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.
This Notice of Privacy has been prepared by Huckleberry House, Inc. It tells you about the ways in which Protected Health Information about you can be created, shared, protected and maintained. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
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 and 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, nurse).
1. Our Duty to Safeguard Your Protected Health Information.
Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for the health care is considered “Protected Health Information” (“PHI”). We are required to extend certain protections to your PHI, and to give you this Notice about our privacy practices that explains how, when and why we may use or disclose your PHI. Except in specified circumstances, we must use or disclose only the minimum necessary PHI to accomplish the intended purpose of the use or disclosure. We are required to follow the privacy practices described in this notice, though [BOLD] we reserve the right to change our privacy practices and the terms of this notice at any time. If we do so, we will post a revised notice in our Administrative Building. Upon request, we will provide you with a revised notice or you can review the notice by accessing our website at www.huckhouse.org.
2. How We May Use and Disclose Your Protected Health Information.
We use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclosure your PHI for purposes of treatment, payment or our health care operations. For uses beyond that, we must have your written authorization unless the law permits or requires us to make the use or 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 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 provides that we are permitted to make some uses/disclosures without your consent or authorization. The following offers more description and some examples of our potential uses/disclosures of your PHI.
- Uses and Disclosures Relating to Treatment, Payment, or Health Care Generally, we may use or disclose your PHI as follows: For treatment: We may disclose your PHI to agency staff and other personnel who are involved in providing services to you. For example, your PHI will be shared among members of your treatment team / program staff working with you. Your PHI may also be shared with outside entities performing ancillary services relating to your treatment such as for consultation purposes, or ADAMH/CMH Boards and/or community mental health agencies involved in provision or coordination of your care. To obtain payment: We may use/disclose your PHI in order to bill and collect payment for the services that you receive. For example, we may release portions of your PHI to the Medicaid program, the ODMH central office, the local ADAMH/CMH Board (through the Multi-Agency Community Information Services Information System (MACSIS), or to the Community Shelter Board through the homeless management information system to get paid for services that we delivered to you. For agency service operations: We may use and disclose medical information about you for agency operations. These uses and disclosures are necessary to run the agency and make sure that all of our clients receive quality care. For example, we may use your PHI in evaluating the quality of services provided or disclose your PHI to our accountant or attorney for audit purposes. We may also disclose your PHI to administrative personnel for tasks such as data entry. If necessary for program operation, for example in the Transitional Living Program, your PHI may be released to utility companies and landlords for housing purposes. Release of your PHI to the Multi-Agency Community Services Information System [MACSIS] and/or state agencies might also be necessary to determine your eligibility for publicly funded services. Appointment reminders: Unless you provide us with alternative instructions, we may send appointment reminders, feedback forms and other similar materials to your home.
- Uses and Disclosures Requiring Authorization: For uses and disclosures beyond treatment, payment and operations purposes we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions described below. 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: The law provides that we may use/disclose your PHI from mental health records without consent or authorization in the following circumstances: When required by law: We may disclose PHI when a law requires that we report information about suspected abuse, neglect or domestic violence, or relating to suspected criminal activity, or in response to a court order. We must also disclose PHI to authorities that monitor compliance with these privacy requirements. For public health activities: We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to the public health authority. For health oversight activities: We may disclose PHI to our central office, the protection and advocacy agency, or another agency responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents. Relating to decedents: We may disclose PHI relating to an individual’s death to coroners, medical examiners or funeral directors, and to organ procurement organizations relating to organ, eye, or tissue donations or transplants. 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. We may release medical information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the agency; and
- 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.
For specific government functions: We may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government benefit programs relating to eligibility and enrollment, and for national security reasons, such as protection of the President.
- Uses and Disclosures of PHI from Alcohol and Other Drug Records Not Requiring [Consent or] Authorization: The law provides that we may use/disclose your PHI from alcohol and other drug records without consent or authorization in the following circumstances: When required by law: We may disclose PHI when a law requires that we report information about suspected child abuse and neglect, or when a crime has been committed on the program premises or against program personnel, or in response to a court order. Relating to decedents: We may disclose PHI relating to an individual’s death if state or federal law requires the information for collection of vital statistics or inquiry into cause of death. For research, audit or evaluation purposes: In certain circumstances, we may disclose PHI for research, audit or evaluation purposes. To avert threat to health or safety: In order to avoid a serious threat to health or safety, we may disclose PHI to law enforcement when a threat is made to commit a crime on the program premises or against program personnel.
Uses and Disclosures Requiring You to have an Opportunity to Object: In the following situations, we may disclose a limited amount of your PHI if we inform you about the disclosure in advance and you do not object, as long as the disclosure is not otherwise prohibited by law. However, if there is an emergency situation and you cannot be given your opportunity to object, disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interests. You must be informed and given an opportunity to object to further disclosure as soon as you are able to do so. To families, friends or others involved in your care: We may share with these people information directly related to their involvement in your care, or payment for your care. We may also share PHI with these people to notify them about your location, general condition, or death.
3. Your Rights Regarding Your Protected Health Information. You have the following rights relating to your protected health information:To request restrictions on uses/disclosures:
You have the right to ask that we limit how we use or disclose your PHI. We will consider your request, but are not legally bound to agree to the restriction. To the extent that we do agree to any restrictions on our use/disclosure of your PHI, we will put the agreement in writing and abide by it except in emergency situations. We cannot agree to limit uses/disclosures that are required by law. To choose how we contact you: You have the right to ask that we send you information at an alternative address or by an alternative means. We must agree to your request as long as it is reasonably easy for us to do so. To inspect and copy your PHI: Unless your access is restricted for clear and documented treatment reasons, you have a right to see your protected health information upon your written request. We will respond to your request within 30 days. If we deny your access, we will give you written reasons for the denial and explain any right to have the denial reviewed. If you want copies of your PHI, a charge for copying may be imposed, depending on your 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. To request amendment of 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. We may deny the request if we determine that the PHI is: (i) correct and complete; (ii) not created by us and/or not part of our records, or; (iii) not permitted to be disclosed. Any denial will state the reasons for denial and explain your rights to have the request and denial, along with any statement 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 change in the PHI. To find out what disclosures have been made: 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, your family, or the facility directory; or pursuant to your written authorization. The list also will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or disclosures made before April, 2003. We will respond to your written request for such a list within 60 days of receiving it. Your request can relate to disclosures going as far back as six years. There will be no charge for up to one such list each year. There may be a charge for more frequent requests.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. To receive this notice: You have a right to receive a paper copy of this Notice and/or an electronic copy by email upon request.
4. How to Complain about our Privacy Practices:
If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a written complaint with the Secretary of the U.S. Department of Health and Human Services. We will take no retaliatory action against you if you make such complaints. You will not be penalized or discriminated against for filing a complaint.
5. Contact Person for Information, or to Submit a Complaint:
If you have questions about this notice or any complaints about our privacy practices, please contact
Name: Lynda Leclerc
Title: Privacy Officer
Address: 1421 Hamlet Street,
Columbus, OH 43201
Phone Number: (614) 294-8097
6. Effective Date:
This Notice of Privacy was effective on April 14, 2003.
I have received a copy of this Notice.
I have received a copy of this Notice.
The following policies deal specifically with Huckleberry House’s sharing of information with the Community Shelter Board (CSB):
What this Policy Covers.
- This policy covers the collection, use, and maintenance of protected personal information for clients of the Huckleberry House Transitional Living Program, as an agency affiliated with the Community Shelter Board (CSB).
- Protected Personal Information (PPI) is any personal information we maintain about a client that:
a. allows identification of an individual directly or indirectly;
b. can be manipulated by a reasonably foreseeable method to identify a specific individual; or
c. can be linked with other available information to identify a specific client.
- We adopted this policy because the Department of Housing and Urban Development issued standards for Homeless Management Information Systems. We intend our policy and practices to be consistent with those standards. See 69 Federal Register 45888 (July 30, 2004).
- We may amend our policy or practices at any time. Amendments may affect PPI that we obtained before the effective date of the amendment.
- We maintain a copy of this policy on our website at www.huckhouse.org
How and Why We Collect PPI.
- We collect PPI only when appropriate to provide services or for another specific purpose of our
organization or when required by law. We may collect information for these purposes:
a. to provide individual case management;
b. to produce aggregate-level reports regarding use of services;
c. to track individual program-level outcomes;
d. to identify unfilled service needs and plan for the provision of new services;
e. to conduct research for consulting and/or educational purposes; and
f. to accomplish any and all other purposes deemed appropriate by CSB.
- We only use lawful and fair means to collect PPI.
- We normally collect with the knowledge or consent of our clients. If you seek our assistance and provide us with PPI, we assume that you consent to the collection of information described in this policy.
- We may also receive PPI about you from: Homefull, Huckleberry House, The Salvation Army, Community Housing Network, Lutheran Social Services/Faith Mission, U.S. Department of Veteran’s Affairs, Columbus Metropolitan Housing Authority, Maryhaven, Volunteers of America of Ohio and Indiana, Equitas Health, National Church Residences, YMCA, Gladden Community House, Netcare Access, YWCA, Homes for Families, Southeast, Inc
- We post a sign at our intake desk or other location explaining the reasons we ask for PPI. The sign says:
How We Use and Disclose PPI.
- We use or disclose PPI for activities described in this part of the policy. We may or may not make any of these uses or disclosures of your PPI. We assume that you consent to the use or disclosure of your PPI for the purposes described below and for other uses and disclosures that we determine to be compatible with these uses or disclosures:
a. to provide or coordinate services to individuals;
b. for functions related to payment or reimbursement for services;
c. to carry out administrative functions such as legal, audits, personnel, oversight and management functions;
d. to create de-identified (anonymous) information;
e. when required by law to the extent that use or disclosure complies with and is limited to the requirements of the law;
f. to avert a serious threat to health or safety if:
i. we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public; and
ii. the use or disclosure is made to a person reasonably able to prevent or lessen the threat, including the target of the threat.
g. to report about an individual we reasonably believe to be a victim of abuse, neglect or domestic violence to a governmental authority (including a social service or protective services agency) authorized by law to receive reports of abuse, neglect or domestic violence in any of the following three circumstances:
i. where the disclosure is required by law and the disclosure complies with and is limited to the requirements of the law;
ii. if the individual agrees to the disclosure; or
iii. to the extent that the disclosure is expressly authorized by statute or regulation and either of the following are applicable:
A. we believe the disclosure is necessary to prevent serious harm to the individual or other potential victims; or
B. if the individual is unable to agree because of incapacity, a law enforcement or other public official authorized to receive the report represents that the PPI for which disclosure is sought is not intended to be used against the individual and that an immediate enforcement activity that depends upon the disclosure would be materially and
adversely affected by waiting until the individual is able to agree to the disclosure; when we make a permitted disclosure about a victim of abuse neglect or domestic violence, we will promptly inform the individual who is the victim that a disclosure has been or will be made, except if:
(i) we, in the exercise of professional judgment, believe informing the individual would place the individual at risk of serious harm; or
(ii) we would be informing a personal representative (such as a family member or friend), and we reasonably believe the personal representative is responsible for the abuse, neglect or other injury, and that informing the personal representative would not be in the best interests of the individual as we determine in the exercise of our professional judgment.
h. to a law enforcement official for a law enforcement purpose (if consistent with applicable law and standards of ethical conduct) under any of these circumstances:
i. in response to a lawful court order, court-ordered warrant, subpoena or summons issued by a judicial officer, or a grand jury subpoena;
ii. if the law enforcement official makes a written request for PPI that:
A. is signed by a supervisory official of the law enforcement agency seeking the PPI;
B. states that the information is relevant and material to a legitimate law enforcement investigation;
C. identifies the PPI sought;
D. is specific and limited in scope to the extent reasonably practicable in light of the purpose for which the information is sought; and
E. states that de-identified information could not be used to accomplish the purpose of the disclosure.
iii. if we believe in good faith that the PPI constitutes evidence of criminal conduct that occurred on our premises;
iv. in response to an oral request for the purpose of identifying or locating a suspect, fugitive, material witness or missing person and the PPI disclosed consists only of name, address, date of birth, place of birth, social security
number and distinguishing physical characteristics; or
A. the official is an authorized federal official seeking PPI for the provision of protective services to the President or other persons authorized by 18 U.S.C. 3056, or to foreign heads of state or other persons authorized by 22 U.S.C. 2709(a)(3), or for the conduct of investigations authorized by 18 U.S.C. 871 and 879 (threats against the President and others); and
B. the information requested is specific and limited in scope to the extent reasonably practicable in light of the purpose for which the information is sought.
i. to comply with government reporting obligations for HMIS and for oversight of compliance with HMIS requirements.
j. to third parties for the following purposes:
i. to permit other systems of care to conduct data matches (i.e., to determine if you are also utilizing services from such other systems of care); and
ii. to permit third party research firms and/or evaluators to perform research and
evaluation services in connection with the programs administered by CSB and
the other agencies;
provided that before PPI is disclosed under this subsection, the third party that will receive such PPI and use it as permitted above must first execute a Data Use & Disclosure Agreement requiring such third party to comply with all applicable laws and regulations, including the privacy standards and disclosure provisions contained in the Department of Housing and Urban Development Homeless Management Information Systems; Data and Technical Standards Final Notice (see 69 Federal Register 45888 (July 30, 2004)), which such standards and provisions are reflected herein.
- Before we make any use or disclosure of your PPI that is not described here, we seek your consent
How to Inspect and Correct PPI.
- You may inspect and have a copy of your PPI that we maintain. We will offer to explain any information that you may not understand.
- We will consider a request from you for correction of inaccurate or incomplete PPI that we maintain about you. If we agree that the information is inaccurate or incomplete, we may delete it or we may choose to mark it as inaccurate or incomplete and to supplement it with additional information.
- We may deny your request for inspection or copying of PPI if:
a. the information was compiled in reasonable anticipation of litigation or comparable proceedings;
b. the information is about another individual (other than a health care provider or homeless provider);
c. the information was obtained under a promise of confidentiality (other than a promise from a health care provider or homeless provider) and if the disclosure would reveal the source of the information; or
d. disclosure of the information would be reasonably likely to endanger the life or physical safety of any individual.
- If we deny a request for access or correction, we will explain the reason for the denial. We will also include, as part of the PPI that we maintain, documentation of the request and the reason for the denial.
- We may reject repeated or harassing requests for access to or correction of PPI.
- We collect only PPI that is relevant to the purposes for which we plan to use it. To the extent necessary for those purposes, we seek to maintain only PPI that is accurate, complete and timely.
- We are developing and implementing a plan to dispose of PPI not in current use seven years after the information was created or last changed. As an alternative to disposal, we may choose to remove identifiers from the PPI.
- We may keep information for a longer period if required to do so by an applicable statute, regulation, contract or other requirement.
Complaints and Accountability.
- We accept and consider questions or complaints about our privacy and security policies and practices.