ATHENS-HOCKING-VINTON 317 BOARD NOTICE OF PRIVACY PRACTICES

Effective: April 14,

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.

If you have any questions about this Notice, please contact:
Bill Dunlap, Deputy Director/Privacy Officer
Athens-Hocking-Vinton 317 Board
7990 Dairy Lane
Athens, Ohio 45701
740-593-3177

OUR PLEDGE REGARDING YOUR HEALTH INFORMATION

At the Athens-Hocking-Vinton 317 Board we understand that health information about you and your health is personal. We are committed to protecting health information about you and safeguarding that information against unauthorized use or disclosure. We are required by law to: 1) assure health information that identifies you is kept private; 2) give you Notice of our legal duties and privacy practices with respect to health information about you; and, 3) follow the terms of the Notice that is currently in effect. This Notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of your health information. The Notice applies to all of the records that we have related to your care.

WHY WE COLLECT PERSONAL HEALTH INFORMATION

We collect personal information to:

• Determine eligibility for health care coverage
• Provide benefits and pay claims
• Conduct our service evaluation programs
• Provide other information for planning and improving alcohol, other drug addiction, and/or mental health services in the community

We may also be required to collect and keep certain information so that we meet legal and regulatory requirements. We keep this information after a client's health care coverage ends.

PERSONAL INFORMATION WE COLLECT

We ask people seeking benefits to provide certain information when they complete an enrollment form. This information may include, for example:

• Name, Address, Phone
• Date Of Birth
• Marital Status
• Social Security Number
• Family Income

We may also receive personal information about you from others, such as:

• Health care providers (doctors, clinics, hospitals)
• Other Alcohol, Drug Addiction and Mental Health (ADAMH) Boards that provide coverage to our clients
• Business partners (companies with whom we have arrangements to assist us in providing products and services)
• Other government agencies (criminal justice system, child welfare, juvenile justice, etc.)

The information we collect from others may include, for example, eligibility, claims and payment information. We create and maintain a record of your enrollment in the Multi-Agency Community Services Information System (MACSIS) of the State of Ohio, and maintain records of payment for treatment you receive in the public system. From time to time, we also receive information from your treatment provider related to your diagnosis, treatment and progress in recovery, and any major unexpected emergencies or crises you may experience that help the Board to plan for and improve the quality of services for the region’s citizens.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

When you receive services paid for in part or in full by the Athens-Hocking-Vinton 317 Board, we may use your personal information for such activities as conducting our normal board business known as health care operations. If the services we paid for were alcohol, other drug addiction, and/or mental health services, we may also use your personal information for billing for such services.

If you have a guardian or a power of attorney we will provide the information to your guardian or attorney in fact.

Examples of how we use your information include:

Payment for Alcohol, Other Drug Addiction, and/or Mental Health Services – We keep records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment for your services from Medicaid, insurance or other sources. For example, we may disclose personal information about the services provided to you to confirm your eligibility for Medicaid and to obtain payment from Medicaid.

Health Care Operations – We use personal information to train staff, manage costs, conduct required business duties, and make plans to better serve you and other community residents who may need alcohol, other drug addiction, and/or mental health services.

Other Services We Provide

We may also use your personal information to:

• Review and evaluate the quality, effectiveness, and efficiency of the services you have
received;

• Conduct program and fiscal audits of programs who have provided you with services;

• Investigate major unusual incidents, report these kinds of incidents and take steps to
protect your health and safety;

• Prepare reports required by the Ohio Department of Mental Health, the Ohio Dept. of Alcohol and Drug Addiction Services and the Ohio Department of Job and Family Services;

• Contact you for assistance in passing levies, unless you notify the Athens-Hocking-Vinton 317 Board that you do not wish to be contacted for these purposes.

Sharing Your Personal Information

There are limited situations when we are permitted or required to disclose personal information without your signed authorization. These situations are:

• To protect victims of abuse, neglect, or domestic violence;

• To reduce or prevent a serious threat to public health and safety;

• For health oversight activities such as investigations, audits, and inspections;

• For local, state, federal agencies to monitor your services;

• For lawsuits and similar proceedings;

• For public health purposes such as reporting communicable diseases, work-related
illnesses, or other diseases and injuries permitted by law; reporting births and deaths,
and reporting reactions to drugs and problems with medical devices;

• When required by law;

• When requested by law enforcement as required by law or court order, except as
limited by laws regarding disclosure of alcohol and other drug treatment;

• To coroners, medical examiners, and funeral directors;

• For organ and tissue donation;

• For workers’ compensation or other similar programs if you are injured at work and are
covered by workers’ compensation or other similar programs;

• For specialized government functions such as intelligence and national security;

All other uses and disclosures, not described in this notice, require your signed authorization. You may revoke your authorization at any time with a written statement.

SAFEGUARDING YOUR PERSONAL INFORMATION

We maintain physical, electronic and procedural safeguards that comply with applicable federal and state laws and regulations to guard your personal information against unauthorized use or disclosure. Any third party processor or consultant used by the Board has signed an agreement with us requiring such entity to maintain the confidentiality of your personal information. We also restrict access to your personal information to those employees who need to know the information in order to perform their job duties. The Board maintains policies and procedures that prohibit employees and agents of the Board from using, disclosing, transferring, providing access to or otherwise divulging client health information to any person or entity other than to the individual who is the subject of the information.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice at any time. We reserve the right to make the revised or changed Notice effective for 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 at the Board Office. The Notice will contain on the first page in the top center, the effective date. In addition, each time there is a change in the Notice, you will receive a copy by mail at the last known address we have in our plan enrollment file.

OTHER USES OF PERSONAL HEALTH INFORMATION

Other uses and disclosures of your personal health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health 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 your health information for the reasons covered by your written permission. 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 services that we provided to you.

Bill Dunlap, Deputy Director/Privacy Officer
Athens-Hocking-Vinton 317 Board
7990 Dairy Lane
Athens, OH 45701
740-593-3177