This notice is distributed to each CMHC client at time of intake, is posted in our waiting areas, and is posted on our website www.communitymentalhealthcenter.org.

This notice describes:

• how medical information about you may be used
• how you can get access to your medical information

  Please review it carefully.

Each time you visit the Community Mental Health Center for Mid-Eastern Iowa (CMHC) a record of your visit is made.  Typically, this record contains your symptoms, diagnosis, treatment, and a plan for future care or treatment.  Understanding what is in your record and how your health information is used helps you to ensure its accuracy.  It also helps you to better understand who, what, when, where, and why other may access your health information, and it helps you make more informed decisions when authorizing disclosure to others.

YOUR HEALTH INFORMATION RIGHTS:

Although your health record is the physical property of the CMHC,  the information belongs to you.

You have the right to:

• request and obtain a paper copy of this notice
• request communications of your health information by alternative means or at alternative locations
• request to inspect and obtain a copy of your health record; however, if there are grounds for denial after review by your service provider, you will be provided with an explanation of the decision to deny access.
• request a restriction on certain uses or disclosures of your information; however, the CMHC is not required to agree to a requested restriction. 
• request an amendment of your protected health information.  We may deny your request for the following reasons:
  1. it is not in writing or does not include a reason
  2. the information was not created by us
  3. the information is not part of the information maintained to make care decisions
  4. the information is not part of the information you are permitted to inspect
  5. the information is accurate and complete to us
• revoke your authorization to use or disclose health information except to the extent that:
  1. action has already been taken
  2. authorization was obtained as a condition of obtaining health insurance coverage.
• obtain an accounting of disclosures of your health information not pertaining to payment, treatment or health care operation or your authorization released after April 14, 2003.

To take any of the above actions, contact our Privacy Officer at 507 E. College Street, Iowa City, IA 52240.

Our responsibilities:

The CMHC is required by law to:

• maintain the privacy of your health information which is protected information.
• provide you with this Privacy Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
• abide by the terms of this notice.
• notify you if we are unable to agree to a requested action.
• accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.  Should our information practices change, we will post notice of this along with the revised policy in our reception areas and will supply you with the revised policy upon request to our Privacy Officer.  We will not use or disclose your health information without your authorization, except as described in this notice.

FOR MORE INFORMATION OR TO REPORT A PROBLEM:

If you have questions and would like additional information, you may contact the CMHC Privacy Officer.  If you believe your privacy rights have been violated, You can file a written complaint with the CMHC's Privacy Officer at 507 E. College Street, Iowa City, IA 52240 or with the Secretary of Health and Human Services.  There will be no retaliation for filing a complaint.

EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH OPERATIONS

We may release your private health information (PHI) in the following circumstances:

• Treatment
  • For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you.
• Payment
  • A bill may be sent to you or a third party payer.  The information on or accompanying the bill may include information hat identifies you, as well as your diagnosis, procedures, and supplies used.
• Regular health operations
  • Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to access the care and outcomes in your case and others like it.  This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
• We may release your health information to family members and those you have authorized
  • Unless you object, we may disclose health information to family members or legal representative who are involved in your care or are involved in payment of your care; however, it is our policy to obtain your authorization for all releases of information whenever possible.  If you are unable to agree or object to such a disclosure, our health professionals, using their best judgment, may disclose information if it is determined to be in your best interest. 
• Workers compensation:
  • We may disclose health information to the extent authorized and to the extent necessary to comply with laws relating to workers compensation or similar programs established by law.
• Public health:
  • As required by law, we may disclose your health information to public health or legal authorities responsible for preventing or controlling disease, injury, or disability.
• Correctional institution:
  • Should you be an inmate of a correctional institution, we may disclose to the institution or agents there of health information necessary for your health and the health and safety of other individuals.
• Business associates:
  • There are some services provided in our organization through contacts with business associates.  Examples include certain medical laboratory for tests, pharmacies, accounting firm, and computer support.  When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered.  To protect your health information, however, we require the business associate to appropriately safeguard your information.
• Research:
  • We may disclose information to researchers when an institutional review board that has reviewed the research proposal, and established protocols in ensure the privacy of your health information has approved their research.
• Food and Drug Administration (FDA):
  • We may disclose to the FDA health information related to adverse effects of medication or post marketing surveillance information to enable product recalls.
• Notification:
  • We may contact you to provide appointment reminders, information about treatment alternatives, other health-related benefits, and/or services that may be of interest to you.
• Law enforcement:
  • We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.  Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
• Emergency:
  • If you have given indication through your words or actions that you are a danger to yourself or someone else, or that there has been incident of child or adult abuse, we are mandated by law and obliged to report this to the appropriate authorities such as the police or DHS.
• The Federal Department of Health and Human Services (DHHS):
  • Under the privacy standards, we must disclose your health information to DHHS as necessary for them to determine our compliance with those standards.

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