Effective Date: April 29, 2015
Your health information (any written or oral information that Mental Health America of West Central Indiana, Inc. creates or receives that describes your health (medical/psychiatric) condition or treatment is personal. Mental Health America of West Central Indiana, Inc. (MHAWCI) pledges to protect your health information as required by law. The intent of this privacy notice is to 1). Inform you of how MHAWCI will use and disclose “protected” health information (PHI), and 2). How you can exercise certain individual rights related to your PHI as a program participant of MHAWCI. Please note that any of your PHI that qualifies as mental health records, alcohol and drug treatment records, communicable disease records, or genetic test records will be safeguarded as Special PHI which will be disclosed only with your prior express written authorization, under a valid court order or as otherwise required by law. MHAWCI is required by law to maintain the privacy of your PHI and to provide you with this notice of our legal duties and privacy practices.
I. How PHI is Used and Disclosed:
To Manage Treatment. MHAWCI may use and disclose your PHI to coordinate or manage your health care and any related services. This includes the management or coordination of your health status and care with another healthcare facility. For example, we may disclose your PHI to a pharmacy to purchase medications. MHAWCI may also disclose your PHI to another physician who may be treating you or consulting with MHAWCI regarding your care.
To Perform Daily Operations. MHAWCI may use or disclose your PHI, as necessary, to carry on the day-to-day operations, and to provide quality services to all program participants, but only on a “need to know” basis. These daily operations may include such activities as employee reviews, professional training programs including those in which students or practitioners in health care learn under supervision; accreditation; certification; licensing, or credentialing activities; compliance reviews and audits; defending a legal or administrative claim; business management development; and other administrative activities.
To Contact You. To support program guidelines, MHAWCI may also contact you at home, either by telephone or mail from time to time 1). To schedule or remind you of an upcoming appointment date or 2). To ask you to return a call to MHAWCI unless you request in writing, to use alternative means to communicate with you regarding these matters.
To be in Contact with Your Family and Friends. MHAWCI may also disclose your PHI to your family member or other relative, a close personal friend, or any other person specified by you from time to time, but only if the PHI is directly related 1). To notify the person of your physical location or sudden change in your condition, while at our place of business. Although you have a right to request reasonable restrictions on these disclosures, MHAWCI will only be able to grant restrictions that are reasonable and not too difficult to administer, none of which would apply in the case of an emergency.In addition, MHAWCI may disclose PHI about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
According to Laws That Require or Permit Disclosure. MHAWCI may disclose your PHI to a health oversight agency for activities including audits; civil, administrative, or criminal investigations, proceedings, or actions; inspections, or other activities necessary for appropriate oversight. MHAWCI will not disclose your PHI if you are subject of an investigation and your PHI is not directly related to your receipt of health care or public benefits
In Connection with Judicial and Administrative Proceedings. MHAWCI may disclose your PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal. In certain circumstances, MHAWCI may disclose your PHI I response to a subpoena if we receive satisfactory assurance that you have been notified of the request or that an effort was made to secure a protective order.
For Law Enforcement Purposes. MHAWCI may disclose your PHI to law enforcement officials to, among other things, 1). Report certain types of wounds or physical injuries, 2). Identify or locate certain individuals, 3). Report limited information if you are the victim of a crime or if your health care was the result of criminal activity, but only to the extent required or permitted by law.
To Coroners, Funeral Directors, and for Organ Donation. MHAWCI may disclose PHI to a coroner or medical examiner for identification purposes, to determine the cause of death, or for the coroner or medical examiner to perform other duties. MHAWCI may disclose PHI to a funeral director in order to permit the funeral director to carry out their duties. PHI may also be disclosed for organ, eye, or tissue donation purposes.
In the Event of a Serious Threat to Health or Safety, or for Specific Government Functions. MHAWCI may, consistent with applicable law and ethical standards of conduct, use or disclose your PHI if we believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or the health and safety of the public or for certain other specified government functions permitted by law. MHAWCI will disclose PHI about you to authorized federal officials so they may provide protection to the President of the United States, other authorized persons, or foreign heads of state or to conduct special investigations.
For Worker’s Compensation. MHAWCI may disclose your PHI to comply with worker’s compensation laws or similar programs.
To Conduct Fundraising. Under certain circumstances, MHAWCI may use and disclose certain of your PHI to communicate with you and conduct fundraising activities on behalf of the agency. Please note that you always have the right to “opt-out” of receiving any future fundraising communications and any such decision will have no impact on your program participation.
II. Prior Written Authorization
With your Prior Written Authorization. MHAWCI will not disclose your PHI, or “special PHI” without first obtaining your express written authorization.
III. Changes to this Notice
MHAWCI reserves the right to change this notice. We reserve the right to make the revised or change notice effective for PHI we already have about you as well as any information we receive in the future. MHAWCI will post a copy of the current notice in each of our offices.
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