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Policy No. 1



If you have any questions about this notice, please contact the

 Ohio Hills Health Services HIPAA Officer

at 740-425-5165


I. Our duty to safeguard your protected health information.

Individually identifiable information about you 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 notice about our privacy practices that explain how, when, and why we may use or disclose you PHI. Except in specific circumstances, we must use or disclose only the minimum necessary PHI to accomplish the purpose of the use and disclosure.


We are required to follow the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the Terms of the Notice at any time.  If we do so, we will post a new Notice in the waiting area. You may request a copy of the new notice from Judy Bertz, RN or the receptionist.


II. How may we use and disclose your Protected Health Information.

We use and disclose PHI for a variety of reasons.  For most uses/disclosures, we may obtain your consent.  For others, we must have your written authorization.  Finally, in certain circumstances, we are permitted to make some uses/disclosures without your consent or authorization.  The following offers more description and examples of our potential use/disclosures of your PHI.


·         Uses and Disclosures related to Treatment, Payment or Health Care Operations.

We may obtain your consent to use/disclose your PHI for the following, however consent is not required:

1.       For treatment: We will use/disclose your PHI to provide, coordinate, or manage your health care and any related services.  We may disclose your PHI to doctors, nurses, and any other health personnel who are involved in providing your health care.  For example, your PHI will be shared among members of your treatment team.

2.       To obtain payment:  We may use/disclose your PHI in order to bill and collect payment for your health care services.  This may include making a determination of eligibility or coverage for insurance benefits and reviewing services provided to you for medical necessity.

3.       For health care operations:  We may use/disclose your PHI in the course of operating our health care operation.  The following are examples of some ways in which we may do this:

§  We may use/disclose your PHI in evaluating the quality services provided to you.

§  We may use/disclose your PHI to our accountant or attorney for audit purposes.

§  We may have a sign-in sheet at the registration desk, where you will be asked to sign you name.  We will also call you by name in the waiting room when the provider is ready to see you.

§  We may use/disclose your PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you.


·         Uses and Disclosures Required Authorizations: 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 if 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 Not Requiring Authorization: The law provides that we may use/disclose your PHI without authorization in the following circumstances:

§  When required by law:  We may disclose Phi when a law requires that we report information about such acts as suspected abuse, neglect, or domestic violence. We also may disclose PHI when required to report information related to suspected criminal activity or in response to a court order.  We must also disclose PHI to authorities who 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 a public health authority.

§  For public oversight activities: We may disclose PHI to a health oversight agency for activities authorized by law such as audits, investigations, and inspections.  Agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.

§  Food and Drug Administration:  We may disclose PHI to the FDA to report adverse event or product defects or problems and such things as may be required.

§  Related to decedents:  We may disclose POHI relating to an individual’s death to coroners, medical examiners, for identification purposes, or for other duties authorized by law.  We may also disclose PHI to a funeral director or authorized by law.  PHI may also be used/disclosed for cadaveric organ, eye, or tissue donations or transplants.

§  For research purposes: We may disclose PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of the PHI.

§  To avert threat to health or safety:  In order to avoid a serious threat to health or safety, we may disclose PHI as necessary.

§  For specific government functions:  We may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government programs relating to eligibility and enrollment, and for national security reasons, such as protection of the President.

§  Inmates:  We may use/disclose PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.


·      Uses and Disclosures Requiring You to have an Opportunity to Object:  In the following situations, we may disclose PHI if we inform you about the disclosure in advance and you do not object. However, if there is an emergency situation and you cannot be given the 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 people information directly related to your family’s, friend’s, or other person’s 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.


III. Your Rights Regarding Your Protected Health Information.  You have the following rights relating to

      your protected health information.


·      To request restricts 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 requested 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 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 request that we send you information at an alternative address or by alternative means.  We will agree to your request as long as it is reasonable for us to complete.

·      To inspect and copy your PHI:  Unless your access is restricted for clear and documented treatment reasons, you have the right to view your PHI contained in a designated record set if you put your request in writing.  A ‘designated record set’ contains medical and billing records and any other that you use we use for making decisions about you.  We will respond to your request to view your PHI within 30 days.  If we deny the request for 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, but may be waived, depending on your circumstances.  You have the right to choose what portions of your information you want copied, and to have prior information on the cost of copying.

·      To request to 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 in 60 days of receiving your request.  We may deny the request if we determine that: (i) the PHI or record that is subject of the request is already accurate and complete. (ii) the information came from another source, unless the other source is no longer available to make corrections.

(iii) the information is not part of a designated record set; or (iv) access to the information by the patient may be denied by applicable law.  Any denial will state the reasons for the denial 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 the change to the PHI.

·      To find out what disclosures have been made: You have a right to get a list of when, or whom, for what purpose, and what content of your PHI has been released other than the following: (i) disclosure of treatment, payment or healthcare operations; (ii) disclosures that we may have made to you, to family members, or friends involved in your care, of for notification purposes; or (iii) for any other disclosures for which you gave authorization.  The list will not include any disclosures made before April 14, 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 (but not earlier than April 14, 2003). There will be no charge for up to one such list ach year.  There may be a charge for more frequent requests.

·      To receive this notice:  You have the right to receive a paper copy of this notice and/or electronic copy by email upon request.



IV. How to Complain about our Privacy Practices:

      If you think we have violated your privacy right or you disagree with a decision we made about

      access to your PHI, you may file a complaint with:

      HIPAA Officer

      Ohio Hills Health Services

      101 E. Main Street

      Barnesville, OH 43713



     You also may file a written complaint with the Secretary of the U.S. Department of Health and

     Human Services, Office of Civil Rights at:

     Office of Civil Rights

      U.S. Department of Health and Human Services

     233 N. Michigan Avenue, Suite 240

     Chicago, IL 60601

     (312) 886-2356 or (800)368-1019

     We will take not retaliatory action against you if you make such a complaint.


VI. Changes to this Notice: We reserve the right to change this Notice.  We reserve the right to

      Make the revised or changed Notice effective for medical information we already have about

      You as well as any information we receive in the future. We will post a copy of the current Notice in

      Our office.  The notice will contain the effective date on the first page, in the upper right hand    

      corner.  In addition, each time you receive treatment with us, we will offer you a copy of the current

      Notice in effect.


V. Effective Date: This Notice was published and becomes effective on April 14, 2003.

Copyright © 2017 Ohio Hills Health Services. All Rights Reserved.
Ohio Hills Health Services is a FTCA Deemed Facility. This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health service employee under 42 U.S.C. 233(g)-(n). Ohio Hills Health Services is a Federally Qualified Health Center (FQHC).