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Effective: April 14, 2003 |
Privacy
Promise
The Lorain County MR/DD Board (Murray Ridge Center) understands that
your personal information needs to be kept private. Protecting your personal information
is important. We follow strict federal and state laws that require us to keep your
personal information confidential.
How We Use Your Personal Information
When you receive services
from the MR/DD Board, we may use your personal information for such activities as
providing you with services, billing for services, and conducting our normal board
business including health care operations.
If you have chosen a personal representative and have agreed to let your
representative obtain your personal information, we will provide the information to your
personal representative. If you have a guardian we will provide the information to your
guardian. |
Examples
of how we use your information include:
Treatment - We keep records of
the care and services provided to you within the MR/DD Board. For example, your service
and support administrator keeps notes on all contacts made in coordinating and arranging
for services. If you see a nurse working for the MR/DD Board, the nurse will keep records
of any care you receive. MR/DD Board staff may share your personal information while
helping to develop your service plan. If MR/DD Board staff want to share your personal
information with anyone who is not employed by the MR/DD Board, you must give them written
permission first. Some personal records, including confidential communications with a
mental health professional and substance abuse records, may have additional restrictions
for use and disclosure under state and federal law.
Payment - We keep records that include payment information and
documentation of the services provided to you. Your information may be used to obtain
payment for your services from Medicaid, insurance or other sources. For example, we may
disclose personal information about the services provided to you to confirm your
eligibility for Medicaid and to obtain payment from Medicaid. The MR/DD Board may use your
personal information to determine the amount and type of Medicaid services you need and
send this information to the proper state department.
Health Care Operations - We use personal information to improve the
quality of care, train staff, manage costs, conduct required business duties, and make
plans to better serve you and other individuals enrolled in the MR/DD Board. For example,
we may use your personal information to evaluate the quality of treatment and services
provided by our service staff.
Other Services We Provide
We may also use your personal information to:
 Determine whether you are eligible for services from the MR/DD
Board
Recommend to you service alternatives and other possible benefits
Tell you about other service providers who may be able to help you
Remind
you of an appointment unless you tell the MR/DD Board staff that you do not wish to be
reminded
To allow the MR/DD Board to review direct service contracts
Allow local, state, federal agencies to monitor your services
To investigate incidents affecting health and safety, to report
these kinds of incidents and to take steps to protect your health and safety
To allow the MR/DD Board to prepare reports required by the Ohio
Department of Mental Retardation and Developmental Disabilities and the Ohio Department of
Job and Family Services
Contact you for assistance in passing levies,
unless you notify the MR/DD Board that you do not wish to be contacted for these purposes |
More
Information
For more information about the practices and rights described in this
notice:
Visit our website at www.loraincountymrdd.org
Contact the MR/DD Board at the phone number
and address on the back of this notice |
Sharing
Your Personal Information
There are limited situations when we are permitted or required to
disclose personal information without your signed authorization. These situations are:
To protect victims of abuse,
neglect, or domestic violence
To reduce or prevent a
serious threat to public health and safety
For health oversight
activities such as investigations, audits, and inspections
For lawsuits and similar
proceedings
For public health purposes
such as reporting communicable diseases, work-related illnesses, or other diseases and
injuries permitted by law; reporting births and deaths, and reporting reactions to drugs
and problems with medical devices
When required by law
When requested by law
enforcement as required by law or court order
To coroners, medical
examiners, and funeral directors
For organ and tissue donation
For workers= compensation or other similar programs if
you are injured at work and are covered by workers= compensation or other similar programs
For specialized government
functions such as intelligence and national security
All other uses and disclosures, not described in this notice, require your
signed authorization. You may revoke your authorization at any time with a written
statement. |
Our
Privacy Responsibilities
The MR/DD Board is required by law to:
Maintain the privacy of your
personal information
Provide this notice that
describes the ways we may use and share your personal information
Follow the terms of the
notice currently in effect.
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We reserve the right to
make changes to this notice at any time and make the new privacy practices effective for
all information we maintain.
Current notices will be posted in the MR/DD Board facilities and on
our website, www.loraincountymrdd.org |
Your
Individual Rights
You have the right to:
Request restrictions on how
we use and share your personal information. We will consider all request for restrictions
carefully but are not required to agree to any restrictions.*
Request that we use a
specific telephone number or address to communicate with you
Inspect and copy your
personal information, including service, medical and billing records. Fees may also
apply.*
Request corrections or
additions to your personal information. You must give the reason for wanting the change.*
Request an accounting of
certain disclosures of your personal information made by us. Your request must state the
period of time desired for the accounting, which must be within the six years prior to
your request. The first accounting is free but a fee will apply if more than one request
is made in a 12-month period.*
Request a paper copy of this
notice even if you agree to receive it electronically.
Requests marked with a star (*) must be made in writing. Contact the MR/DD
Board Privacy Office for the appropriate form for the request. |
Our
Organization
This notice describes the privacy practices of the Lorain County Board
of MR/DD (Murray Ridge Center). This notice also describes the privacy practices of
person or entities which have signed a contract with the MR/DD Board and which are acting
as business associates, and have promised to follow the same rules of confidentiality.
The MR/DD Board includes:
Elyria Administration Building, Service and Support Administration
Building, Elyria, Lorain, and Oberlin Work Activity Centers, Murray Ridge School,
Community Employment, Board operated Group Homes including: South Professor, East College,
Liberty Lane, Academy Court, East Ninth, and Meister Road as well as the MR/DD Board
employees and volunteers at those facilities.
If you want to know about the privacy practices of service providers who
are not employed by the MR/DD Board and who are not business associates, you should
contact them directly. |
Contact
Us
If you would like further information about your privacy rights, are
concerned that your privacy rights have been violated, or disagree with a decision that we
made about access to your personal information:
Contact the Lorain County MR/DD Board
Privacy Officer, 1091
Infirmary Road, Elyria, OH 44035 Phone: (440) 329-3734
Complaint Officer, 1091 Infirmary Road, Elyria, OH 44035 Phone: (440)
329-3734
We will investigate all complaints and will not retaliate against you
for filing a complaint.
You also may file a written complaint with either
The Secretary of the U.S. Department of Health and Human Services, 200
Independence Avenue SW, Washington D.C., 20201 or call 1-877-696-6775 or
The Office for Civil Rights, U.S. Department of Health and Human Services
at 200 Independence Avenue SW, Room 509F, HHH Building, Washington D.C., 20201 or call OCR=s hotline - voice at 1-800-368-1019, or
e-mail at ocrmail@hs.gov.
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