use Your Personal Information

When you receive services from the FCBMRDD, 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, and have signed an authorization, we will provide the information to your personal representative. If you have a guardian we will provide this 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 FCBMRDD. For example, your Individual Support Coordinator keeps notes on all contacts made in coordinating and arranging for services. If you see a nurse working for the FCBMRDD, the nurse will keep records of any care you receive. FCBMRDD staff may share your personal information while helping to develop your service plan.

If FCBMRDD staff want to share your personal information with anyone who is not employed by the FCBMRDD, 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 disclosures 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 for 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 FCBMRDD 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 FCBMRDD. For example, we may use your personal information to evaluate the quality of treatment and services provided by our staff.

Other Services We Provide

• We may also use your personal information to:
• Determine whether you are eligible for services from the FCBMRDD;
• 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 FCBMRDD staff that you do not wish to be reminded;
• Allow the FCBMRDD to review direct service contracts;
• Allow local, state, and federal agencies to monitor your services;
• Investigate incidents affecting health and safety, to report these kind of incidents and to take steps to protect your health and safety;

Allow the FCBMRDD to prepare reports required by the Ohio Department of MRDD and the Ohio Department of Job and Family Services;

Contact you for assistance in passing levies, unless you notify the FCBMRDD that you do not wish to be contacted for these purposes.

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;

• 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 FCBMRDD 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 FCBMRDD facilities and copies available upon request.

Privacy Promise

The FCBMRDD understands that your personal information needs to be kept private. Protecting you personal information is important. We follow strict federal and state laws that require us to keep your personal information confidential.

Your Individual Rights

You have the right to:

• Request restrictions on how we use and share your personal information. We will consider all request 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 FCBMRDD Privacy Office for the appropriate form for your request.

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:

The FCBMRDD Privacy Officer

(740) 687-7240

We will investigate all complaints and will not retaliate against you for filing a complaint. You also may file a written complaint with either:

Secretary

U.S. Department of

Health and Human Services

200 Independence Avenue SW

Washington D.C. 20201

Telephone 1-877-6775

Or

The Office of Civil Rights

U.S. Department of

Health and Human Services

200 Independence Avenue SW

Room 509F HHH Building

Washington D.C. 20201

OCR Hotline at 1-800-368-1019

Or

Email at ocrmail@hhs.gov

School age clients are protected by the rules of the Federal Educational Rights and Privacy Act of 1974