HIPAA Statement

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:

sumbul2a.gif (226 bytes) Determine whether you are eligible for services from the MR/DD Board

sumbul2a.gif (226 bytes) Recommend to you service alternatives and other possible benefits

sumbul2a.gif (226 bytes) Tell you about other service providers who may be able to help you

sumbul2a.gif (226 bytes) Remind you of an appointment unless you tell the MR/DD Board staff that you do not wish to be reminded

sumbul2a.gif (226 bytes) To allow the MR/DD Board to review direct service contracts

sumbul2a.gif (226 bytes) Allow local, state, federal agencies to monitor your services

sumbul2a.gif (226 bytes) To investigate incidents affecting health and safety, to report these kinds of incidents and to take steps to protect your health and safety

sumbul2a.gif (226 bytes) 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:

sumbul2a.gif (226 bytes) To protect victims of abuse, neglect, or domestic violence

sumbul2a.gif (226 bytes) To reduce or prevent a serious threat to public health and safety

sumbul2a.gif (226 bytes) For health oversight activities such as investigations, audits, and inspections

sumbul2a.gif (226 bytes) For lawsuits and similar proceedings

sumbul2a.gif (226 bytes) 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

sumbul2a.gif (226 bytes) When required by law

sumbul2a.gif (226 bytes) When requested by law enforcement as required by law or court order

sumbul2a.gif (226 bytes) To coroners, medical examiners, and funeral directors

sumbul2a.gif (226 bytes) For organ and tissue donation

sumbul2a.gif (226 bytes) For workers= compensation or other similar programs if you are injured at work and are covered by workers= compensation or other similar programs

sumbul2a.gif (226 bytes) 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:

sumbul2a.gif (226 bytes) Maintain the privacy of your personal information

sumbul2a.gif (226 bytes) Provide this notice that describes the ways we may use and share your personal information

sumbul2a.gif (226 bytes) Follow the terms of the notice currently in effect.

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:

sumbul2a.gif (226 bytes) 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.*

sumbul2a.gif (226 bytes) Request that we use a specific telephone number or address to communicate with you

sumbul2a.gif (226 bytes) Inspect and copy your personal information, including service, medical and billing records. Fees may also apply.*

sumbul2a.gif (226 bytes) Request corrections or additions to your personal information. You must give the reason for wanting the change.*

sumbul2a.gif (226 bytes) 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.*

sumbul2a.gif (226 bytes) 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 [email protected].