Center for Chemical Addictions Treatment
Notice of Privacy Practices
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Pledge Regarding Medical Information:
The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it and safeguarding it against unauthorized use and disclosure. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and certain duties we have regarding the use and disclosure of medical information. This notice applies to all of the health and billing records related to your care.
Our Legal Duty
Law Requires Us to:
- Keep all identifiable health information about you private.
- Give you this notice describing our legal duties, privacy practices, your rights regarding your medical information.
- Follow the terms of the notice that is currently in effect.
Uses and Disclosures of Your Medical Information
Upon admission to our facility you will be asked to sign a "Consent to Treat". Upon signing this document you give us the right to share your health information to other entities for the purpose of payment, treatment, and our facility operations. The following are descriptions and examples of each one of these types of uses:
Your protected information will be used, as needed, to obtain payment for your services from third party payers such as, depending on your payee source, your health insurance company, the Ohio Department of Alcohol and Drug Addictions Services, Cincinnati Health Network, etc.
Example: Upon admission you applied for financial assistance using public funds which then enabled us to charge you on a sliding scale fee based on your income. We would share appropriate information with the Hamilton County Alcohol and Drug Addiction Services Board in order for us to receive payment through those public funds to assist with your bill.
Your protected information will be shared among appropriate CCAT staff, as necessary, to provide you with quality treatment.
Example: You entered the facility to be treated for chemical addiction. You also have diabetes. A number of healthcare and support staff need to know about your diabetes during your stay.
- The doctor treating you needs to know in order to treat you appropriately.
- The nurses need to know to monitor your symptoms and medication interactions.
- The dietary staff need to know about your diabetes to arrange for proper meals.
We may use and disclose your medical information in order for us to maintain our daily operations. Types of uses under this category may include use of your information for evaluating the performance of our employees, to conduct training programs, for fiscal audits, for performance and quality improvement, and to get the accreditation, certificates, licenses, and credentials we need to serve you.
Example: In order for us to receive our Joint Commission Accreditation we let a Joint Commission Surveyor review your chart to evaluate the quality of the care given to you during your stay.
Additional Uses and Disclosures
Federal law permits us to disclose information without your written permission:
- Pursuant to an agreement with a qualified service organization/business associate
- To report a crime committed on our premises or against our personnel
- To medical personnel in a medical emergency
- To appropriate authorities to report suspected child abuse or neglect
- As allowed by court order or required by law
Except as otherwise permitted or required, as described above, we may not use or disclose your protected health information without your written authorization. Further, we are required to use or disclose your protected health information consistent with the terms of your authorization. You may revoke such an authorization with a written request at any time, except to the extent of information that has already been released as a result of that authorization.
Your Individual Rights
You Have a Right to:
Request Restrictions - You have a right to submit a written request to our Privacy Officer to restrict or limit the health information we use or share for payment, treatment, or operations. We are not required to agree to these restrictions, but if we do, we will abide by these restrictions.
Request Confidential Communications - You have a right to submit a written request to our Privacy Officer that we communicate with you about health matters in a certain way or to a certain location.
Inspect and Copy Health Information - You have a right to submit a written request to view or get copies of the health information we collect on you. Under certain circumstances we may not share information containing psychotherapy notes or information compiled to use in a civil, criminal, or administrative proceeding, or in other limited circumstances. Requested copies of information are subject to reasonable cost-based fees for retrieval and copying. Postage charges may also apply if a mailing has been requested.
Amend - You have a right to submit a written request to our Privacy Officer that we make a change to any health information we collect on you. This request must include a detailed reason why we should make such an amendment. We do have the right to deny your request to amend for certain reasons. If we deny your request, we will provide you with a written explanation. You may respond with a written statement of disagreement that will be added to the information you wanted changed, along with any rebuttal we make to such statement of disagreement.
Request an Accounting of Disclosures - You have a right to submit a written request to our Privacy Officer to receive an accounting of all the times we shared your medical information for purposes other than treatment, payment, operations, or information released as a direct result of an authorization made by you. Your request must state the period of time for which you desire the accounting, which must fall within 6 years prior to your request. We maintain the right to charge a fee for any accountings requested beyond the first one.
Obtain a Paper Copy of this Notice Upon Request - You have a right to obtain a paper copy of this notice by making a request in writing to our Privacy Officer.
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 health information we already have about you as well as any information we receive in the future. Any updated notices will be posted in the front lobby of our facility as well as on our web site. All notices will contain the effective date on the first page, top center.
Questions and Complaints
If you have any questions about this notice please ask to speak to our Privacy Officer. (Please see contact information below.) If you have a complaint about our privacy policies and procedures or feel your privacy rights have been violated, you may contact our Privacy Officer to file a complaint. We will investigate all complaints and not retaliate against you for filing such complaints. You also may file a complaint with the Department of Health and Human Services.
CCAT PRIVACY OFFICER:
Patti L. Webb, RHIT
Center for Chemical Addictions Treatment
830 Ezzard Charles Drive
Cincinnati, OH 45214
DEPARTMENT OF HEALTH AND HUMAN SERVICES:
Region V, Office for Civil Rights
U.S. Dept. of Health and Human Services
233 N. Michigan Avenue, Suite 240
Chicago , Illinois 60601
Phone: (312) 886-2359 Fax: (312) 886-1807 TDD (312) 353-5693