Notice Effective
Date: 4/14/06
THE MISSOURI DEPARTMENT OF MENTAL HEALTH AND
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.
This notice is to explain the rules around the privacy of your own
medical/health records and our legal duties on how to protect the privacy of
your medical/health records that we create or receive. Generally, we are required by law to ensure
that medical/health information that identifies you is kept private. We are required by law to follow the terms
of the notice that are the most current.
This notice will explain:
·
how we may use and disclose your
medical/health information,
·
our obligations related to the use and
disclosure of your medical/health information and
·
your rights related to any
medical/health information that we have about you.
This notice applies to the
medical/health records that are generated in or by this facility. The terms “medical” and “medical/health” in
this Notice means information about your physical or mental condition which
make you eligible for our services, or which arise while we are serving
you. For example, this may include
psychological tests, psychiatric assessments or medical or social assessments.
We may obtain, but we are not required to, your consent for the use or
disclosure of your protected health information for treatment, payment or
health care operations. We are required
to obtain your authorization for the use or disclosure of your information for
other specific purposes or reasons. We
have listed some of the types of uses or disclosures below. Not every possible use or disclosure is
covered, but all of the ways that we are allowed to use and disclose
information will fall into one of the categories.
If you have any questions about the content of this Notice of Privacy
Practices, or if you need to contact someone at the facility about any of the
information contained in this Notice of Privacy Practices, the contact person
is the Privacy Officer or designee:
Southeast Missouri Community Treatment Center, Inc.
(573) 431-0554
In addition to facility departments, employees, staff and other facility
personnel, the following people will also follow the practices described in
this Notice of Privacy Practices:
·
Any health care professional who is
authorized to enter information in your medical/health record;
·
Any member of a volunteer group that we
allow to help you while you are in the facility; and
·
All providers that the Department of
Mental Health contracts with to provide direct treatment services to our
consumers.
In addition, individuals and providers may share medical
information with each other about DMH consumers they serve in common for the
purpose of treatment, payment or health care operations as those terms are
described later in this Notice of Privacy Practices.
HOW WE MAY USE AND DISCLOSE
MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose
medical/health information. For each category of uses or disclosures we will
explain what we mean and try to give some examples. Not every use or disclosure
in a category will be listed. However, all of the ways we are permitted to use
and disclose information will fall within one of the categories.
Use and Disclosure of Medical Information
We can use or disclose medical information about you
regarding your treatment, payment for services, or for facility operations, and
we will make a good faith effort to have you acknowledge your copy of the
Notice of Privacy Practices.
Treatment
We may use medical (protected health information, or PHI) information
about you to provide you with treatment or services. We may disclose medical
information about you to qualified mental health professionals, or QMHPs;
qualified mental retardation professionals or QMRPs; or to qualified
counselors; or, technicians, medical students or residents, or other facility
personnel, volunteers or interns who are involved in providing services for you
at the facility, or interpreters needed in order to make your treatment
accessible to you. For example, your treatment
team members will internally discuss your medical/health information in order
to develop and carry out a plan for your services. Different departments of the facility also
may share medical/health information about you in order to coordinate the different
things you need, such as prescriptions, medical tests, special dietary needs,
respite care, personal assistance, day programs, etc. We also may disclose
medical/health information about you to people outside the facility who may be
involved in your medical care after you leave the facility, such as community
health/mental health/developmental disability/substance abuse providers or
others we use to provide services that are part of your care, but only the
minimum necessary amount of information will be used or disclosed to carry this
out. Please note that the definition of treatment does allow DMH
to share PHI when necessary to consult with other providers, or when necessary
to refer you to another provider, or even to treat a different individual.
Payment We may use and disclose medical/health
information about you so that the treatment and services you receive at the
facility may be billed to and payment may be collected from you, an insurance
company or a third party. For example, we may need to provide your insurance
plan information about psychiatric treatment or habilitation services you
received at the facility so your insurance plan, or any applicable Medicaid or
Medicare funds, will pay us for the services. We may also tell your insurance
plan or other payor about a service you are going to receive in order to obtain
prior approval or to determine whether the service is covered. In addition, in order to correctly determine
your ability to pay for services, we may disclose your information to the
Social Security Administration, the Division of Employment Security, or the Department of Social Services.
Health Care Operations
We may use and disclose medical/health information about you for
facility operations. These uses and disclosures are necessary to run the
facility or the Department of Mental Health and make sure that all of our
consumers receive quality care. For example, we may use medical/health
information for quality improvement to review our treatment and services and to
evaluate the performance of our staff in caring for you. We may also combine
medical information about many facility consumers to decide what additional
services the facility should offer, what services are not needed, and whether
certain new treatments are effective. We may also disclose information to
doctors, nurses, technicians, medical students and residents, and other
facility personnel as listed above for review and learning purposes. We may
also combine the medical/health information we have with medical/health
information from other facilities to compare how we are doing and see where we
can make improvements in the care and services we offer. It may also be
necessary to obtain or exchange your information with the Department of
Elementary and Secondary Education, the Department of Social Services,
Vocational Rehabilitation, the Office of State Courts Administrator, or other
Other Uses and Disclosures of Medical/Health Information That
Do Not Require Your Consent or Authorization:
We
can use or disclose health information about you without your consent or
authorization when:
·
there is an emergency or when we are required by law to
treat you,
·
when we are required by law to use or disclose certain
information, or
·
when there are substantial communication barriers to
obtaining consent from you.
We
can also use or disclose health information about you without your consent or
authorization for:
Appointment Reminders
We may use and disclose medical information to contact you as a reminder
that you have an appointment for treatment or services at the facility.
Treatment Alternatives and Health-Related Benefits and
Services We may use and disclose medical
information to tell you about or recommend possible treatment options or
alternatives or health-related benefits or services that may be of interest to
you.
Individuals Involved in Disaster Relief Should a disaster occur, we may disclose
medical information about you to any agency assisting in a disaster relief
effort so that your family can be notified about your condition, status and location.
Research
Under certain circumstances, we may use and disclose medical/health
information about you for research purposes when a waiver of authorization has
been approved by the Institutional Review Board, or Privacy Committee. For
example, a research project may involve comparing the health and recovery of
all consumers who received one medication to those who received another for the
same condition. All research projects, however, are subject to a special
approval process under
As Required By Law We will disclose medical/health information
about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or
Safety We may use and disclose
medical/health information about you when necessary to prevent a serious threat
to the health and safety of you, the public, or any other person. However, any such disclosure would only be to
someone able to help prevent the threat.
SPECIAL SITUATIONS
Organ and Tissue Donation
If you are an organ donor, we may release medical/health information to
organizations that handle organ procurement or organ, eye or tissue
transplantation or to an organ donation bank, as necessary to facilitate organ
or tissue donation and transplantation.
Military and Veterans
If you are a member of the armed forces, we may release medical/health
information about you as required by military command authorities. We may also
release medical information about foreign military personnel to the appropriate
foreign military authority.
Workers' Compensation When disclosure is necessary to comply with
Workers’ Compensation laws or purposes, we may release medical/health information
about you for workers' compensation or similar programs. These programs provide
benefits for work-related injuries or illness.
Public Health Risks We
may disclose medical/health information about you for public health activities.
These activities generally include the following: to prevent or control disease, injury or
disability; to report births and deaths; to report child abuse or neglect; to
report reactions to medications or problems with products; to notify people of
recalls of products they may be using; to notify a person who may have been
exposed to a disease or may be at risk for contracting or spreading a disease
or condition; to notify the appropriate government authority if we believe a
consumer has been the victim of abuse, neglect or domestic violence. We will
only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities
We may disclose medical/health information to a health oversight agency
for activities authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure. These activities
are necessary for the government to monitor the health care system, government
programs, and compliance with civil rights laws.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose
medical/health information about you in response to a court or administrative
order.
Law Enforcement We may
release medical/health information if asked to do so by a law enforcement
official; however, if the material is protected by 42 CFR Part 2 (a federal law
protecting the confidentiality of drug and alcohol abuse treatment records), a
court order is required. We may also
release limited medical/health information to law enforcement in the following
situations: (1) about a consumer who may
be a victim of a crime if, under certain limited circumstances, we are unable
to obtain the consumer’s agreement; (2) about a death we believe may be the
result of criminal conduct; (3) about criminal conduct at the facility; (4)
about a consumer where a consumer commits or threatens to commit a crime on the
premises or against program staff (in
which case we may release the consumer’s name, address, and last known whereabouts);
(5) in emergency circumstances, to report a crime, the location of the crime or
victims, and the identity, description and/or location of the person who
committed the crime; and (6) when the consumer is a forensic client and we are
required to share with law enforcement by Missouri statute.
Coroners, Medical Examiners and Funeral Directors We may release medical/health information to
a coroner or medical examiner. This may be necessary, for example, to identify
a deceased person or determine the cause of death. We may also release
medical/health information about consumers of a facility to funeral directors
as necessary to carry out their duties.
National Security and Intelligence Activities We may release medical information about you
to authorized federal officials for intelligence, counterintelligence, and
other national security activities authorized by law.
Protective Services for the President
and Others We may disclose medical
information about you to authorized federal officials so they may conduct
special investigations or provide protection to the President and other
authorized persons or foreign heads of state.
Inmates If you are an
inmate of a correctional institution or under the custody of a law enforcement
official, we may release medical/health information about you to the
correctional institution or law enforcement official if the release is
necessary (1) for the institution to provide you with health care; (2) to
protect your health and safety or the health and safety of others; or (3) for
the safety and security of the correctional institution.
Emergency or Disaster
Events
In the interest of public safety and
planning for community needs in an emergency or disaster event, we may disclose
general information about you to emergency managers, fire, law enforcement,
public health authorities, emergency medical services such as ambulance
districts, utilities, and other public works officials regarding:
·
The
numbers and locations of DMH clients in community and state-operated settings;
·
Any
special needs identified in these settings for purposes of rescue such as
sensory, cognitive and mobility impairments;
·
Special
assistance and supports needed to effectively meet these needs such as
communication devices, specialized equipment for evacuation, etc;
·
Necessary
information to order necessary treatment or prophylaxis supplies and
medications in the event of a public health emergency;
·
Emergency
notification contacts to expedite contact with families, legal guardians or
representatives or others regarding need for evacuation or emergency medical
care;
·
Any
special needs that justify prioritization of utility restoration such as but
not limited to dependence on respirator or other medical equipment, phone for
emergency contact, etc.; or
·
Any
other information that is deemed necessary to protect the health, safety and
well-being of DMH consumers.
YOUR RIGHTS REGARDING MEDICAL/HEALTH INFORMATION ABOUT YOU.
You have the following rights regarding medical information
we maintain about you:
Right to Inspect and Copy
You have the right to inspect and copy your medical/health information
with the exception of psychotherapy notes and information compiled in
anticipation of litigation. To inspect
and copy your medical/health information, you must submit your request in
writing to this facility’s Privacy Officer or designee. If you request a copy
of the information, we may charge a fee for the costs of copying, mailing or
other supplies associated with your request.
We may deny your request to inspect and copy in certain limited circumstances.
If you are denied access to your medical/health information because of a threat
or harm issue, you may request that the denial be reviewed. Another licensed
health care professional chosen by the facility will review your request and
the denial. The person conducting the review will not be the person who denied
your request. We will comply with the outcome of the review.
Right to Request an Amendment
If you feel that medical/health information we have about you is
incorrect or incomplete, you may ask us to amend the information. You have the
right to request an amendment for as long as the information is kept by or for
the facility. Requests for an amendment
must be made in writing and submitted to the Privacy Officer or designee. You must provide a reason to support your
request for an amendment. We may deny
your request if it is not in writing or if it does not include a reason
supporting the request. In addition, we may deny your request if you ask us to
amend information that:
·
Was not created by us, unless the
person or entity that created the information is no longer available to make
the amendment;
·
Is not part of the medical information
kept by or for the facility;
·
Is not part of the information which
you would be permitted to inspect and copy; or
·
Is accurate and complete.
Right to an Accounting of Disclosures You have the right to
request an "accounting of disclosures", a list of the disclosures
made by the facility of your medical/health information. To request an accounting of disclosures, you
must submit your request in writing to this facility’s Privacy Officer or
designee. Your request must state a time
period which may not go back more than six years and cannot include dates
before April 14, 2003. Your request
should indicate in what form you want the list (for example, on paper or
electronically). The first list you
request within a twelve-month period will be free. For additional lists in a
twelve-month period, we may charge you for the cost of providing the list. We will notify you what that cost will be and
give you an opportunity to withdraw or modify your request before you are
charged. There are some disclosures that
we do not have to track. For example,
when you give us an authorization to disclose some information, we do not have
to track that disclosure.
Right to Request Restrictions
You have the right to request a restriction or limitation on the
medical/health information we use or disclose about you for treatment, payment
or health care operations. For example, you could ask that we not use or
disclose information about your family history to a particular community
provider. 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 a
restrictions on the use or disclosure of your medical/health information for
treatment, payment or health care operations, you must make your request in
writing to the facility’s Privacy Officer or designee. 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 (for example,
disclosures to your spouse).
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. For example, you can ask that
we only contact you at work or by mail.
To request confidential communications, you must make your request in
writing to the facility’s Privacy Officer or designee. Your request must specify how or where you
wish to be contacted. We will not ask
you the reason for your request and will accommodate all reasonable requests.
Right to a Paper Copy of This Notice You have the right to a paper copy of this
notice even if you have agreed to receive the notice electronically. You may
ask us to give you a copy of this notice at any time by contacting the
facility’s Privacy Officer or designee.
You may also obtain a copy of this notice at our website, http://www.dmh.mo.gov/
If you wish to exercise any of these
rights, please contact:
Southeast Missouri Community Treatment Center, Inc.
(573) 431-0554
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We may make the revised notice effective for
medical/health 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
facility. The notice will contain on the first page, in the top right-hand
corner, the effective date. In addition,
each time you register at or are admitted or apply for services to the facility
for treatment or services, we will offer you a copy of the current notice in
effect. If you want to request any
revised Notice of Privacy Practice, you may access it at our website, http://www.dmh.mo.gov/
COMPLAINTS
If you
believe your privacy rights have been violated, you may:
·
File a complaint with the facility,
contact Privacy Officer or Designee, at the following address and telephone
number.
Southeast Missouri Community Treatment Center, Inc.
(573) 431-0554
·
File a complaint with the Region VII,
Office for Civil Rights (OCR), U.S. Department of Health and Human
Services. You may call them at
816.426.7278 or write to them at
·
File written complaints with the Department of Health and
Human Services Office for
Civil Rights (OCR) by mail, fax,
or email. If you need help filing a complaint or have a question about
the complaint form, please call this OCR toll free number: 1-800-368-1019.
You can submit your complaint in any written format. It
is recommend that you use the OCR Health Information Privacy Complaint Form
which can be found on our web site or at an OCR Regional office. If you
prefer, you may submit a written complaint in your own format. Be sure to
include the following information in your written complaint::
·
If you are filing a
complaint on someone's behalf, also provide the name of the person on whose
behalf you are filing.
·
Name, full address and
phone of the person, agency or organization you believe violated your (or
someone else's) health information privacy rights or committed another
violation of the Privacy Rule.
·
Briefly describe what
happened. How, why, and when do believe your (or someone else's) health
information privacy rights were violated, or the Privacy Rule otherwise was
violated?
·
Any other relevant
information.
·
Please sign your name
and date your letter.
The following information is
optional:
·
Do you need special
accommodations for us to communicate with you about this complaint?
·
If we cannot reach you
directly, is there someone else we can contact to help us reach you?
·
Have you filed your
complaint somewhere else?
The Privacy Rule, developed under authority of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), prohibits the
alleged violating party from taking retaliatory action against anyone for
filing a complaint with the Office for Civil Rights. You should notify OCR
immediately in the event of any retaliatory action.
To submit a complaint with OCR, please use one of the
following methods. If you mail or fax the complaint, be sure to follow
the instructions above for determining the correct regional office.
Option 1: Open and print out the Health Information Privacy Complaint
Form in PDF format (you will need Adobe Reader software) and
fill it out. Return the completed complaint to the appropriate OCR
Regional Office by mail or fax.
Option 2: Download the Health Information Privacy Complaint
Form in Microsoft Word format to your own computer, fill out and
save the form using Microsoft Word. Use the Tab and Shift/Tab on your
keyboard to move from field to field in the form. Then, you can either:
(a) print the completed form and mail or fax it to the appropriate OCR Regional
Office; or (b) email the form to OCR at OCRComplaint@hhs.gov.
Option 3: If you choose not to use the
OCR-provided Health Information Privacy Complaint Form (although we recommend
that you do), please provide the information specified above and either: (a)
send a letter or fax to the appropriate OCR Regional Office; or (b) send an
email OCR at OCRComplaint@hhs.gov.
If you require an answer regarding a general health information privacy
question, please view our Frequently Asked Questions (FAQs). If you still
need assistance, you may call OCR (toll-free) at: 1-866-627-7748. You may
also send an email to OCRPrivacy@hhs.gov with suggestions regarding future
FAQs. Emails will not receive individual responses.
Website:
http://www.hhs.gov/ocr/hipaa
All complaints must be submitted in
writing. You will not be penalized for
filing a complaint.
OTHER
USES OR DISCLOSURES OF MEDICAL/HEALTH INFORMATION.
Uses
or disclosures not covered in this Notice of Privacy Practices will not be made
without your written authorization. If
you provide us written authorization to use or disclose information, you can
change your mind and revoke your authorization at any time, as long as it is in
writing. If you revoke your
authorization, we will no longer use or disclose the information. However, we will not be able to take back any
disclosures that we have made pursuant to your previous authorization.