Privacy Promise
The Cuyahoga County Board of Mental Retardation & Developmental
Disabilities (CCBMR/DD) 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 CCBMR/DD, we may use your
personal information for such activities as providing you with
services, billing for services and conducting our normal agency
business known as health care operations.
If you have chosen a personal representative and have agreed
to let your personal 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 CCBMR/DD. 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 CCBMR/DD, the nurse will keep records of any care you
receive. CCBMR/DD staff may share your personal information
while helping to develop your service plan.
If CCBMR/DD staff want to share your personal information
with anyone who is not employed by the CCBMR/DD, you must
give your 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 CCBMR/DD
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 CCBMR/DD. 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 CCBMR/DD services;
- Recommend service alternatives and other possible benefits to you;
- Tell you about other service providers who may be able to help you;
- Remind you of an appointment, unless you tell the CCBMR/DD staff that
you do not wish to be reminded;
- Allow the CCBMR/DD to review direct service contracts;
- Allow local, state and federal agencies to monitor your services;
- Investigate incidents affecting health and safety, to report these
kinds of incidents and to take steps to protect your health and safety;
- Allow the CCBMR/DD 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
CCBMR/DD 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:
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, as 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 CCBMR/DD 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.
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 CCBMR/DD facilities and
on this website.
You may also request a copy of any notice from the CCBMR/DD
Privacy Office.
Your Individual Rights
You have the right to:
- Request restrictions on how we use and share your personal information.
We will consider all requests for restrictions carefully but are not
required to agree to any restriction.*
- 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 apply.*
- Request corrections or additions to your personal information. You
must give the reasons 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
CCBMR/DD Privacy Office for the appropriate form for your request.
Our Organization
This notice describes the privacy practices of the Cuyahoga County Board
of Mental Retardation & Developmental Disabilities (CCBMR/DD). This
notice also describes the privacy practices of individuals or entities
which have signed a contract with the CCBMR/DD, which are acting as business
associates and which have promised to follow the same rules of confidentiality.
The CCBMR/DD includes all services and supports provided by CCBMR/DD as
well as the CCBMR/DD employees and volunteers.
If you want to know about the privacy practices of service
providers who are not employed by the CCBMR/DD 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 CCBMR/DD:
Privacy Officer
1275 Lakeside Ave. East
Cleveland, Ohio 44114
or e-mail PrivacyOfficer@ccbmrdd.org.
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 at
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@hhs.gov.
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