Oesterlen Services for Youth, Inc.
NOTICE OF PRIVACY PRACTICES
Effective: April 14, 2003
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 Oesterlen’s Privacy Officer.
WHO WILL FOLLOW THE REQUIREMENTS OF THIS NOTICE:
This notice describes our agency’s practices and those of:
1. ADAMHS Board
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care of services you receive at the agency. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the agency, whether made by agency personnel or staff under contract to the agency (example, psychiatrist).
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
HOW MAY WE USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
1. Prevent or control disease, injury or disability;
2. Report births and deaths;
3. Report child abuse or neglect;
4. Report reactions to medications or problems with products;
5. Notify people of recalls of products they may be using;
6. Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
7. Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
1. In response to a court order, subpoena, warrant, summons or similar process;
2. To identify or locate a suspect, fugitive, material witness, or missing person;
3. About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
4. About a death we believe may be the result of criminal conduct;
5. About criminal conduct at the agency; and
6. In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
You have the following rights regarding medical information we maintain about you:
1. Was not created by us, or the person or entity that created the information is no longer available to make the amendment;
2. Is not part of the medical information kept by or for the agency;
3. Is not part of the information which you would be permitted to inspect and copy; or
4. Is accurate and complete.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical 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 in the agency. The notice will contain on the first page in the top center, the effective date. In addition, each time you register at or are re-admitted to the agency for treatment or health care services, you will be offered a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the agency or with the Secretary of the Department of Health and Human Services. To file a complaint with the agency, contact Oesterlen Services for Youth, Inc., 1918 Mechanicsburg Road, Springfield, Ohio 45503 Attn: Privacy Officer, Director of Operations (937) 399-6101. All complaints must be submitted in writing.
Complaints to the Secretary HHS: HIPPA Complaint
7500 Security Blvd., C5-24-04
Baltimore, MD 21244
You will not be penalized or discriminated against for filing a complaint.
OTHER USES OF MEDICAL INFORMATION:
Other uses and disclosures of medical 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 medical 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 medical information about you for the reasons covered by your written authorization. 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 care that we provided to you.
Copyright © 2018 Oesterlen Services for Youth, Inc. All rights reserved.
(937) 399-6609 fax
1918 Mechanicsburg Road
Springfield, Ohio 45503