Lookout Mountain Community Services, Privacy Statement

Lookout Mountain Community Services

Notice of Privacy Practices

(Effective 7-1-05)

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.

We are required to maintain the privacy of your protected health information and to provide you with this notice of our legal duties and privacy practices with respect to your protected health information. If you have any questions about this Privacy Notice, please contact our Privacy Officer, Carol Gobbel, by mail at P.O. Box 1027, LaFayette, GA 30728 or by telephone at 706-638-5580 ext. 131.

INTRODUCTION

This Notice of Privacy Practices describes how we, Lookout Mountain Community Services, may use and disclose protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. This Notice describes your rights regarding health information we obtain or maintain about you and a brief description of how you may exercise these rights. This Notice also states the obligations we have to safeguard your protected health information.

“Protected Health Information,” means health information (including identifying information about you, such as your name, address, etc.) we have collected from you or received from other persons. It may include information about your past, present or future physical or mental health condition, health care provided to you, and payment for health care services provided to you.

ISSUES AND DISCLOSURES

I. Not Requiring an Authorization

1. Treatment

We will use and disclose health information without your authorization to provide, manage, and coordinate your health care and any related services. For example, our staff may discuss your treatment needs and progress during clinical treatment meetings, or we may need to disclose health information to outside providers to coordinate your care such as pharmacy needs or lab work.

It is our practice in some programs to provide you with appointment reminders, information about possible treatment alternatives or services that may be of interest to you. This information will be provided by telephone or by mail at the number and address provided by you. In providing this information, we may disclose this information to individuals who respond to the telephone or to individuals who may open mail addressed to you. If you do not want us to provide you with this information at the provided address and telephone number, you must notify the Privacy Officer in writing at the address listed above.

2. Payment

We will use and disclose your health information without your authorization to obtain payment for our services to you. For example, we may disclose your diagnosis and treatment needs to your public (Medicaid, Medicare, Peachcare, etc) or private health insurance plan to obtain payment for services or to receive authorization /coverage verification prior to the delivery of services.

3. Health Care Operations

We are permitted to use and disclose protected health care information without your authorization in the course of operating Lookout Mountain Community Services. For example, information may be used for licensing, accreditation, or quality assurance procedures. When information is disclosed to “business associates” of Lookout Mountain Community Services such as consultants, accountants, and lawyers, they also are required to abide by all federal and state regulations regarding the protection of your health care information.

II. Not Requiring An Authorization Or Your Opportunity To Object

We are permitted to use and disclose protected health information without your authorization in the following situations.

A. When required by federal, state, or local law;

B. To medical personnel, such as a paramedic in an emergency treatment situation;

C. To prevent serious imminent threat to the health or safety of you, the public, or another person. Under these circumstances, we will only disclose information to someone able to help prevent or lessen the threat.

D. To report abuse or neglect of a child, the elderly, or someone with a disability.

E. For public health activities such as to prevent or control disease, injury, disability.

F. After a death, to a medical examiner or coroner with a valid subpoena.

G. To a health care agency authorized by law to oversee Medicaid, Medicare, Office of Regulatory Services, and other programs regulating health care and civil rights laws.

H. For judicial and administrative proceedings in response to a court, judge, or administrative order. We may also disclose protected health information in certain cases in response to a subpoena, discovery request, or other lawful process, subject to your notice and opportunity to object.

I. For authorized federal officials involved in specific government functions such as protecting national security or the President.

J. To law enforcement officials for enforcement or investigative purposes when legally required to do so. We may also disclose protected health information when reporting a crime or threat of a crime on our premises or against our personnel.

K. To a correctional institution or a law enforcement official having lawful custody of you, if such information is needed to coordinate care or protect the health and safety of you or others.

III. Without Authorization But With An Opportunity To Object

If you are present and able to make health care decisions we will inform you in advance of the use or disclosure of protected health information and you will have the opportunity to agree to or prohibit or restrict the use or disclosure. We may orally inform you and obtain your oral agreement or objection for use or disclosure of your protected health information.

In situations where you (1) have given authorization or (2) you were given an opportunity to object but did not do so or (3) cannot agree or object because of incapacity or (4) we reasonably infer from the circumstances, based upon the exercise of professional judgment, that you do not object to the disclosure, and (4) we have determined the disclosure of your protected health information is in your best interest, we may disclose limited protected health information to individuals directly involved in your treatment or payment of treatment.

In an emergency situation or disaster, and determining a disclosure of your protected health information is in your best interest, we may disclose limited information to your listed emergency contact person, legal representative, family, personal friend, or disaster relief organization about your location, general condition, or death.

IV. With Permission

Uses and disclosures not described above in Sections I - III will generally be made only with your written authorization. You have the right to revoke this authorization at any time. If you revoke your authorization we will make no further uses or disclosures of your health information under that authorization, unless we have already taken an action relying upon the uses or disclosures previously authorized.

V. Confidentiality Of Substance Abuse Records

Federal law and regulations protect the confidentiality of drug and alcohol abuse records. As a general rule, we may not tell a person outside the program that you attend the program, or disclose information identifying you as an alcohol or drug abuse consumer, unless:

A. You authorize the disclosure in writing.

B. The disclosure is permitted by a court order.

C. The disclosure is made to medical personnel in a medical emergency.

D. For research, audit or program evaluation by qualified and authorized personnel or regulatory agency.

E. You commit or threaten to commit a crime at a LMCS facility or against our staff.

F. As required by law, to report child abuse or neglect.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION

I. Right to Inspect and Copy

You have the right to request an opportunity to inspect or copy health information used to make decisions about your care, including clinical and billing records. Written requests are to be submitted to the Medical Record Technician at your treatment site. There may be a fee for the cost of copying. Your request may be denied if the treating physician determines that disclosure is detrimental to your physical or mental health. A notation to that effect will be made part of your medical record. You may file a complaint as outlined in this handout.

II. Right to Amend

For as long as we keep records about you, you have the right to request in writing that we amend any protected health information you believe is incorrect or incomplete. A request to amend your records must be completed on a blank sheet of paper, dated, signed and include a statement of why you believe the information in the record is incorrect or inaccurate. Approved amendments will be inserted into your medical record in the section that you amended. If your request is denied, you will be given a written notice within 60 days along with instructions about filing a complaint. An example of why your request may be denied is if we did not create the information or the information is not part of our records.

III. Right to an Accounting of Disclosures

You have the right to request that we provide you with a list of disclosures we have made of your protected health information. This list will not include certain disclosures of your health information like those made for purposes of treatment, payment, and health care operations or those you have authorized. Written requests are to be submitted to the Medical Record Technician at your treatment site and must include the time period for which you are requesting the disclosure list. This time period may not exceed six (6) years and cannot include dates prior to April 14, 2003. There will be no charge for the first accounting you request within a 12 month period. For additional lists within the same 12 month period, we will advise you in advance of any fees we may impose.

IV. Right to Request Restrictions

You have the right to ask that we limit how we use or disclose your protected health information. You can submit a written request to restrict disclosure to the Privacy Officer as listed on page 1. We are not legally bound to agree to the restrictions. If your request is approved, we will honor your request unless the restricted health information is needed in the case of emergency treatment or disclosure is required by law.

V. Right to Request Confidential Communications

You have the right to request how and where we contact you about medical matters. Your request must be in writing and submitted to the Privacy Officer at the address listed on page 1. We will accommodate your request whenever reasonably possible.

VI. Right to a Paper Copy of this Notice

You have a right to obtain additional paper copies of this Notice of Privacy Practices at any time. To obtain a paper copy, contact the Front Desk staff at your treatment site or you may contact the Privacy Officer.

COMPLAINTS REGARDING PROTECTED HEALTH INFORMATION

If you believe your privacy rights have been violated, you may file a complaint with us by contacting our Privacy Officer as listed on page 1 or with the U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, D.C. 20201.

All complaints must be submitted in writing. Upon request, our Privacy Officer will assist you with writing your complaint. We will not retaliate against you for filing a complaint.

CHANGES TO THIS NOTICE

The current Notice of Privacy Practices is posted at our main office and at each site where we provide care. We reserve the right to change the terms of our Notice of Privacy Practices. We also reserve the right to make the revised or changed Notice of Privacy Practices effective for all health information we already have about you as well as any health information we receive in the future. Any revised Notice will be posted as stated above. You may obtain a paper copy of the revised Notice of Privacy Practices from the Front Desk staff at your treatment site or by contacting our Privacy Officer.

Send electronic mail to webmaster@lmcs.org with questions or comments about this web site.

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	Lookout Mountain Community Services Notice of Privacy Practices (Effective 7-1-05) 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. We are required to maintain the privacy of your protected health information and to provide you with this notice of our legal duties and privacy practices with respect to your protected health information. If you have any questions about this Privacy Notice, please contact our Privacy Officer, Carol Gobbel, by mail at P.O. Box 1027, LaFayette, GA 30728 or by telephone at 706-638-5580 ext. 131. INTRODUCTION This Notice of Privacy Practices describes how we, Lookout Mountain Community Services, may use and disclose protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. This Notice describes your rights regarding health information we obtain or maintain about you and a brief description of how you may exercise these rights. This Notice also states the obligations we have to safeguard your protected health information. “Protected Health Information,” means health information (including identifying information about you, such as your name, address, etc.) we have collected from you or received from other persons. It may include information about your past, present or future physical or mental health condition, health care provided to you, and payment for health care services provided to you. ISSUES AND DISCLOSURES I. Not Requiring an Authorization 1. Treatment We will use and disclose health information without your authorization to provide, manage, and coordinate your health care and any related services. For example, our staff may discuss your treatment needs and progress during clinical treatment meetings, or we may need to disclose health information to outside providers to coordinate your care such as pharmacy needs or lab work. It is our practice in some programs to provide you with appointment reminders, information about possible treatment alternatives or services that may be of interest to you. This information will be provided by telephone or by mail at the number and address provided by you. In providing this information, we may disclose this information to individuals who respond to the telephone or to individuals who may open mail addressed to you. If you do not want us to provide you with this information at the provided address and telephone number, you must notify the Privacy Officer in writing at the address listed above. 2. Payment We will use and disclose your health information without your authorization to obtain payment for our services to you. For example, we may disclose your diagnosis and treatment needs to your public (Medicaid, Medicare, Peachcare, etc) or private health insurance plan to obtain payment for services or to receive authorization /coverage verification prior to the delivery of services. 3. Health Care Operations We are permitted to use and disclose protected health care information without your authorization in the course of operating Lookout Mountain Community Services. For example, information may be used for licensing, accreditation, or quality assurance procedures. When information is disclosed to “business associates” of Lookout Mountain Community Services such as consultants, accountants, and lawyers, they also are required to abide by all federal and state regulations regarding the protection of your health care information. II. Not Requiring An Authorization Or Your Opportunity To Object We are permitted to use and disclose protected health information without your authorization in the following situations. A. When required by federal, state, or local law; B. To medical personnel, such as a paramedic in an emergency treatment situation; C. To prevent serious imminent threat to the health or safety of you, the public, or another person. Under these circumstances, we will only disclose information to someone able to help prevent or lessen the threat. D. To report abuse or neglect of a child, the elderly, or someone with a disability. E. For public health activities such as to prevent or control disease, injury, disability. F. After a death, to a medical examiner or coroner with a valid subpoena. G. To a health care agency authorized by law to oversee Medicaid, Medicare, Office of Regulatory Services, and other programs regulating health care and civil rights laws. H. For judicial and administrative proceedings in response to a court, judge, or administrative order. We may also disclose protected health information in certain cases in response to a subpoena, discovery request, or other lawful process, subject to your notice and opportunity to object. I. For authorized federal officials involved in specific government functions such as protecting national security or the President. J. To law enforcement officials for enforcement or investigative purposes when legally required to do so. We may also disclose protected health information when reporting a crime or threat of a crime on our premises or against our personnel. K. To a correctional institution or a law enforcement official having lawful custody of you, if such information is needed to coordinate care or protect the health and safety of you or others. III. Without Authorization But With An Opportunity To Object If you are present and able to make health care decisions we will inform you in advance of the use or disclosure of protected health information and you will have the opportunity to agree to or prohibit or restrict the use or disclosure. We may orally inform you and obtain your oral agreement or objection for use or disclosure of your protected health information. In situations where you (1) have given authorization or (2) you were given an opportunity to object but did not do so or (3) cannot agree or object because of incapacity or (4) we reasonably infer from the circumstances, based upon the exercise of professional judgment, that you do not object to the disclosure, and (4) we have determined the disclosure of your protected health information is in your best interest, we may disclose limited protected health information to individuals directly involved in your treatment or payment of treatment. In an emergency situation or disaster, and determining a disclosure of your protected health information is in your best interest, we may disclose limited information to your listed emergency contact person, legal representative, family, personal friend, or disaster relief organization about your location, general condition, or death. IV. With Permission Uses and disclosures not described above in Sections I - III will generally be made only with your written authorization. You have the right to revoke this authorization at any time. If you revoke your authorization we will make no further uses or disclosures of your health information under that authorization, unless we have already taken an action relying upon the uses or disclosures previously authorized. V. Confidentiality Of Substance Abuse Records Federal law and regulations protect the confidentiality of drug and alcohol abuse records. As a general rule, we may not tell a person outside the program that you attend the program, or disclose information identifying you as an alcohol or drug abuse consumer, unless: A. You authorize the disclosure in writing. B. The disclosure is permitted by a court order. C. The disclosure is made to medical personnel in a medical emergency. D. For research, audit or program evaluation by qualified and authorized personnel or regulatory agency. E. You commit or threaten to commit a crime at a LMCS facility or against our staff. F. As required by law, to report child abuse or neglect. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION I. Right to Inspect and Copy You have the right to request an opportunity to inspect or copy health information used to make decisions about your care, including clinical and billing records. Written requests are to be submitted to the Medical Record Technician at your treatment site. There may be a fee for the cost of copying. Your request may be denied if the treating physician determines that disclosure is detrimental to your physical or mental health. A notation to that effect will be made part of your medical record. You may file a complaint as outlined in this handout. II. Right to Amend For as long as we keep records about you, you have the right to request in writing that we amend any protected health information you believe is incorrect or incomplete. A request to amend your records must be completed on a blank sheet of paper, dated, signed and include a statement of why you believe the information in the record is incorrect or inaccurate. Approved amendments will be inserted into your medical record in the section that you amended. If your request is denied, you will be given a written notice within 60 days along with instructions about filing a complaint. An example of why your request may be denied is if we did not create the information or the information is not part of our records. III. Right to an Accounting of Disclosures You have the right to request that we provide you with a list of disclosures we have made of your protected health information. This list will not include certain disclosures of your health information like those made for purposes of treatment, payment, and health care operations or those you have authorized. Written requests are to be submitted to the Medical Record Technician at your treatment site and must include the time period for which you are requesting the disclosure list. This time period may not exceed six (6) years and cannot include dates prior to April 14, 2003. There will be no charge for the first accounting you request within a 12 month period. For additional lists within the same 12 month period, we will advise you in advance of any fees we may impose. IV. Right to Request Restrictions You have the right to ask that we limit how we use or disclose your protected health information. You can submit a written request to restrict disclosure to the Privacy Officer as listed on page 1. We are not legally bound to agree to the restrictions. If your request is approved, we will honor your request unless the restricted health information is needed in the case of emergency treatment or disclosure is required by law. V. Right to Request Confidential Communications You have the right to request how and where we contact you about medical matters. Your request must be in writing and submitted to the Privacy Officer at the address listed on page 1. We will accommodate your request whenever reasonably possible. VI. Right to a Paper Copy of this Notice You have a right to obtain additional paper copies of this Notice of Privacy Practices at any time. To obtain a paper copy, contact the Front Desk staff at your treatment site or you may contact the Privacy Officer. COMPLAINTS REGARDING PROTECTED HEALTH INFORMATION If you believe your privacy rights have been violated, you may file a complaint with us by contacting our Privacy Officer as listed on page 1 or with the U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, D.C. 20201. All complaints must be submitted in writing. Upon request, our Privacy Officer will assist you with writing your complaint. We will not retaliate against you for filing a complaint. CHANGES TO THIS NOTICE The current Notice of Privacy Practices is posted at our main office and at each site where we provide care. We reserve the right to change the terms of our Notice of Privacy Practices. We also reserve the right to make the revised or changed Notice of Privacy Practices effective for all health information we already have about you as well as any health information we receive in the future. Any revised Notice will be posted as stated above. You may obtain a paper copy of the revised Notice of Privacy Practices from the Front Desk staff at your treatment site or by contacting our Privacy Officer. Send electronic mail to webmaster@lmcs.org with questions or comments about this web site.
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