Effective Date: 4/16/03

Revised: 6/1/05

Revised:  9/21/05

Reviewed: 6/2/08

NOTICE OF PRIVACY PRACTICES

GRAND LAKE MENTAL HEALTH, INC.

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 applies to all of Grand Lake Mental Health, Inc. facilities. A copy of this may be found in the Administrative Office of each GLMHC facility.  If you have any questions about this notice, please contact the Health Information Administrator at 918-906-7522.

WHO WILL FOLLOW THIS NOTICE

This notice describes our organization’s practices and that of:

• Any health care professional authorized to enter information into your medical record.
• All departments and units of GLMHC.
• All employees, staff and other GLMHC personnel, including physicians, psychologists, and therapists who are independent contractors of GLMHC.
• GLMHC, Inc. includes community mental health clinics.  All these entities, sites, and locations follow the terms of this notice and may share medical information with each other for treatment, payment or health care operation purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical information about you and your health is personal and we are committed to protecting your medical information.  We create a record of the care and services you receive at GLMHC, Inc.  We need this record to provide you with quality care and to comply with certain legal requirements.  This notice applies to all of the records of your care generated by GLMHC, Inc.

This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

·         make sure that medical information that identifies you is kept private;

·         give you notice of our legal duties and privacy practices with respect to medical information about you; and

·         follow the terms of the notice that is currently in effect.

*Medical information includes all confidential health information:  medical, mental health and substance abuse.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we may use and disclose medical information without obtaining your authorization in advance.  For each category of uses or disclosures we will explain what we mean and try to give an example.  Not every use of 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.

Routine Uses

·         For Treatment.   We may use medical information about you to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, clinicians or other GLMHC personnel who are involved in taking care of you at GLMHC.  For example, a doctor prescribing medicine for you would need to know other medications that you are taking and the reason for taking these medicines to help prevent any medication interaction problems.  Different areas of GLMHC, Inc. also may share medical information about you in order to coordinate the different things you need, such as lab work, prescriptions and other testing. This would also include the sharing of information among students of a professional training program that GLMHC may sponsor.  Information may also be shared for purposes of treatment and follow-up with the Department of Mental Health and Substance Abuse and their contractors if the client’s services are being paid for by DMHSAS.

·         For Payment.  We may use and disclose medical information about you so that the treatment and services you receive at the GLMHC may be billed and payment may be collected from you, an insurance company or a third party.  We may disclose medical information to your health plan, insurance company, HMO, or their utilization review contractor to obtain prior approval or to determine whether your plan will cover a particular treatment.

·         For Healthcare Operations.  We may use and disclose medical information about you for healthcare operations.  These uses and disclosures are necessary to run GLMHC and make sure that all of our clients receive quality care.  For example, we may use medical information 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 GLMHC clients to decide what additional services GLMHC should offer, what services are not needed, and whether certain new treatments are effective.  We may also disclose information to doctors, nurses, clinicians and other GLMHC personnel for review and learning purposes.  We may also combine the medical information we have with medical information from other healthcare organizations to compare how we are doing and see whether we can make improvements in the care and services we offer.  We will remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

·         Appointment Reminders.  We may use and disclose medical information to contact you as a reminder that you have an appointment for services at GLMHC.

·         Treatment Alternatives.  We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

·         Health-Related Benefits and Services.  We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

·         As Required By Law.  We will disclose medical information about you when required to do so by federal, state or local law such as those circumstances listed below under “Public Health Risks”.  In Oklahoma, GLMHC is required to disclose records and information as necessary and appropriate to individuals and agencies that hold a contract with the Department of Mental Health and Substance Abuse Services.

·         To Avert a Serious Threat to Health or Safety.  We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure, however, would only be to someone able to help prevent the threat.

  Special Situations

·         Contracted Pharmaceutical Services.   We may release information about you to our contracted pharmaceutical services for the purpose of filling your medication prescriptions.

·         Workers’ Compensation.  We may release medical information about you to your employer or his/her designee for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

·         Public Health Risks.  We may disclose medical information about you for public health activities.  These activities generally include the following:

1.      to prevent or control disease, injury or disability;

2.      to report deaths;

3.      to report child abuse or neglect;

4.      to report reactions to medications or problems with products;

5.      to notify people of recalls of products they may be using;

6.      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;

7.      to notify the appropriate government authority if we believe a patient has been the victim of abuse or neglect. 

·         Health Oversight Activities.  We may disclose medical 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.

·         Accrediting Organizations.  We may disclose medical information to an organization that GLMHC has contracted with for purposes of accreditation such as CARF, JCAHO, the Department of Mental Health, and the Oklahoma Health Care Authority, etc.

·         Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court order.

·         Law Enforcement.  We may release medical information if asked to do so by a law enforcement official:

1.      In response to a court order, warrant, summons or similar process;

2.      To identify or locate a suspect, fugitive, material witness, or missing person;

3.      About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;

4.      About a death we believe may be the result of criminal conduct;

5.      About criminal conduct at the facility; and

6.      In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

·         Coroners, Medical Examiners and Funeral Directors.  We may release medical 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 information about patients of GLMHC 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 provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

YOUR RIGHTS REGARDING MEDICAL 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 request to inspect and copy medical information that may be used to make decisions about your care.  This request must be made in writing to GLMHC.  If you request a copy of the information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request.  The fee would be at the Oklahoma statutory rate plus postage.  If your request is denied by the Clinical Director or Practitioner, you will receive a written explanation for the denial.

• Right to Amend.  If you feel that medical 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 GLHMC. 

To request an amendment, your request must be made in writing and submitted to the Clinical Director for GLMHC, 114 West Delaware, Nowata, OK  74048.  In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support 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 GLMHC;

·         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.”  This is a list of the disclosures we made of medical information about you.

To request this list or accounting of disclosures, you must submit your request in writing to GLMHC.  Your request must state a time period which may not be longer that six years and may not include dates before April 14, 2003.  The first list you request within a 12 month period will be free.  For additional lists, we may charge you for the cost of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

• Right to Request Restrictions.  You have the right to request a restriction of limitation on the medical information we use or disclose about you for treatment, payment or health care operations.  You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.

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 restrictions, you must make your request in writing to GLMHC.  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 communication, you must make your request in writing to GLMHC.  We will not ask you the reason for your request.  We will accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted.

• Right to a Paper Copy of This Notice.  You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  To obtain a paper copy of this notice, please contact the Administrative office of any GLMHC facility.

CHANGES TO THIS NOTICE.

We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for medical 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 administrative office of each facility.  The notice will contain on the first page, in the top right-hand corner, the effective date.  In addition, each time you are admitted to the GLMHC for treatment or health care services, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with GLMHC or with the Secretary of the Department of Health and Human Services.  To file a complaint with GLMHC, contact the Health Information Administrator at 918-906-7522.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to its use will be made only with your written permission.  If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provide to you.

SPECIAL NOTICE REGARDING CONFIDENTIALITY

OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS

The confidentiality of alcohol and drug abuse patient records maintained by GLMHC is protected by Federal law and regulations.  Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as an alcohol or drug abuser UNLESS:

            1. The patient consents in writing;

            2. The disclosure is allowed by a court order; or

            3. The disclosure is made to medical personnel in a medical emergency or to qualified

                personnel for research, audit, or program evaluation.

Violation of the Federal law and regulations by a program is a crime.  Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.

Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime.

Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.

(See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for Federal laws and 42 CFR part 2 for Federal regulations.)

 
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