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We must keep your health care information from others who do not need to know it. |
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You may ask that we not share certain health care information. (In some instances, we may
not be able to agree with your request.) |
Who Sees and Shares My
Health Information?
Your private health information may be
used by health care providers such as doctors, nurses, therapists
and social workers who take care of you. They may need your private
health information in order to determine your plan of care. This
may cover health care services you had before now, or services you
may have later on. We may share health information about you in
order to help you get services you may need. We may also use your
information to contact you about appointment reminders or to tell
you about treatment alternatives.
How is Payment Made?
Bills might be sent to Medicare, Ohio
Medicaid, or BCMH. The bill has information about what services you
had.
May I See My Health
Information?
You may see your health information,
unless it is the private notes taken by a mental health provider or
it is part of a legal case. Most of the time you can receive a copy
if you ask. You may be charged a small amount for the copying
costs. If you think some of the information is wrong, you may ask
in writing that it be changed or new information be added. You may
ask that the changes or new information be sent to others who have
received your health information from us. You may ask for a list of
any places where health information may have been sent, unless it
was sent for treatment, for payment, for checking to make sure you
receive quality care, or to make sure the laws are being followed.
What If My Health
Information Needs to Go Somewhere Else?
You may be asked to sign a separate
form, called an authorization form, allowing your health care
information to go somewhere else if:
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Your health care provider needs to send it to other places |
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You want us to send it to another health care provider |
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You want it sent to another person for you |
The authorization form tells us what,
where and to whom the information must be sent.
Your authorization is good for six (6)
months or until the date you put on the form. You can cancel or
limit the amount of information sent at any time by letting us know
in writing.
NOTE: If you are less that 18
years old, your parents or guardians will receive you private health
information, unless by law you are able to consent for your own
health care treatment. If you are, then your private health
information will not be shared with parents or guardians unless you
sign an authorization form. You may also ask to have your health
information sent to a different person that is helping you with your
health care.
Could My Health Information
Be Released Without My Authorization?
When private health information is
released with Authorization, it is normally used to support
Treatment or Payment of medical situations or it may be released for
the use of Medicaid Operations. The release of health information
for this purpose is not tracked or accountable to you, the
patient/recipient (HIPAA rule 164.506). Any other release made
without your authorization is tracked and is accountable. We always
report:
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Contagious diseases |
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2. |
Reactions and problems with medicine |
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To the appropriate authorities
when abuse may be suspected |
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4. |
Work related injuries to
Workers Compensation |
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5. |
To a provider who needs to know
if you have Ohio Medicaid |
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6. |
Birth, death, and immunization
information |
Could My Health Information Be Released Without My Authorization?
To find out if your health information
has been released without your authorization for purposes other than
Treatment, Payment or Operations, you may call the Privacy Officer
and ask for a “Request for Accounting for Disclosures” form. Fill
out the form and return it to:
Privacy Officer
Van Wert County Health Department
140 Fox Rd., Suite 402
Van Wert, OH 45891
Ph: 419-238-0808
May I Have a Copy of This
Notice?
This notice is yours. If we change
anything in this notice, you will get a new notice during your next
visit to our office.
Questions or Comments?
If you have any questions about this
notice, or you think that we have not protected your private health
information and you wish to complain about it, please contact us at:
Complaint Officer
Van Wert County Health Department
140 Fox Rd., Suite 402
Van Wert, OH 45891
Ph: 419-238-0808
What Will Happen If I File
a Complaint?
Absolutely nothing. Your complaint
will be investigated. It is against the law for us to take
retaliatory or other negative action against you if you file a
complaint.
