Clayton Center Community Service Board
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MENTAL HEALTH AND MEDICAL
INFORMATION
ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
You have a right to privacy with respect to your
past, present, and future mental health and medical information. Clayton Center Community Service Board is
required by law to protect your information and to provide you with this Notice
of our legal duties and privacy practices with respect to your protected health
information. You have the right to
receive a paper copy of this Notice.
We are required to follow the privacy practices
described in this Notice, though we reserve the right to change our privacy
practices and the terms of this Notice at any time. In the event this Notice is revised, you
may requests a paper copy of the revised notice or view the revised notice at
the above web address.
We use and disclose protected health information for a variety of reasons. In general, our use and disclosures fall within the following three categories: treatment, payment, and health care operations.
Treatment – We will use your
protected health information and disclose it to others as necessary to provide
treatment to you. For example,
members of our clinical staff may access your record in the course of your
care, or share information in the process of coordinating your care. Such staff members include physicians,
psychologists, nurses, and other mental health professionals. Additionally, disclosure to another
facility, community health center, or private practitioner may become necessary
for your continued treatment.
Payment – We will use or disclose your
protected health information as necessary to arrange for payment of services
provided to you. For example,
information about your diagnosis and the services we provide to you may be
included in a bill that we send to a third-party payer.
Health Care Operations – We will use or
disclose your protected health information in the course of operating Clayton
Center CSB or for the health care operations of another organization that has a
relationship with you. For example,
our quality assurance staff reviews records to ensure that our high standards
of treatment delivery are reached consistently. In addition, Clayton Center CSB may
contract with outside companies, or “business associates”, such as
consultants, accountants, lawyers, and medical transcriptionists, to provide
services that may involve the use of your protected health information.
Unless
you instruct us otherwise, we may also send appointment reminders, information
about treatment options and other health-related benefits that may be of
interest, and other similar materials to you.
Uses and Disclosures Requiring Your Authorization
We
are generally prohibited from using or disclosing your protected health
information for purposes other than treatment, payment, and health care
operations without your written authorization, unless the use or disclosure is
within one of the categories described below. In addition, we generally may not use or
disclose psychotherapy notes written by your medial health provider without
your written authorization, even for treatment, payment and health care
operations. You have the right to
revoke your authorization in writing at any time, except to the extent that we
have already undertaken an action in reliance upon your authorization.
Uses and Disclosures Not Requiring an Authorization
By
law, we may use or disclose certain of your protected health information
without an authorization in the following circumstances.
When required by law – We may disclose protected health
information when a law requires that we report information about suspected
abuse, neglect, or domestic violence, or relating to certain criminal activity,
or in response to a court order. We
must also disclose protected health information to authorities that monitor our
compliance with these privacy requirements.
For public health activities – We may disclose certain protected health
information to public health agencies as permitted or required by law.
For health oversight activities – We may disclose certain protected
health information to certain government agencies for oversight activities by
law.
Judicial and Administrative Proceedings – We may disclose
protected health information in response to a court or administrative
order. We may also disclose
protected health information in certain cases in response to a subpoena,
discovery request, or other lawful process, subject to your notice and
opportunity to object.
Relating to deceased individuals – We may disclose protected health
information related to death to pursuant to a valid subpoena of a coroner or
medical examiner.
To avert a serious threat to health or safety – We may disclose
protected health information, in order to avoid serious threat to your health
or safety and the health and safety of the public or another person.
For specific government functions – We may disclose protected health
information as required by military authorities, to correctional facilities in
certain situations, to government benefit programs related to eligibility and
enrollment, and for national security and intelligence reasons, such as
protection of the President.
Uses and Disclosures of Alcohol/Drug Treatment Records
At
Clayton Community Service Board, personally identifying information related to
the treatment of substance abuse has special legal privacy protections. We will not disclose any information
identifying you as a individual of our services or provide any mental health or
medical information related to substance abuse treatment except in certain
circumstances, including but not limited to: (1) you consent in writing; (2) a
court orders disclosure of the information after a show cause hearing as
required under Georgia Law; (3) medical personnel need the information to meet
a medical emergency; (4) qualifying personnel use the information for the
purpose of conducting research, management audits, or program evaluation; or
(5) it is necessary to report a crime or threat to commit a crime or to report
child abuse or neglect as required by law.
As applicable, you will be provided an additional notice regarding the
confidentiality of substance abuse information.
Uses and Disclosures to Which You May Object
In
the following situations, we may disclose a limited amount of your protected
health information if we inform you in advance and you do not object, as long
as the disclosure is not otherwise prohibited by law:
To families, friends, or others involved in your care – We may share with
these people certain information directly related to their involvement in your
care, or payment for your care. We
may share certain protected health information with these people to notify them
about your location, general condition, or death.
Individual directories – Your name, location, and general condition
may be put into a facility individual directory of disclosure to callers or
visitors who ask for you by name.
Additionally, your religious affiliation may be shared with clergy.
Your Rights Regarding Your Protected Health
Information
You
have the following rights with respect to your protected health information:
To obtain access to your protected health information – You generally have
the right to see and obtain copies of your protected health information upon
written request. We may deny you
access to review or copy your protected health information. If your request is denied, we must
provide you with a reason for the denial and explain any right to have the
denial reviewed. If we grant your
written request for copies of your protected health information, we will advise
you in advance of any fees we may impose for the costs of copying and mailing.
To request restrictions on uses and disclosures – You have the right
to ask that we limit how we use or disclose your protected health
information. We will consider your
request, but are not legally bound to agree to the restriction. If we do agree to any restriction, we
will put the agreement in writing and abide by it except in the case of
emergency situations. We cannot
agree to limit uses and disclosures that are required by law.
To receive confidential communications – You have the right
to request that we communicate with you by using an alternative address or by
alternative means. We must agree to
your request as long as it is reasonable for us to comply.
To an accounting of disclosures – You have the right to receive upon
written request an accounting of when, to whom, for what purpose, and what
content of your protected health information has been released for the past six
years. This list will not include
the following instances for disclosure: for treatment, payment, and health care
operations; to you, to your family, or for a facility directory; or pursuant to
your written authorization. The
list of disclosures will not include any certain other disclosures, such as
those made to law enforcement officials or correctional facilities, for
national security purpose, or disclosures made before April 14, 2003. There will be no charge for the first
accounting you request within a 12-month period. For additional lists within the same
period, we will advise you of any fees we may impose.
To request an amendment – If you believe that your protected health
information is incorrect or incomplete, you have the right to request in
writing that we amend the information.
Your request must include the reason you are seeking a change. We may deny your request if (1) we did
not create the information or the information is not part of our records; (2)
the information is not permitted to be disclosed; or (3) the information is correct
and complete. Any denial must be in
writing and must state the reasons for the denial and explain your right to
submit a statement of disagreement and to have your statement (and any
rebuttal), along with your request and the denial, appended to your record.
Contact Information Regarding Our Privacy Practices
If you have questions,
concerns, or complaints about our privacy practices, or if you disagree with a
decision regarding access to your information, please contact the Privacy
Officer, Clayton Center Community Service Board,