Privacy Notice

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review carefully.

If you have questions about this Privacy Notice, please contact our Client Rights Officer at # 225-0990.

Protecting the privacy of information about your health is important to us and a responsibility we take seriously. This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by the law. This notice also describes your rights regarding health information we maintain about you and a brief description of how you may exercise these rights. This notice further states the obligations we have to protect your health information.

Protected health information means health information (including identifying information about you) we have collected from you or received from your health care providers, health plans, your employer or a health care clearinghouse. It may include information about your past, present, or future physical health or mental health condition, or the provision of your health care, and payment for your health care services.

We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information. We are also required to comply with the terms of our current Notices of Privacy Practices. This notice was developed by Southeast, Inc. relating to obligations imposed by the Health Information Portability and Accountability Act (HIPAA). We reserve the right to change our privacy practices and terms of this notice at any time.

I. How we will use and disclose your health information

We use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclose your PHI for purposes of treatment, to receive payment for our services or our health care operations. Beyond that, we must have your written authorization unless the law permits or requires us to make the disclosure without your authorization. If we disclose your PHI to an outside entity in order for that entity to perform a function on our behalf, we must first have in place an agreement from the outside entity that it will extend the same degree of privacy protection to your information that we must apply to your PHI. However, the law does provide that we are permitted to make some uses/disclosures without your consent or authorization.

We will use and disclose your information as described in each category listed below.

  • Uses & disclosures relating to treatment, payment, or health care operations. Generally, we may use or disclose your PHI as follows:

Treatment: We may disclose your PHI to doctors, nurses, clinicians, therapist, case managers or other health care personnel who are involved in providing your health care. For example, your PHI will be shared among your treatment team or with central pharmacy staff. Your PHI may be shared with outside entities performing ancillary services related to your treatment, such as lab work or medical care.

  • To obtain payment: Once you have signed our Consent For Release of Information – Billing, we may use/disclose your PHI so that treatment and services you received are billed to, and collected from your health plan or other third party payer. For example, we may disclose your health information to permit your health plan to take certain actions before your health plan approves or pays for your services. These actions may include: making a determination of eligibility or coverage for health insurance or reviewing your services to determine if they were medically necessary. We may release portions of your PHI to the Medicaid program, the ODMH central office, the local ADAMH Board (through the Multi-Agency Community Information Services Information System (MACSIS) to get paid for services that we deliver to you.
  • Appointment reminders: Unless you provide us with alternative instructions, we may call you to remind you of appointments or send you appointment reminders and other similar materials to your home.
  • Health care operations: We use /disclose information about you for our operations. These uses and disclosures are necessary to run our organization and make sure our consumers receive quality care. These activities may include by way of example, quality assessment and improvement, reviewing performance or qualifications of our clinicians, licensing, accreditations, business planning and development and general administrative activities. We may combine health information for many of our consumers to decide what additional services we should offer. We may combine our health information with health information from other providers to compare how we are doing and see where we can make improvements in our services. When we combine our health information with information of other providers, we will remove identifying information so others may use it to study health care or health delivery without identifying specific clients.
  • Apothecare Pharmacy operations: For individuals using Apothecare Pharmacy, a program owned and operated by Southeast, Inc. , your PHI may be shared with pharmacy staff to complete functions necessary in filling your medication orders. If you elect to have someone, other than yourself , pick up your medications at the pharmacy, you will need to provide the pharmacy with either a verbal or written authorization allowing the person to pick up the medications.

II. Uses and Disclosures Requiring Authorization

For uses and disclosures beyond treatment, payment or operations purposes we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions described below. We will ask you to sign the Consent For Release of Information form and specify what information is to be disclosed. Authorizations can be revoked at any time to stop future uses/disclosures except to the extent that we have already undertaken an action in reliance upon your authorization.

Uses and Disclosures of PHI From Mental Health Records Not Requiring Consent or Authorization

  • When required by law: We may disclose PHI when law requires that we report information about suspected abuse, neglect or in response to a court order, subpoena, warrant, summons or similar process requiring us to do so. We must also disclose PHI to authorities that monitor compliance with these privacy requirements.
  • For public health: We may disclose PHI when we are required to collect information about disease or injury or to report the vital statistics to the public health authority.

  • Emergencies: We may use and disclose your PHI in an emergency treatment situation. By way of example, we may provide your PHI to a paramedic who is transporting you in an ambulance. We will try to obtain your consent as soon as reasonably practical after you have received the emergency treatment.
  • To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm. This includes for purpose of responding to a threat of an imminently dangerous activity by you against yourself or another person.
  • Relating to decedents: We may disclose PHI relating to an individual’s death to coroners, medical examiners or funeral directors.

  • For specific government functions: We may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government benefits programs relating to eligibility and enrollment, and for national security reasons such as protection of the President.
  • Health oversight activities: We may disclose PHI about you to a health oversight agency for activities authorized by law. Oversight agencies include government agencies that oversee health care systems; government benefits programs such as Medicare/Medicaid, other government programs regulating health care and civil rights law.
  • Workers’ Compensation: We may disclose PHI about you to comply with the states’ Workers’ Compensation Law.
  • Persons involved in your care: We may provide PHI about you to someone who helps pay for your care. We may use or disclose your PHI to notify or assist in notifying your family in an emergency, personal representative or any other person responsible for your care of your location, general condition or death. We may also use or disclose your health information to an entity assisting in disaster relief effort and to coordinate uses and disclosures for this purpose to family or other individuals involved in your care. And, if your are not in an emergency situation but are unable to make health care decisions, we will disclose your PHI to: (a) a person designated to participate in your care in accordance with an advance directive validly executed under state law; (b) your guardian or other fiduciary if one has been appointment by court; (c) the state agency responsible for consenting to your care.

III. Confidentiality of Substance Abuse records

For individuals who receive treatment, diagnosis or referral for treatment from drugs or alcohol abuse programs, the confidentiality of drug or alcohol abuse records is protected by federal law and regulations. As a general rule, we may not tell a person outside the program that you attend any of these programs, or disclose any information identifying you as an alcohol or drug abuser, unless:

  • You authorize the disclosure in writing
  • The disclosure is by court order
  • The disclosure is made to medical personnel in a medical emergency or audit or program evaluation purposes
  • You threaten to commit a crime either at the drug abuse or alcohol program or against any person who works for our drug abuse or alcohol program
  • As required by Federal Confidentiality rules (42 CFR Part 2)

IV. Your rights regarding your health information

  • A. Your right to inspect and copy :
  • Unless your access is restricted for clear, and documented reasons, you have the right to see your protected health information upon written request. This would include clinical and billing records but not psychotherapy notes.
  • We will respond to your request within 30 days. If we deny your access, we will give you in writing reasons for the denial and explain any right to have the denial reviewed.
  • You must submit your request in writing to our Client Right’s Officer. If you request a copy of the information, we may charge a fee for the cost of copying, mailing and supplies associated with the request, depending on the circumstances. You have a right to choose what portions of your information you want copied and to have prior information on the cost of copying.
  • B. Right to amend your PHI:
  • If you believe that there is a mistake or missing information in our record of your PHI, you may request, in writing, that we correct or add to the record. We will respond within 60 days of receiving your request. This would include clinical and billing records but not psychotherapy notes.
  • To request an amendment, you must submit a written document to our Client Right’s Officer at Southeast and tell us why you believe the information is incorrect or inaccurate.
  • We may deny your request if we determine the PHI is: (a) correct and complete; (b) not created by us and/or not part of our record; (c) not permitted to be disclosed. Any denial will state the reasons for the denial and explain your rights to have the request and denial, along with any statements in response that you provide, appended to your PHI. If we approve the request for amendment, we will change the PHI and so inform you, and tell others that need to know about the changes to your PHI.
  • C. Right to an accounting of disclosures:
  • You have a right to get a list of when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure: for treatment, payment, and operations; to you, or pursuant to your written authorizations. The list will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or disclosures made before April 14, 2003.
  • To request an accounting of disclosures, you must submit a request in writing to the Client Rights Officer at Southeast. We will respond to your written request within 60 days of receiving it. Your request may relate to disclosure going back as far as six years after April 14, 2003. There will be no charge for up to one list each year. There may be a charge for more frequent requests.
  • D. Right to request confidential communications:
  • You have the right to request that we communicate with you about your PHI care only in a certain location or through a certain method. For example, you may request that we contact you only by mail or phone.
  • To request such a confidential communication, you must make your request in writing to the Client Rights Officer. We will accommodate all reasonable requests.
  • E. To receive this notice:
  • You have the right to receive a paper copy of this request this
  • notice an/or an electronic copy by email upon request.
  • F. Complaints:

If you think we may have violated your privacy rights, or if you disagree with a decision we made about your access to your PHI, you may file a complaint with our Client Rights Officer. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services.

To File A Complaint

We will take no retaliation against you if you make a complaint. If you believe your privacy rights have been violated by Southeast, you may file a written complaint-

With: Client Rights Officer Phone: 614-225-0990

Southeast, Inc.

16 W. Long Street

Columbus, Ohio 43215



With: Client Rights Officer Phone: 614-224-1057

ADAMH

447 E. Broad St.

Columbus, Ohio 43215



With: Office for Civil Rights Medical Privacy, Complaint Division

US Department of Health and Human Services

200 Independence Avenue, SW

Room 509H HHH Building

Washington, D. C. 20201 Phone: 1-877-696-6775