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 describes how Crossroads Health (covered entity), uses or discloses your Protected Health Information (PHI). PHI is information that identifies you and relates to health care services, the payment of 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.
Federal law requires that we maintain the privacy of your PHI and provide to 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 in which the material change is reflected.
How We May Use or Disclose PHI For Treatment, Payment, and Health Care Operations
For Treatment. We may use and disclose your PHI to coordinate or manage your care at Crossroads Health and with individuals or organizations outside of Crossroads Health that are involved in your care, such as your attending physician, other health care professionals, pharmacies, 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 receive through Crossroads Health. For example, some PHI is transmitted to the Ohio Department of Jobs and Family Services when billing transactions are conducted. We may also provide your PHI to third party processors that handle PHI, such as managed care companies and payment authorization services.
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 includes but is 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 Crossroads Health’s business management and general administrative activities. 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 customers. Another example may be the disclosure of your PHI to staff or contracted personnel for certain limited training purposes.
How We May Use or Disclose PHI For Appointment Reminders, Treatment Alternatives, or Fundraising Activities
We may use and disclose your PHI to contact you as a reminder that you have an appointment. We may use and disclose your PHI to advise you or recommend possible service options or alternatives that may be of interest to you. We may contact you for fundraising and marketing activities. However, you will be provided the opportunity to opt out of receiving such fundraising communications.
Disclosures You May 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 psychotherapy notes, 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. We are required to obtain your consent for certain disclosures of health information involving the performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition, or drug or alcohol treatment that you have received as part of a drug or alcohol treatment program. 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.
How We May Use or Disclose PHI for Other Specific Uses
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. Crossroads Health 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.
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 Law Enforcement Purposes. As permitted or required by law, we may disclose specific and limited PHI about you for certain law enforcement purposes.
For Research Purposes. We may, under very select circumstances, use your PHI for research. Before we disclose any of your PHI for such research purposes in a way that you could be identified, the project will be subject to an extensive review and approval process, unless otherwise prohibited as with Medicaid.
For Specified Government Functions. Federal regulations may require or authorize us to use or disclose your PHI to facilitate specified 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 Workers’ 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.
Engage in Marketing/Social Media. With your authorization and/or acknowledgement, and/or as permitted by law, we may create social media publications at the discretion of Crossroads Health staff members that may include your likeness. Most often, your PHI will not be disclosed without your prior written authorization if the publication specifically identifies you and is not pertaining to a public event.
Health Information Exchanges. We may participate in certain health information exchanges whereby we may disclose your health information, as permitted by law, to other health care providers or entities for treatment, payment, or health care operations purposes. A full list of these arrangements can be obtained by calling the Crossroads Health Privacy Office at 440.255.1700.
Healthcare Continuity. Consistent with applicable law, we may disclose pertinent medical information with your other providers, insurer, pharmacy, laboratories, and any other known treating entity to ensure effective care.
Telemedicine. It may be clinically appropriate to engage in treatment with you via the means of telemedicine. This communication will be through an encrypted and on a secure network, but we cannot guarantee your privacy if you are in a public setting. For ways to maintain your privacy while participating in telemedicine please talk with your service provider prior to engaging in this practice.
Your Rights with Respect to PHI
You have the following rights regarding PHI that we maintain:
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 able to communicate on your own, an individual identified in a psychiatric or healthcare advance directive, or other method recognized by applicable law. We may, however, reject a representative if, in our professional judgment, we determine that it is in your best interest.
Right 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. To request such restrictions, please contact your Crossroads Health service provider or Crossroads Health’s Privacy Officer at (440) 255-1700.
Right 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 Crossroads Health service provider or Crossroads Health’s Privacy Officer at (440) 255-1700.
Right to Inspect and Copy Your PHI. Unless your access to your records is restricted for clear and documented treatment reasons, you have a right to see your PHI upon request. You have the right to inspect and copy such health information, including billing records, at a reasonable time and place. A request to inspect and copy records containing your PHI may be made to your Crossroads Health service provider or Crossroads Health’s Records Department (440) 255-1700.
If you request a copy of such health information, we may charge reasonable copying, processing, and personnel fees.
Right to Amend 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 to your Crossroads Health service provider or Crossroads Health’s Privacy Officer at 8445 Munson Rd., Mentor, OH 44060. 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 related to your health care.
Request to Know What Disclosures Have Been Made. You have the 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 Crossroads Health service provider or Crossroads Health’ Privacy Officer at 8445 Munson Rd., Mentor, OH 44060. The request must specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years prior to the date on which the accounting is requested. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable, cost-based fee.
Right to a Paper Copy of This Notice. You have a right to receive paper copy of this Notice at any time, even if you have received this Notice previously or electronically. To obtain a paper copy, please contact your Crossroads Health service provider or Crossroads Health’s Privacy Officer at (440) 255-1700.
Where to File a Complaint
You have the right to complain to us 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 Crossroads Health service provider or Crossroads Health’s Privacy Officer at 8445 Munson Rd., Mentor, OH 44060. 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.
You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C., 20201 or call toll-free (877) 696-6775, by e-mail to OCRComplaint@hhs.gov or to Midwest Region, Office for Civil Rights, U.S. Department of Health and Human Services, 233 N. Michigan Ave., Suite 240, Chicago, IL. 60601, by phone via the Customer Response Center at (800) 368-1019, by fax at (202) 619-3818, or via TDD at (800) 537-7697.
We have designated the 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 Privacy Officer, Nicole Vojtush, directly or through your Crossroads Health service provider at 8445 Munson Rd., Mentor, OH 44060; (440) 255-1700.
This Notice is effective January 10, 2020