This Notice tells you how your medical information may be used or shared. It also tells how you can get your information. Please read it carefully. Ask us if you have any questions or contact Derek Lee at firstname.lastname@example.org.
Why We Keep Information About You
We keep medical information about you to help care for you and because the law requires us to. The law also says we must:
- protect your medical information;
- give you this Notice; and
- follow what this Notice says.
What the Words We Use Mean
- “Notice” means this Notice of Privacy Practices.
- “The Hope Institute” means all The Hope Institute Campuses, our staff, volunteers, contractors and any affiliated organizations covered by the Notice.
- “We,” “our,” or “us” means one or more The Hope Institute organizations, providers, or staff.
- “You” means the patient that the medical information is about.
- “Medical information” means all the paper and electronic records related to a patient’s physical and mental health care—past, present, or future. These records tell who the patient is and includes information about billing and payment.
- “Use” means sharing or using medical information within The Hope Institute.
- “Share” means giving medical information, or access to information, to someone outside The Hope Institute.
How We May Use and Share Information about You
We use electronic record systems to manage your care. These systems have safeguards to protect the information in them. We also have policies and training that limit the use of information to those who need it to do their job. Clinicians and other people who are not employed by The Hope Institute may share information they have about you with our employees in order to care for you. Hospitals, clinics, doctors and other caregivers, programs, and services may share medical information about you for many reasons. Here are a few examples:
We may use and share medical information to treat you. Medical information may also be shared when needed to plan for your care after you leave The Hope Institute.
For Billing and Payment
We may use and share your information so that we and others who have provided services to you can bill and collect payment for these services. For example, we may share your medical information with your health plan:
- so your health plan will pay for care you received at The Hope Institute.
- to get approval before doing a procedure
- so your health plan can make sure they have paid the right amount to The Hope Institute
We may also share your information with a collection agency if a bill is overdue.
For Business Reasons
We may use and share information about you for business reasons. When we do this, we may, if we can, take out information that identifies who you are. Some of the business reasons we may use or share your medical information include:
- to follow laws and regulations;
- to train and educate;
- for credentialing, licensure, certification, and accreditation;
- to improve our care and services;
- to budget and plan;
- to do an audit;
- to maintain computer systems;
- to evaluate our staff;
- to decide if we should offer more services;
- to find out how satisfied our patients are; and
- to bill and collect payment.
Anyone we share information with in order to do these tasks on behalf of us must also protect and restrict the use of your medical information.
To Contact You about Appointments, Insurance, and Other Matters
We may contact you by mail, phone, text, or email for many reasons, including to:
- remind you about an appointment
- ask about insurance, billing, or payment
- follow up on your care
We may leave voice messages at the telephone number you give to us.
To Inform Family Members and Friends Involved in Your Care or Paying for Your Care
Whenever possible, we will allow you to tell us who you would like to be involved in your care. However, in emergencies or other situations in which you are unable to tell us who to share information with, we will only share information with those legally permitted to receive the information.
We may use and share medical information about you for the research we do to improve public health and develop new knowledge. For example, a research project may compare the health and recovery of patients who received one treatment for an illness to those who received a different treatment for the same illness. We use and share your information for research only as allowed by federal and state rules. Each research project is approved through a special process that balances the research needs with the patient’s need for privacy. In most cases, if the research involves your care or the sharing of medical information that can identify you, we will first explain to you how your information will be used and ask your consent to use the information. We may access your medical information before the approval process to design the research project and provide the information needed for approval. Health information used to prepare a research project does not leave The Hope Institute.
To Stop a Serious Threat
We may share your medical information to prevent a serious and urgent threat to the health and safety of you or someone else, as authorized or required by law.
With Military Authorities
If you are a member or veteran of the armed forces, we may share your medical information with the military as authorized or required by law. We may also share information about foreign military personnel to the proper foreign military authority.
For Worker’s Compensation
We may share your medical information as authorized by laws relating to worker’s compensation or similar programs.
For Health Oversight and Public Health Reporting
We may share information for audits, investigations, inspections, and licensing with agencies that oversee health organizations.
We may also share your medical information in reports to public health agencies.
Some reasons for this include:
- to prevent or control disease and injuries
- to report certain kinds of events, such as births and deaths
- to report abuse or neglect of children, elders, or dependent adults
- to let someone know that they may have been exposed to a disease or may spread a disease
- to notify the authorities as authorized or required by law that a patient has been the victim of abuse, neglect, or domestic violence.
For Lawsuits and Disputes
We may share your medical information as directed by a court order, discovery request, or other lawful instructions from a court or authorized government agency when needed for a legal or administrative proceeding.
With Law Enforcement and Other Officials
We may share your medical information with a law enforcement official as authorized or required by law.
We May Also Share Your Medical Information with:
- coroners, medical examiners, and funeral directors, so they can carry out their duties
- federal officials for national security and intelligence activities
- a correctional institution if you are an inmate
Other Uses of Your Medical Information
We will not use or share your medical information for reasons other than those described in this Notice unless you agree in writing. For example, you may want us to give medical information to your employer. We will do this only with your written approval.
We are not permitted to use your information in order to conduct marketing activities unless you have specifically authorized the communication.
Psychotherapy notes are notes recorded by a mental health professional that document or analyze the contents of a conversation in a counseling session and are kept separated from the rest of your medical record. There are limited circumstances in which we will use or disclose psychotherapy notes without a written authorization from you. The originator of the notes may use them for treatment purposes. We may use psychotherapy notes in our own mental health counseling training programs. We may also use psychotherapy notes in defense of a legal action or other proceeding brought by you, as required by law, or to avert a serious threat to a person’s or the public’s health or safety.
Sale of Protected Health Information
We are not permitted to sell your information unless you have specifically authorized the disclosure.
Your Rights Regarding Your Medical Information
The records we create and maintain using your medical information are the custody of The Hope Institute, but you have the following rights:
Right to Review and Receive a Copy of Your Medical Information
You have the right to look at and receive a copy of your medical information, including billing records. You must make your request in writing and it must be signed by you or your representative. We may charge a fee to cover copying, mailing, and other costs and supplies. In rare cases, we may deny your request for certain information. If we deny your request, we will give you the reason why in writing. Medical Record locations for our providers are listed at the end of this notice.
Right to Ask for a Change in Your Medical Information
If you believe the information we have about you is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information. The request must be made in writing and directed to Derek Lee at email@example.com. We cannot remove any information from the record. We can only add new information to complete or correct the existing information. We may deny your request; if we deny your request we will state in writing why we denied your request.
Right to Ask For a List of When Your Medical Information Was Shared
You have the right to ask for a list of when your medical information was shared without your written consent. This list will NOT include uses or sharing:
- for treatment, payment, or business reasons
- with you or someone representing you
- with those who ask for your information as listed in the hospital directory
- with family members or friends involved in your care
- in those very few instances where the law does not require or permit it
- as part of a limited data set with direct identifiers removed
- releases before April 14, 2003.
You must request this list in writing from Derek Lee at firstname.lastname@example.org. Your request must state the time period for which you want the list. The time period may not be longer than 6 years from the date of your request. You may be charged reasonable copying and mailing fees associated with this list.
Right to Notice in Case of a Breach
You have a right to know if your information has been breached (unauthorized acquisition, access, use, or disclosure of certain categories of health information). We will follow what the privacy laws require to let you know if your information has been shared in error.
Right to Ask for Limits on the Use and Sharing of Your Medical Information
You may request in writing that we not use or disclose your information for treatment (other than emergency treatment), payment, or operations purposes, or to individuals involved in your care, unless required by law.
We will consider your request and respond, but we are not required to honor the request. However, we will accept a request for a restriction on a disclosure of your information to a health plan for payment or operations purposes, if not otherwise required by law, if the information pertains solely to an item or services for which someone other than a health plan on your behalf has paid in full.
Right to Limit Sharing of Information with Health Plans
If you paid in full for your services, you have the right to limit the information that is shared with your health plan or insurer. To limit this information, you must ask before you receive any services. Let us know you want to limit sharing with your health plan when you schedule your appointment. Any information shared before we receive payment in full, such as information for pre- authorizing your insurance, may be shared. Also, because we have a medical record system that combines all your records, we can limit information only for an episode of care. If you wish to limit information beyond an episode of care, you will have to pay in full for each future visit as well.
Right to Ask for Confidential Communications
You have the right to ask us to communicate with you in a certain way or at a certain place. For example, you can ask that we contact you only at work or only using a post office box. You do not need to tell us the reason for your request. Your request must say how or where you wish to be contacted. You must also tell us what address to send your bills for payment. We will accept all reasonable requests. However, if we are unable to contact you using the ways or locations you have requested, we may contact you using any information we have.
Right to Get a Paper Copy of This Notice
You have the right to get a paper copy of this Notice, even if you have agreed to receive it electronically. You may get a copy:
- at any of our facilities
- by contacting your clinician or visiting www.TheHopeInsitute.net
Changes to this Notice
We have the right to change this Notice at any time. Any change could apply to medical information we already have about you, as well as information we receive in the future. The effective date of this Notice is on the first page of the Notice. A copy of the current Notice is posted throughout The Hope Institute locations and www.TheHopeInstitute.net.
How to Ask a Question or Report a Complaint
If you have questions about this Notice or want to talk about a problem without filing a formal complaint, please contact Derek Lee at email@example.com. If you believe your privacy rights have been violated, you may file a complaint with us. Please send your complaint to Derek Lee at firstname.lastname@example.org.. You may also file a complaint with the Office of Civil Rights. You will not be treated differently for filing a complaint.
How to Contact Us
1070 Commerce Dr., Building One, Suite #101
Perrysburg, OH 43551