NOTICE OF
PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL AND HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. Purpose of This Notice
This notice describes how we, Riveon Mental Health and Recovery Services, use or disclose your Private Health Information (PHI). PHI is information that identifies you and relates to health care services, the payment for health care services or your physical or mental health or condition, in the past, present or future. This notice also describes your rights to access and control your PHI.
2. Acknowledgment of Receipt of this Notice
You will be asked to sign a Treatment Consent form acknowledging your receipt of this Notice. Our intent is to make sure you are aware of the possible uses and disclosures of your PHI and your privacy rights. The delivery of health care services will in no way be conditioned upon your signed acknowledgment. If you refuse to sign the acknowledgment, we will continue to provide treatment, and will use and disclose your PHI for treatment, payment, and health care operations when necessary.
3. Our Responsibilities
Federal law requires that we maintain the privacy of your PHI and provide you with this Notice of our legal duties and privacy practices. We are required to notify affected individuals following a breach of unsecured PHI. We are required to abide by the terms of this Notice, which may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI that we maintain. We will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures, your rights, our duties, or other practices stated in this Notice. Except when required by law, a material change to this notice will not be implemented before the effective date of the new notice.
4. How We May Use or Disclose Private Health Information (PHI)
- Disclosures You Authorize Us to Make. We will not use or disclose your PHI without authorization, except as described in this Notice. Most uses and disclosures of your client record, as applicable, require your authorization. Subject to certain limited exceptions, we may not use or disclose PHI for marketing without your authorization. We may not sell PHI without your authorization. You may give us written authorization to use and/or disclose health information to anyone for any purpose. If you authorize us to use or disclose such information, you may revoke that authorization in writing at any time.
- For Treatment. We may use and disclose your PHI to coordinate or manage your care within the agency and with individuals or organizations outside of the agency that are involved in your care, such as your attending physician, other health care professionals, contracted service providers or related organizations. For example, certain service providers involved in your care may need information about your medical condition in order for us to deliver services properly and appropriately.
- To Obtain or Provide Payment. We may include your PHI in invoices to collect or provide payment to or from third parties for the care you received through the agency. For example, some PHI is transmitted to the Mental Health, Alcohol and Drug Addiction Services Board of the county in which services were rendered and the Ohio Department of Job and Family Services when billing transactions are conducted.
- To Conduct Health Care Operations. We may use and disclose PHI for our own operations and as necessary to provide quality care to all of our service recipients. Health care operations include but are not limited to the following activities: quality assessment and improvement activities; activities designed to improve health or reduce health care costs; protocol development, case management and care coordination; professional review and performance evaluation; review and auditing, including compliance reviews, medical reviews, legal services and compliance programs; and business management and general administrative activities of the agency. For example, we may use PHI to evaluate our staff performance or combine your health information with other consumer PHI to evaluate how to better serve all of our clients. Another example may be the disclosure of your PHI to staff or contracted personnel for certain limited training purposes.
- For Appointment Reminders, Treatment Alternatives Surveys or Fundraising Activities. We may use and disclose your PHI to contact you about your treatment. We will attempt to use your preferred contact method (may include phone, text or email). Such contact may include appointment reminders, agency updates or other correspondence. We may use or disclose your PHI to advise you or recommend possible service options or alternatives that may be of interest to you. You may opt out of any or all methods of communication by following the opt-out instructions in any communication you receive from us.
- When Legally Required. We will disclose your PHI when required by any federal, state or local law.
- In the Event of a Serious Threat to Life, Health or Safety. We may, consistent with applicable law and ethical standards of conduct, disclose your PHI if we, in good faith, believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to your life, health, or safety, or to the health and safety of the public.
- When There Are Risks to Public Health. The agency may disclose your PHI for public activities and purposes allowed by law in order to prevent or control disease, injury or disability; report disease, injury, and vital events such as birth or death; conduct public health surveillance, investigations, and interventions; or notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
- To Report Abuse, Neglect or Domestic Violence. We may notify government authorities if we believe a consumer is the victim of abuse, neglect or domestic violence. We will make this disclosure only when required or authorized by law, or when the consumer agrees to the disclosure.
- To Conduct Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. However, we may not disclose your PHI if you are the subject of an investigation and your PHI is not directly related to your receipt of health care or public benefits.
- For Law Enforcement Purposes. As permitted or required by law, we may disclose specific and limited PHI about you for certain law enforcement purposes.
- In Connection With Judicial and Administrative Proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order, or, in response to a subpoena, discovery request or other lawful process, if we determine that reasonable efforts have been made by the party seeking the information to either notify you about the request or to secure a qualified protective order regarding your health information. Under Ohio law, some requests may require a court order for the release of any confidential medical information.
- For Research Purposes. At times our agency may participate in research studies where your PHI will be used. An agency staff person will alert you to research opportunities and they will share with you what the project is about, how it can benefit you and your course of treatment and any side effects. If you agree to participate in the research, you will sign a consent form. All research participation is completely voluntary, you will remain anonymous and you may discontinue, at any time, without fear of losing existing services.
- For Specific Government Functions. Federal regulations may require or authorize us to use or disclose your PHI to facilitate specific government functions relating to military and veterans; national security and intelligence activities; protective services for the President and others; medical suitability determinations; and inmates and law enforcement custody.
- For Worker’s Compensation. We may use or disclose your PHI for Workers Compensation or similar programs.
- Transfer of Information at Death. In certain circumstances, we may disclose your PHI to funeral directors, medical examiners, and coroners to carry out their duties consistent with applicable law.
- Organ Procurement Organizations. Consistent with applicable law, we may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purposes of tissue donation and transplant.
- Reproductive Healthcare. Unless required or permitted by law, we will not disclose or use your PHI when there is an investigation into any person for the mere act of seeking, obtaining, providing, or facilitating reproductive healthcare. We will not disclose or use your PHI when there is Imposing liability. Imposing criminal, civil, or administrative liability on any person for the mere act of seeking, obtaining, providing, or facilitating reproductive healthcare.
5. Your Rights with Respect to Your Private Health Information (PHI)
You have the following rights regarding PHI that we maintain:
- To Receive This Notice. You have a right to receive a paper copy of this Notice at any time, even if you have received this Notice previously.
- To Choose How We Contact You. You have the right to ask that we send you information at an alternative address or by an alternative means.
- To Request Restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on our disclosure of your PHI to someone who is involved in your care or the payment of your care. Although we will consider your request, please be aware that we are under no obligation to accept it or to abide by it unless the request concerns a disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains solely to a health care service for which the provider has been paid out of pocket in full. We cannot agree to limit disclosures that are required by law. To request restrictions, please contact your primary service provider or the agency’s Privacy Officer.
- To Receive Confidential Communications. You have the right to request that we communicate with you in a confidential manner. For example, you may ask us to conduct communications pertaining to your health information only with you privately, with no other family members present. If you wish to receive confidential communications, please contact your primary service provider or the agency’s Privacy Officer at (440) 204-4330. We may not require that you provide an explanation for your request and will attempt to honor any reasonable request.
- To Inspect and Receive a Copy of Your PHI. Unless your access is restricted for clear and documented treatment reasons, you have the right to see your PHI upon request. We agree to respond to your request within 30 days. If you want copies of your PHI, there is usually a charge for copying for which you would be responsible. You have the right to choose what parts of your information you would like copied and to have prior information regarding the cost of copying. If you wish to review and/or receive copies of your PHI, your request should be made to your primary service provider or the agency Privacy Officer.
- To Request Amendment of Your PHI. You have the right to request that we amend your records, if you believe that your PHI is incorrect or incomplete. That request may be made as long as we maintain the information. A request for an amendment of records must be made in writing. We may deny the request if it is not in writing, or does not include a reason for the amendment. The request also may be denied if your health information records were not created by us, if the records you are requesting are not part of our records, if the health information you wish to amend is not part of the health information you are permitted to inspect and copy, or if, in our opinion, the records containing your health information are accurate and complete. We take the position that amendments may take the form of including a written statement from you and may not include changing, defacing, or destroying any necessary information regarding your health care.
- To Know What Disclosures Have Been Made. You have a right to request an accounting of disclosures of your PHI made by us for certain reasons, including reasons related to public purposes authorized by law, and certain research. The request for an accounting must be made in writing to your primary service provider or the Privacy Officer. The request must specify the time period. Requests may not be made for periods of time in excess of six (6) years prior to the date on which the records are requested. We will provide the first accounting you request during any 12-month period without charge. Subsequent requests may be subject to a reasonable, cost-based fee.
- Right to a Personal Representative. You may identify persons to us who may serve as your authorized personal representative, such as a court-appointed guardian, a properly executed and specific power-of-attorney granting such authority, a Durable Power of Attorney for Health Care if it allows such person to act when you are unable to communicate on your own, or other method recognized by applicable law. We may, however, reject a representative if, in our professional judgment, we determine that it is not in your best interest.
How to Get Information or to Submit a Complaint:
You have the right to file a complaint if you believe that your privacy rights have been violated, including the denial of any rights set forth in this notice. Any complaints to us shall be made in writing to your primary service provider or the agency’s privacy officer. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
Dan Haight
Privacy Officer
6140 South Broadway,
Lorain, OH 44053
(440) 989-4920
You may also file a written complaint with
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
(877) 696-6775 or
[email protected]
Region V – Civil Rights
US Department of Health and Human Services
223 N. Michigan – Suite 240
Chicago, IL
(312) 886-2359
We have designated the agency’s privacy Officer as our contact point for all issues regarding consumer privacy and your rights under this notice. If you have any questions regarding this notice, please contact your primary service provider or the agency’s privacy officer
Effective date: This Notice is effective July 1, 2024
Riveon Mental Health and Recovery is a 501(c)(3) private, non-profit organization serving the needs of Erie, Cuyahoga, Huron and Lorain County residents