Privacy Notice

This notice describes how personal and medical information about you may be used and disclosed and how you can get access to this information.*  Please review it carefully.  Effective April 14, 2003

*This adds to your protections through recipient rights.

HIPAA and recipient rights

A federal act called the Health Insurance Portability and Accountability Act (HIPAA) gives you some additional rights to what you have through recipient rights.  This notice gives you information on these additional rights through HIPAA.  You will be given other information that describes your rights through recipient rights.  

Understanding the type of information we have

We get information about you when you enroll in a Newaygo County Mental Health (NCMH) program.  It includes your date of birth, sex, ID number, and other personal    information.  We also get bills, reports from your mental health service provider, and other data about your services through us.  

Our privacy commitment to you

We care about your privacy.  The information we collect about you is private.  We must give you a notice of our privacy practices.  Only people who have both the need and legal right may see your information.  Unless you give us permission in writing, we will only disclose your information for purposes of treatment/services, payment, business operations, or when we are required by law to do so.

Treatment/services - We may disclose information about you to coordinate your    services.  For example, we give information to a provider in order for you to receive the services that you have agreed to through your person-centered plan.

Payment - We may use and disclose information so the care you get can be properly billed and paid for.  For example, we may ask your case manager for details before we pay the bill for your care.

Business operations - We may need to use and disclose information for our business operations.  For example, we may use information to review the quality of the services you get.

Exceptions - For certain kinds of records, your permission may be needed, even for release for treatment, payment, and business operations.

As required by law - We will release information when we are required by law to do so.  Examples of such releases would be for law enforcement or national security        purposes, subpoenas or other court orders, communicable disease reporting, disaster relief, review of our activities by government agencies, to avert a serious threat to health or safety, or in other kinds of emergencies.

With your permission - If you give permission in writing, we may use and disclose your personal information.  If you give permission, you have the right to change your mind.  This must be in writing, too.  We cannot take back any uses or disclosures    already made with your permission.  

Your privacy rights

    You have the following rights regarding the health information that we have about you.  Your requests must be made in writing to the privacy officer at NCMH.

Your right to inspect and copy - In most cases, you have the right to look at or get copies of your records.  You may be charged a fee for the cost of copying records.

Your right to change - You may ask us to change your records if you feel that there is a mistake.  We can deny your request for certain reasons, but we must give you a written reason for our denial.

Your right to a list of disclosures - You have the right to ask for a list of disclosure made after April 14, 2003.  This list will not include the times that information was disclosed for treatment, payment, or business operations.  This list will not include information provided directly to you or your family, or information that was sent with your authorization.

Your right to request restrictions on our use or disclosure of information - You have the right to ask for limits on how your information is used or disclosed.  We are not required to agree to such requests.

Your right to request confidential communications - You have the right to ask that we share information with you in a certain way or in a certain place.  For example, you may ask us to send information to your work address instead of your home address.  You do not have to explain the basis for your request.

Changes to this notice

 We reserve the right to revise this notice.  A   revised notice will be effective for information we already have about you as well as any information we may receive in the future.  We are required by law to comply with whatever notice is currently in effect.  Any changes to our notice will be published on our web site at www.newaygocmh.org. If the changes are important to protecting YOUR privacy, a new notice will be mailed to you before it takes effect.  

How to use your rights under this notice

If you have questions or would like more information, you may contact our privacy officer at 231-689-7330 or 1-800-968-7330.

If you believe your privacy rights have been violated, you can file a complaint with our privacy office or the Department of Health and Human Services.  

    Complaints and communications to us  

Privacy Officer

Newaygo County Mental Health

1049 Newell, PO Box 867

White Cloud MI  49349

231-689-7330 or 1-800-968-7330

email:  ncmh@ncats.net  

   Complaints to the federal government

Region V, Office for Civil Rights

U.S. Department of Health & Human Services

233 N. Michigan Avenue, Suite 240

Chicago IL  60601

Phone:  312-886-2359

Fax:  312-886-1807

TDD:  312-353-5693

 Copies of this notice

 You have the right to receive an additional copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.  Please call or write to us to request a copy.

 This notice is available in other languages and alternate formats that meet the guidelines for the Health Insurance Portability and Accountability Act (HIPAA).

 Esta notificaion esta disponible en otras    lenguas y formatos diferentes que satisfacen las normas del Health Insurance Portability and Accountability Act (HIPAA).