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West Iowa Community Mental Health Center
Notice of Privacy Practices
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.
If you have any questions about this Privacy Notice, please contact our Privacy officer, at 263-3172.
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding health information we maintain about you and a brief description of how you may exercise these rights. This Notice further states the obligations we have to protect your health information.
"Protected health information" means health information (including identifying information about you) we have collected from you or received from your health care providers, health plans, your employer or a health care clearinghouse. It may include information about your past, present or future physical or mental health condition, the provision of your health care, and payment for your health care services.
We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information. We are also required to comply with the terms of our current Notice of Privacy Practices.
How We Will Use and Disclose Your Health Information
We will use and disclose your health information as described in each category listed below. For each category, we will explain what we mean in general, but not describe all specific uses or disclosures of health information.
For Treatment. We may use and disclose your health information among our clinicians and other staff (including clinicians other than your therapist or principal clinician), who work at West Iowa Community Mental Health Center. For example, our staff may discuss your care for purposes of guidance and supervision. We will not disclose your treatment-related information to another person or entity outside of West Iowa Community Mental Health Center without your authorization, except in cases where other providers of professional services may be involved in your care (IA Code 228.5). For example, we may discuss your medication with your pharmacy.
For Payment. We will obtain your written authorization before disclosing your health information to your insurance company or other third party payer. (IA Code 228.7) It is necessary for us to disclose this information so that the treatment and services provided by us may be billed to, and payment is collected from, your health plan or other third party payer. This information may be used in the following ways:
 making a determination of eligibility or coverage for health
insurance;
reviewing your services to determine if they were appropriately authorized or certified in advance of your care
Collections: If you have failed to arrange for payment of your fee within a reasonable time after the notification, we may disclose information necessary for the collection of the fee to a person or agency providing collection services. (IA Code 228.5)
For Health Care Operations. We may use and disclose health information about you without your authorization for our health care operations. These uses and disclosures are necessary to run our organization and make sure that our consumers receive quality care. These activities may include, by way of example, quality assessment and improvement, reviewing the performance or qualifications of our clinicians, training students in clinical activities, licensing, accreditation, business planning and development, and general administrative activities.
We may also use and disclose your health information to contact you to remind you of your appointment. We may use and disclose your health information to inform you about possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you. If you do not want us to provide you with information about health-related benefits or services, you must notify the Privacy Officer in writing at P.O. Box 187, Denison, IA 51442. Please state clearly that you do not want to receive materials about health-related benefits or services.
Fundraising Activities. We may use or disclose health information about you to contact you about raising money for our programs, services, and operations. If you do not want us to contact you for fundraising purposes, you must notify the Privacy Officer in writing at P.O. Box 187, Denison, IA 51442. Please state clearly that you do not want to receive any fundraising solicitations from us.
Disaster Relief. We may use and disclose your health information to an organization assisting in disaster relief efforts: however, we will first ask your permission to disclose such information.
Persons Involved in Your Care. We will obtain your written authorization before disclosing health information to persons involved in your care (family, friends, attorney, physician). The law identifies the following exceptions:
Disclosure may be made to the spouse, parent, adult child, or adult
sibling of an individual who has a chronic mental illness. (IA Code
228.8)
A person has been designated with a valid health care power of
attorney.
A guardian has been appointed for you by a court.
A state agency is responsible for consenting to your care.
Custody of Children. Unless ordered by a court of law, both parents have legal access to their child's clinical record, including medical, educational, and law enforcement information. (IA Code 598.41)
Special Circumstances. Situations may arise which warrant us to use or disclose protected health information without your consent or authorization. The law specifically allows us to use or disclose protected health information without your consent or authorization in the following special circumstances:
1. As Required By Law. We will disclose health information about you when required to do so by federal, state or local law.
2. Emergencies. We may use and disclose your health information to another facility, physician, or mental health professional in cases of an emergency treatment situation. (IA Code 228.2) For example, we may provide your health information to a paramedic who is transporting you in an ambulance.
3. To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious and imminent threat to your health or safety or to the health or safety of the public or another person. Under these circumstances, we will only disclose health information to someone who is able to help prevent or lessen the threat.
4. Child/Dependent Adult Abuse. We are required by law to report child and dependent adult abuse or neglect. (IA Code 232 & IA Code 235B) We may also disclose information to the Department of Human Services when they have an open investigation of child or dependent adult abuse or neglect.
5. Health Oversight Activities. We may disclose health information about you to a health oversight agency for activities authorized by law. Examples of health oversight activities include audits, investigations, inspections or judicial/administrative proceedings that you are not the subject of. In most cases, the oversight activity will be for the purpose of overseeing the care rendered by our facility or our facility's compliance with certain laws and regulations.
6. Disclosures in Legal Proceedings. We may disclose health information about you to a court or administrative agency when a judge or administrative agency orders us to do so. We also may disclose health information about you in legal proceedings without your permission or without a judge or administrative agency's order when: (IA Code 228.6)
you are a party to a legal proceeding and we receive a subpoena for your health information.
you offer your mental or emotional condition as an element of a claim or a defense.
it is necessary to initiate or complete civil commitment proceedings under Chapter 229.
7. Law Enforcement Activities. We may disclose health information to a law enforcement official for law enforcement purposes when:
a court order, subpoena, warrant, summons or similar process requires us to do so;
we report a "serious injury" that we believe may be the result of criminal conduct; (IA Code 147.111)
we report criminal conduct occurring on the premises of our facility; or
we determine that the law enforcement purpose is to respond to a threat of an imminently
dangerous activity by you against yourself or another person; or
the disclosure is otherwise required by law.
8. Workers Compensation. We are required to disclose your health information in workers compensation cases. (IA Code 85.27)
Uses and Disclosures of Your Health Information with Your Permission.
Uses and disclosures not described above will generally be made with your written permission, called an "authorization." You have the right to revoke an authorization at any time. If you revoke your authorization we will not make any further uses or disclosures of your health information under that authorization, unless we have already taken an action relying upon the uses or disclosures you have previously authorized.
Your Rights Regarding Your Health Information.
A. Right to Inspect and Copy. You have the right to request an
opportunity to inspect or copy health information used to make decisions about your care. We may deny your request
to inspect or copy your health information in certain limited circumstances.
B. Right to Amend. For as long as we keep records about you,
you have the right to request us to amend any health information used to make decisions about your care - whether they are
decisions about your treatment or payment of your care. In certain situations, we may deny your request for an amendment,
i.e. if it is not in writing or does not include a reason to support the request. You have the right to appeal our decision to deny
your request.
C. Right to an Accounting of Disclosures. You have the right to
request that we provide you with an accounting of disclosures we have made of your health information. An
accounting is a list of disclosures. But this list will not include certain disclosures of
your health information, by way of example, those we have made for purposes of treatment, payment, and health care
operations. For your convenience, you may submit your request on a form called a "Request For Accounting," which you may
obtain from our Privacy Officer. The request should state the time period for which you wish to receive an accounting. This
time period should not be longer than six years and not include
dates before April 14, 2003.
D. Right to Request Restrictions. You have the right to request
a restriction on the health information we use or disclose about you for treatment, payment or health care
operations. You may also ask that any part (or all) of your health information not be
disclosed to family members or friends who may be involved in your care. We are not required to agree to a restriction that you
may request. If we do agree, we will honor your request unless the restricted health information is needed to provide you with
emergency treatment.
E. Right to Request Confidential Communications. You have the right to request that we communicate with you about your
health care only in a certain location or through a certain method. For example, you may request that we contact you only at work
or by e-mail.
F. Right to a Paper Copy of this Notice. You have the right to
obtain a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this Notice of Privacy
Practices electronically, you may still obtain a paper copy.
Important Contact Information. In order to enforce any of your rights described above, you must send a written request to our Privacy Officer at P.O. Box 187, Denison, IA 51442.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact our Complaint Officer at P.O. Box 187, Denison, IA 51442, (712) 263-3172. All complaints must be submitted in writing. There will be no retaliation for the filing of a complaint.
Changes to this Notice
We reserve the right to change the terms of our Notice of Privacy Practices. We also reserve the right to make the revised or changed Notice of Privacy Practices effective for all health information we already have about you as well as any health information we receive in the future. We will post a copy of the current Notice of Privacy Practices at our main office and at each site where we provide care. You may also obtain a copy of the current Notice of Privacy Practices by calling us at (712) 263-3172 or by asking for one any time you are at our offices.
Board
App. (3-10-03)
Effective
Date: April 14, 2003
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