MEDINA COUNTY ADAMH BOARD
NOTICE OF PRIVACY PRACTICES
Effective Date: September 23, 2013
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.

OUR DUTIES
The Medina County ADAMH Board is committed to protecting your
health information and safeguarding that information against
unauthorized use or disclosure. We follow federal and state laws that
require us to keep your personal information confidential. This Notice
will tell you how we may use and disclose your health information.  It
also describes your rights and the obligations we have regarding the
use and disclosure of your health information.  
We are required by law to: 1) maintain the privacy of your health
information; 2) provide you Notice of our legal duties and privacy
practices with respect to your health information; 3) abide by the
terms of the Notice that is currently in effect; and 4) notify you if
there is a breach of your unsecured health information. 
HOW WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH
INFORMATION
When you receive services paid for in full or part by the Board, we
receive health information about you.  We may receive, use or share
that health information for such activities as payment for services
provided to you, conducting our internal health care operations,
communicating with your healthcare providers about your treatment
and for other purposes permitted or required by law. The following
are examples of the types of uses and disclosures of your personal
information that we are permitted to make: 
Payment - We may use or disclose information about the services
provided to you and payment for those services for payment
activities such as confirming your eligibility, obtaining payment for
services, managing your claims, utilization review activities and
processing of health care data. 
Health Care Operations - We may use your health information to
train staff, manage costs, conduct quality review activities, perform
required business duties, and improve our services and business
operations.
Treatment - We do not provide treatment but we may share your
personal health information with your health care providers to assist
in coordinating your care.
Other Uses and Disclosures - We may also use or disclose your
personal health information for the following reasons as permitted or
required by applicable law: 
· To authorized representatives such as parents and guardians,
or people given written permission by you, the client;
· To alert proper authorities if we reasonably believe that you
may be a victim of abuse, neglect, domestic violence or other
crimes;
· To reduce or prevent threats to public health and safety; for
health oversight activities such as evaluations, investigations,
audits, and inspections; to governmental agencies that
monitor your services;
· For lawsuits and similar proceedings;
· For public health purposes such as to prevent the spread of a
communicable disease;
· For certain approved research purposes; for law enforcement
reasons if required by law or in regards to a crime or suspect;
· To correctional institutions in regards to inmates;
· To coroners, medical examiners and funeral directors (for
decedents);
· As required by law; for organ and tissue donation;
· For specialized government functions such as military and
veterans activities, national security and intelligence
purposes, and protection of the President; for Workers’
Compensation purposes;
· For the management and coordination of public benefits
programs;
· To respond to requests from the U.S. Department of Health
and Human Services; and
· For us to receive assistance from consultants that have
signed an agreement requiring them to maintain the
confidentiality of your personal information. 
Uses and Disclosures That Require Your Permission
We are prohibited from selling your personal information, such as to
a company that wants your information in order to contact you about
their services, without your written permission.  

We are prohibited from using or disclosing your personal information
for marketing purposes, such as to promote our services, without
your written permission.

All other uses and disclosures of your health information not
described in this Notice 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 purposes state in your
written permission except for those that we have already made prior
to your revoking that permission.  
Prohibited Uses and Disclosures
If we use or disclose your health information for underwriting
purposes, we are prohibited from using and disclosing the genetic
information in your health information for such purposes. 

POTENTIAL IMPACT OF OTHER APPLICABLE LAWS
If any state or federal privacy laws require us to provide you with
more privacy protections than those explained here, then we must
also follow that law. For example, drug and alcohol treatment records
generally receive greater protections under federal law. 
YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH
INFORMATION
You have the following rights regarding your health information:
· Right to Request Restrictions. You have the right to request
that we restrict the information we use or disclose about you
for purposes of treatment, payment, health care operations
and informing individuals involved in your care about your
care or payment for that care.  We will consider all requests
for restrictions carefully but are not required to agree to any
requested restrictions.*
· Right to Request Confidential Communications. You have the
right to request that when we need to communicate with you,
we do so in a certain way or at a certain location.  For
example, you can request that we only contact you by mail or
at a certain phone number. 
· Right to Inspect and Copy.  You have the right to request
access to certain health information we have about you.  Fees
may apply to copied information.*
· Right to Amend.  You have the right to request corrections or
additions to certain health information we have about you. 
You must provide us with your reasons for requesting the
change.*
· Right to An Accounting of Disclosures.  You have the right to
request an accounting of the disclosures we make of your
health information, except for those made with your
permission and those related to treatment, payment, our
health care operations, and certain other purposes. Your
request must include a timeframe for the accounting, which
must be within the six years prior to your request. The first
accounting is free but a fee will apply if more than one
request is made in a 12-month period.*
· Right to a Paper Copy of Notice.  You have the right to receive
a paper copy of this Notice. This Notice is also available at
our web site:
http://www.medinamentalhealth.com/hipaa/privacy.pdf,
but you may obtain a paper copy by contacting the Board
Office.

To exercise any of the rights described in this paragraph, please
contact the ADAMH Board at:

Melanie Woods, Privacy Officer
246 Northland Drive
Medina, Ohio, 44256
330-723-9642
or email:  office@adamhmedina.org
* To exercise rights marked with a star (*), your request must be
made in writing.  Please contact us if you need assistance.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice at any time.  We reserve
the right to make the revised 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 our current Notice at our office
and on our website at: http://www.medinamentalhealth.com. In
addition, each time there is a change to our Notice, you will receive
information about the revised Notice and how you can obtain a copy
of it.  The effective date of each Notice is listed on the first page in
the top center. 

TO FILE A COMPLAINT
If you believe your privacy rights have been violated, you may file a
complaint with the ADAMH Board or with the Secretary of the
Department of Health and Human Services. To file a complaint with
the Board, contact the Privacy Officer at the address above. You will
not be retaliated against for filing a complaint.  If you wish to file a
complaint with the Secretary you may send the complaint to:

Office for Civil Rights
U.S. Department of Health and Human Services
Attn: Regional Manager
233 N. Michigan Ave., Suite 240
Chicago, IL 60601
















HIPAA Notice of Privacy Practicies
Ohio Association of County Behavioral Health Authorities
Supporting Behavioral
Healthcare in Medina County

ADAMH

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