THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS INFORMATION CAREFULLY.
If you have any questions about this notice, please contact the Privacy Management at 216-651-1450.
I. WHO WILL FOLLOW THIS NOTICE
This notice describes The Women’s Recovery Center’s practices and that of:
A. All clinical staff that may enter information into client charts
B. Any member of a volunteer group we allow to help you while you are involved in treatment services
C. All employees and staff of The Women’s Recovery Center
II. OUR PLEDGE ABOUT MEDICAL INFORMATION
The Women’s Recovery Center understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services that you receive at the Women’s Recovery Center. We need this record to provide you with quality care and to comply with certain laws. This notice applies to all of the records of your care created by The Women’s Recovery Center. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
A. Maintain the privacy of medical information that identifies you.
B. Give you this notice of our legal duties and privacy practices with respect to medical information about you.
C. Follow the terms of the notice that is currently in effect.
III. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following items explain ways that we use and disclose medical information. For each item of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure will be listed. However, all of the ways we are allowed to use and disclose information will fall within one of the items.
A. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to members of the clinical treatment team that are involved in your care at The Women’s Recovery Center.
B. We may use and disclose medical information about you so that the treatment and services you receive at The Women’s Recovery Center may be billed to and payment may be collected from you, an insurance company or a third party.
C. We may disclose medical information to those identified as having a Release of Information including but not limited to the Department of Probation, Child Protective Services, Counselors, Doctors, etc.
D. Appointment Reminders. We may use and disclose medical information to contact you to remind you of an appointment at The Women’s Recovery Center.
E. Business Associates. Individuals or organizations that are not part of the Women’s Recovery Center may provide certain aspects of your care or services related to your care, such as billing. We will disclose medical information as needed so the appropriate service can be rendered. We will obtain assurances that these individuals or organizations will also safeguard your information and protect your privacy.
F. As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. This may include disclosures to Boards governing the professional practice of health care providers.
G. To Avert a Serious Threat to Health or Safety. We may use and disclose medical about you when needed to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
H. Lawsuits 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 disclose medical information to defend a lawsuit brought against The Women’s Recovery Center or any of its staff. 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.
I. Law Enforcement. We may release medical information if asked to do so by a law enforcement official.
1. In response to a court order, subpoena (with proper authorization), warrant, summons or similar process.
2. To identify or locate a suspect, fugitive, material witness, or missing person.
3. About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement.
4. About a death we believe may be the result of criminal conduct.
5. About criminal conduct at the Women’s Recovery Center.
6. 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.
J. Emergency Circumstances. We may release medical information about you if you are unable to object due to incapacity or if there is a need for emergency treatment. We may disclose some or all of your personal health information for the facility’s directory based on previous selections that were expressed by you. We may also disclose some or all of your personal health information if it is in your best interest, which would be determined by The Women’s Recovery Center in the exercise of professional judgment.
K. Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be needed, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as needed to carry out their duties.
V. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:
A. Right to Inspect and Copy. 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 information gathered in anticipation of a legal proceeding and information prohibited by law. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to The Women’s Recovery Center, 6209 Storer Avenue, Cleveland, Ohio 44109. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies used due to your request. We may deny your request to inspect and copy of records in these and other very limited cases. If you are denied access to medical information, you may request that the denial be reviewed. Another health care administrator chosen by The Women’s Center will review your request and the denial. The person doing the review will not be the person who denied your request. We will comply with the outcome of the review.
B. Right to Amend. If you feel that medical information we have about you is wrong or missing, you may ask us to amend the information. You have the right to request a change as long as the information is kept by or for The Women’s Recovery Center. To request an amendment, your request must state the reason for your request and must be made in writing and submitted to The Women’s Recovery Center. 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. We may also deny your request if you ask us to amend information that:
1. Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
2. Is not part of the medical information kept by or for The Women’s Recovery Center.
3. Is not part of the information, which you would be allowed to inspect and copy.
4. Is correct and complete.
If your request is granted, The Women’s Recovery Center will make the amendment and inform you when it is done. If your request is denied, we will provide you with a written denial stating the basis for denial. You have the right to submit a written statement disagreeing with the denial. The Women’s Center must act on a request no later than 60 days after receipt of your request or notify you in writing that we need an additional 30 days.
C. Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information about you that is outside of the information disclosed as described in this document. For example, disclosures for treatment, payment, health care operations, or those, which you have authorized, are part of the expected disclosures and therefore would not be included in a disclosure history. To request this list or accounting of disclosures, you must submit your request in writing to the Women’s Center. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For more lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
D. Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, or payment. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to the Clinical Director marked “personal and confidential”. In your request, you must tell us
(1) what information you want to limit;
(2) whether you want to limit our use, disclosure or both; and
(3) to whom you want the limits to apply.
E. Right to Revoke Authorization. You have the right to revoke your authorization at any time only if it is in writing.
F. Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request in writing to the Director of Medical Records marked “personal and confidential”. We will not ask you the reason for your request. Your record must specify how or where you would like us to contact you. We will comply with all reasonable requests.
G. Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at anytime. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website,www.womensctr.org.
VI. CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in The Women’s Center. The notice will contain on the first page, in the top right-hand corner, the effective date. If the notice is changed, a revised copy will be available for your review on our website and/or in paper copy at locations indicated above.
If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with The Women’s Center, you may contact the Clinical Director, at 6209 Storer Avenue, Cleveland, Ohio, 44102. You may also telephone the Clinical Director at 216- 651-1450. You may contact the Secretary of the Department of Health and Human Services, Washington D.C., in writing within 180 days of the time that you feel your privacy rights have been violated. You will not be penalized for filing a complaint.
VIII. OTHER USES OF MEDICAL INFORMATION
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 permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, 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 permission, and that we are required to retain our records of the care that we provided to you.
IX. EFFECTIVE DATE OF THIS NOTICE
This notice is effective on April 14, 2003.