NEW PHILADELPHIA CITY HEALTH DEPARTMENT

NOTICE OF PRIVACY PRACTICES

HIPAA (Health Insurance Portability and Accountability Act)

Effective Date: 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.

The New Philadelphia City Health Department (NPHD) provides many types of services, such as health, environmental and Vital Statistics. NPHD staff must collect information about you to provide these services. NPHD knows that information we collect about you is private. NPHD is required to protect this information by Federal and State Law. We call this information “protected health information (PHI).”

The Notice of Privacy Practices will tell you how NPHD may use or disclose information about you. Not all situations will be described. NPHD is required to give you notice of our privacy practices for the information we collect and keep about you. NPHD is required to follow the terms of the notice currently in effect.

NPHD May Use and Disclose Information Without Your Authorization

For Treatment. NPHD may use or disclose information with health care providers who are involved in your health care. For example, information may be shared to create and carry out a plan for your treatment.

For Payment. NPHD may use or disclose information to get payment or to pay for the health care services you receive. For example, NPHD may provide PHI to bill your health plan for health care provided to you.

For Health Care Operations. NPHD may use or disclose information in order to manage its programs and activities. For example, NPHD may use PHI to review the quality of services you receive.

Appointments and Other Health Information. NPHD may send or call you to remind you of medical care appointments.

For Public Health Activities. NPHD is a public health agency that keeps and updates vital records, such as births and deaths, and tracks some diseases.

For Health Oversight Activities. NPHD may use or disclose information to inspect or investigate health care providers.

As Required by Law and Law Enforcement. NPHD will use and disclose information when required or permitted by federal or state law or by a court order.

For Abuse Reports and Investigations. NPHD is required by law to receive and investigate reports of abuse.

For Government Programs. NPHD may use and disclose information for public benefits under government programs.

To Avoid Harm. NPHD may disclose PHI to law enforcement in order to avoid a serious threat to the health and safety of a person or the public.

For Research. NPHD uses information for studies and to develop reports. These reports do not identify specific people.

Disclosures to Family, Friends and others. NPHD may disclose information to your family and other persons who are involved in your medical care. You have the right to object to sharing this information.

Other Uses and Disclosures Require Your Written Authorization.

For other situations, NPHD will ask for your written authorization before using or disclosing information. You may cancel this authorization at any time in writing. NPHD cannot take back any uses or disclosures already made with your authorization.

Other Laws Protect PHI. Many NPHD programs have other laws for the use and disclosure of information about you. For example, you must give your written authorization for NPHD to use and disclose your mental health and chemical dependency treatment records.

Your PHI Privacy Rights

When information is maintained by NPHD as a public health agency, the public health records are governed by other State and Federal laws and are not subject to the rights described below.

Right to See and Get Copies of Your Records. In most cases, you have the right to look at or get copies of your records. You must make the request in writing. You may be charged a fee for the cost of copying your records.

Right to Request a Correction or Update of your Records. You may ask NPHD to change or add missing information to your records if you think there is a mistake. You must make the request in writing, and provide a reason for your request.

Right to Get a List of Disclosures. You have the right to ask NPHD for a list of disclosures made after April 14, 2003. You must make the request in writing. This list will not include any disclosures made for the purposes of treatment, payment, or health care operations. The list will not include information provided directly to you or your family, or information that was sent with your authorization.

Right to Request Limits on Uses or Disclosures of PHI. You have the right to ask that NPHD limit how your information is used or disclosed. You must make the request in writing and tell NPHD what information you want to limit and to whom you want the limits to apply. NPHD is not required to agree to the restriction. You can request that the restrictions be terminated in writing or verbally.

Right to Revoke Permission. If you are asked to sign an authorization to use or disclose information, you can cancel that authorization at any time. You must make the request in writing. This will not affect information that has already been shared.

Right to Choose How We Communicate with you. You have the right to ask that NPHD share information with you in a certain way or in a certain place. For example, you may ask NPHD to send information to your work address instead of your home address. You must make this request in writing. You do not have to explain the basis for your request.

Right to Get a Paper Copy of this notice. You have the right to ask for a paper copy of this notice at any time.

How to contact NPHD to Review, Correct, or

Limit Your Protected Health Information (PHI)

You may contact your local NPHD or the NPHD Privacy Officer at the address listed at the end of this notice to:

Ask to look at or copy your records Ask to correct or change your records

Ask to limit how information about you Ask for a list of the times NPHD disclosed

is used or disclosed. information about you

Ask to cancel your authorization

NPHD may deny your request to look at, copy or change your records. If NPHD denies your request, NPHD will send a letter that tells you why your request is being denied and how you can ask for a review of the denial. You will also receive information about how to file a complaint with NPHD.

How to File a Complaint or Report a Problem

You may contact any of the people listed below if you want to file a complaint or to report a problem with how NPHD has used or disclosed information about you. Your benefits will not be affected by any complaints you make. NPHD cannot retaliate against you for filing a complaint, cooperating in an investigation or refusing to agree to something that you believe to be unlawful.

NEW PHILADELPHIA CITY HEALTH DEPARTMENT

166 East High Avenue

New Philadelphia, Ohio 44663

Phone: 330-364-4491 ext. 218 Fax: 330-364-8830 Email: health4u@ tusco.net

For More Information

If you have any questions about this notice or need more information, please contact NPHD Privacy Officer.

For More Information

In the future, NPHD may change its notice of Privacy Practices. Any changes will apply to information NPHD already has, as well as any information NPHD receives in the future. A copy of the new notice will be posted at the New Philadelphia City Health Department and provided as required by law. You may ask for a copy of the current notice anytime you visit the NPHD.

ELH: HIPAA Notice of Privacy

03/12/03 BOH Approved