THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Iroquois Center for Human Development, Inc. (ICHD) is a non-profit community mental health center. Kansas’ privacy laws and the federal Health Insurance Portability and Accountability Act (HIPAA) govern privacy matters between ICHD and its participants concerning the privacy of identifiable health information. In some cases Kansas’ law may govern the privacy of your personal health information (PHI) and in others HIPAA may govern. Information contained in an ICHD client’s file is confidential by law and we at ICHD are committed to protecting this information.
The health claims submitted on your behalf include protected health information and are processed electronically for payment and data collection by claims administrators according to Kansas’ law and contractual terms of confidentiality with ICHD. ICHD uses and discloses your health information for business operations such as required mental health management involving your participation to facilitate treatment and delivery of mental health services. ICHD or its claims administrators may request additional health information from a provider, according to a written authorization, such as doctor’s statements, to determine medical necessity concerning pre-certification for out-patient and mental health benefits. ICHD may contact an individual to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.
Disclosures of your PHI without authorizations as required by law would be court orders and court ordered warrants, grand jury subpoenas, administrative subpoenas, or statutes that require the production of information. HIPAA permits a Covered Entity (CE) to release PHI to a health oversight agency both federal and state.
You have the right to: a) inspect and copy your health information, with the exception of psychotherapy notes and information that requires a court order; b) amend and restrict the health information that ICHD discloses about you, however ICHD is not required to agree to a requested amendment or restriction; c) request your communications remain confidential or request an alternate means of communication with ICHD; d)receive a copy of this Notice; e) file a grievance if you believe ICHD has improperly disclosed your information; f) request a listing of disclosures made by ICHD after April 14, 2003 which were disclosed pursuant to a written authorization, g) receive a paper copy of this Notice upon request if you have received this notice electronically, and h) revoke your consent or authorization to use or disclose health information except to the extent that we have taken action in reliance on the consent or authorization.
ICHD reserves the right to change the terms of this Privacy Notice and will provide all interested persons a revised notice either by U.S. Postal Service delivered to the individual’s mailing address on file with ICHD or electronic communication by posting the revised Privacy Notice on the ICHD web site http://irqcenter.com/.
If you believe your privacy rights have been violated, call or send a written complaint to ICHD HIPAA Privacy Officer at 610 E. Grant, Greensburg, Kansas 67054, (620) 723-2272 and/or Secretary of DHHS, 200 Independence Ave. SW, Washington, DC, 1-877-696-6775. No retaliation is allowed against the individual filing a complaint.
This notice is effective April 14th, 2003
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