- Notice of
Privacy Practices - General (DHMH
4617)
THIS NOTICE
DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY.
- Safeguarding Your Protected Health
Information
The Maryland Department of Health
and Mental Hygiene (DHMH) is committed to protecting your
health information. In order to provide treatment or to pay
for your healthcare, DHMH will ask for certain health
information and that health information will be put into your
record. The record usually contains your symptoms,
examination and test results, diagnoses, and treatment.
That information, referred to as your health or medical
record, and legally regulated as health information may be
used for a variety of purposes. DHMH is required to follow the
privacy practices described in this Notice, although DHMH
reserves the right to change our privacy practices and the
terms of this Notice at any time. You may request a copy of
the new notice from any DHMH agency. It is also posted on our
website at http://www.dhmh.state.md.us/.
How DHMH May Use and
Disclose Your Protected Health Information
DHMH employees
will only use your health information when doing their
jobs. For uses beyond what DHMH normally does, DHMH must
have your written authorization unless the law permits or
requires it. The following are some examples of our possible
uses and disclosures of your health information.
Uses
and Disclosures Relating to Treatment, Payment, or Health Care
Operations:
For
treatment: DHMH may use or
share your health information to approve, deny treatment and
to determine if your medical treatment is appropriate.
For example, DHMH health care providers may need to review
your treatment plan with your healthcare provider for medical
necessity or for coordination of care.
To
obtain payment: DHMH may use and
share your health information in order to bill and collect
payment for your health care services and to determine your
eligibility to participate in our services. For example, your
health care provider may send claims for payment of medical
services provided to you.
For
health care operations: DHMH may use and
share your health information to evaluate the quality of
services provided, or to our state or federal auditors.
Other Uses
and Disclosures of health information required or allowed by
law:
Information
purposes:
Unless you provide
us with alternative instructions, DHMH may send appointment
reminders and other materials about the program to your
home.
Required by law:
DHMH may disclose
health information when a law requires us to do so.
Public health
activities: DHMH may disclose
health information when DHMH is required to collect or report
information about disease or injury, or to report vital
statistics to other divisions in the department and other
public health authorities.
Health oversight
activities: DHMH may disclose
your health information to other divisions in the department
and other agencies for oversight activities required by
law. Examples of these oversight activities are audits,
inspections, investigations, and licensure.
Coroners, Medical
Examiners, Funeral Directors and Organ Donations:
DHMH may disclose
health information relating to a death to coroners, medical
examiners or funeral directors, and to authorized
organizations relating to organ, eye, or tissue donations or
transplants.
Research purposes:
In certain
circumstances, and under supervision of our Institutional
Review Board or other designated privacy board, DHMH may
disclose health information to assist medical
research.
Avert threat to
health or safety: In order to avoid
a serious threat to health or safety, DHMH may disclose health
information as necessary to law enforcement or other persons
who can reasonably prevent or lessen the threat of
harm.
Abuse and
Neglect:
DHMH will disclose
your health information to appropriate authorities if we
reasonably believe that you are a possible victim of abuse,
neglect, domestic violence, or some other crime. DHMH
may disclose your health information to the extent necessary
to avert a serious threat to your health or safety or the
health or safety of others.
Specific
government functions: DHMH may disclose
health information of military personnel and veterans in
certain situations, to correctional facilities in certain
situations, to government benefit programs relating to
eligibility and enrollment, and for national security reasons,
such as protection of the President.
Families, friends
or others involved in your care: DHMH may share
your health information with people as it is directly related
to their involvement in your care or payment of your
care. DHMH may also share health information with people
to notify them about your location, general condition, or
death.
Worker’s
Compensation: DHMH may disclose
health information to worker’s compensation programs that
provide benefits for work-related injuries or illnesses
without regard to fault.
Patient
Directories: The health plan
under which you are enrolled does not maintain a directory for
disclosure to callers or visitors who ask for you by
name. You will not be identified to an unknown
caller or visitor without authorization.
Lawsuits, Disputes
and Claims:
If you are
involved in a lawsuit, a dispute, or a claim, DHMH may
disclose your health information in response to a court or
administrative order, subpoena, discovery request,
investigation of a claim filed on your behalf, or other lawful
process.
Law
Enforcement:
DHMH may disclose
your health information to a law enforcement official for
purposes that are required by law or in response to a
subpoena.
You
have a Right to:
Request
restrictions: You have a right
to request a restriction or limitation on the health
information DHMH uses or discloses about you. DHMH will
accommodate your request if possible, but is not legally
required to agree to the requested restriction. If DHMH agrees
to a restriction, DHMH will follow it except in emergency
situations.
Request
Confidential Communications: You have the right
to ask that DHMH send you information at an alternative
address or by alternative means. DHMH must agree to your
request as long as it is reasonably easy for us to do
so.
Inspect and copy:
You have a right
to see your health information upon your written
request. If you want copies of your health information, you
may be charged a fee for copying, depending on your
circumstances. You have a right to choose what portions of
your information you want copied and to have prior information
on the cost of copying.
Request amendment:
You may request in
writing that DHMH correct or add to your health record.
DHMH may deny the request if DHMH determines that the health
information is: (1) correct and complete; (2) not created by
us and/or not part of our records; or (3) not permitted to be
disclosed. If DHMH approves the request for amendment, DHMH
will change the health information and inform you, and will
tell others that need to know about the change in the health
information.
Accounting of
disclosures: You have a right
to request a list of the disclosures made of your health
information after April 14, 2003. Exceptions are health
information that has been used for treatment, payment, and
operations. In addition, DHMH does not have to list
disclosures made to you, based on your written authorization,
provided for national security, to law enforcement officials
or correctional facilities. There will be no charge for
up to one such list each year.
Notice:
You have the right
to receive a paper copy of this Notice and/or an electronic
copy by email upon request.
For
More Information
This document is
available in other languages and alternate formats that meet
the guidelines for the Americans with Disabilities Act. If you
have questions and would like more information, you may
contact the facility, program, or local health department
where you receive DHMH services.
To Report a
Problem about our Privacy Practices
If you believe
your privacy rights have been violated, you may file a
complaint.
 |
You can file a complaint with
the Department of Health and Mental Hygiene, Division of
Corporate Compliance at
1-866-770-7175.
|
|
|
You can file a complaint with
the Secretary of the U.S. Department of Health and Human
Services, Office of Civil Rights. You may call the
Department of Health and Mental Hygiene for the contact
information. |
DHMH will take no
retaliatory action against you if you make such
complaints.
Effective Date: This
notice is effective on April 14, 2003.
Notice
of Privacy Practices for Mental Hygiene and Developmental
Disabilities Facility Residents (DHMH 4618)
THIS NOTICE
DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY.
Safeguarding Your Protected Health
Information
The Maryland Department of Health
and Mental Hygiene (DHMH) is committed to protecting your
health information. In order to provide treatment or to pay
for your healthcare, DHMH will ask for certain health
information and that health information will be put into your
record. The record usually contains your symptoms,
examination and test results, diagnoses, and treatment.
That information, referred to as your health or medical
record, and legally regulated as health information may be
used for a variety of purposes. DHMH is required to follow the
privacy practices described in this Notice, although DHMH
reserves the right to change our privacy practices and the
terms of this Notice at any time. You may request a copy of
the new notice from any DHMH agency. It is also posted on our
website at http://www.dhmh.state.md.us/
How DHMH May Use and
Disclose Your Protected Health Information
DHMH employees
will only use your health information when doing their
jobs. For uses beyond what DHMH normally does, DHMH must
have your written authorization unless the law permits or
requires it. The following are some examples of our possible
uses and disclosures of your health information.
Uses
and Disclosures Relating to Treatment, Payment, or Health Care
Operations:
For
treatment: DHMH may use or
share your health information to approve, deny treatment and
to determine if your medical treatment is appropriate.
For example, DHMH health care providers may need to review
your treatment plan with your healthcare provider for medical
necessity or for coordination of care.
To
obtain payment: DHMH may use and
share your health information in order to bill and collect
payment for your health care services and to determine your
eligibility to participate in our services. For example, your
health care provider may send claims for payment of medical
services provided to you.
For
health care operations: DHMH may use and
share your health information to evaluate the quality of
services provided, or to our state or federal auditors.
Other Uses
and Disclosures of health information required or allowed by
law:
Information
purposes:
Unless you provide
us with alternative instructions, DHMH may send appointment
reminders and other materials about the program to your
home.
Required by law:
DHMH may disclose
health information when a law requires us to do so.
Public health
activities: DHMH may disclose
health information when DHMH is required to collect or report
information about disease or injury, or to report vital
statistics to other divisions in the department and other
public health authorities.
Health oversight
activities: DHMH may disclose
your health information to other divisions in the department
and other agencies for oversight activities required by
law. Examples of these oversight activities are audits,
inspections, investigations, and licensure.
Coroners, Medical
Examiners, Funeral Directors and Organ Donations:
DHMH may disclose
health information relating to a death to coroners, medical
examiners or funeral directors, and to authorized
organizations relating to organ, eye, or tissue donations or
transplants.
Research purposes:
In certain
circumstances, and under supervision of our Institutional
Review Board or other designated privacy board, DHMH may
disclose health information to assist medical
research.
Avert threat to
health or safety: In order to avoid
a serious threat to health or safety, DHMH may disclose health
information as necessary to law enforcement or other persons
who can reasonably prevent or lessen the threat of
harm.
Abuse and
Neglect:
DHMH will disclose
your health information to appropriate authorities if we
reasonably believe that you are a possible victim of abuse,
neglect, domestic violence, or some other crime. DHMH
may disclose your health information to the extent necessary
to avert a serious threat to your health or safety or the
health or safety of others.
Specific
government functions: DHMH may disclose
health information of military personnel and veterans in
certain situations, to correctional facilities in certain
situations, to government benefit programs relating to
eligibility and enrollment, and for national security reasons,
such as protection of the President.
Families, friends
or others involved in your care: DHMH may share
your health information with people as it is directly related
to their involvement in your care or payment of your
care. DHMH may also share health information with people
to notify them about your location, general condition, or
death.
Worker’s
Compensation: DHMH may disclose
health information to worker’s compensation programs that
provide benefits for work-related injuries or illnesses
without regard to fault.
Patient
Directories: The health plan
under which you are enrolled does not maintain a directory for
disclosure to callers or visitors who ask for you by
name. You will not be identified to an unknown
caller or visitor without authorization.
Lawsuits, Disputes
and Claims:
If you are
involved in a lawsuit, a dispute, or a claim, DHMH may
disclose your health information in response to a court or
administrative order, subpoena, discovery request,
investigation of a claim filed on your behalf, or other lawful
process.
Law
Enforcement:
DHMH may disclose
your health information to a law enforcement official for
purposes that are required by law or in response to a
subpoena.
You
have a Right to:
Request
restrictions: You have a right
to request a restriction or limitation on the health
information DHMH uses or discloses about you. DHMH will
accommodate your request if possible, but is not legally
required to agree to the requested restriction. If DHMH agrees
to a restriction, DHMH will follow it except in emergency
situations.
Request
Confidential Communications: You have the right
to ask that DHMH send you information at an alternative
address or by alternative means. DHMH must agree to your
request as long as it is reasonably easy for us to do
so.
Inspect and copy:
You have a right
to see your health information upon your written
request. If you want copies of your health information, you
may be charged a fee for copying, depending on your
circumstances. You have a right to choose what portions of
your information you want copied and to have prior information
on the cost of copying.
Request amendment:
You may request in
writing that DHMH correct or add to your health record.
DHMH may deny the request if DHMH determines that the health
information is: (1) correct and complete; (2) not created by
us and/or not part of our records; or (3) not permitted to be
disclosed. If DHMH approves the request for amendment, DHMH
will change the health information and inform you, and will
tell others that need to know about the change in the health
information.
Accounting of
disclosures: You have a right
to request a list of the disclosures made of your health
information after April 14, 2003. Exceptions are health
information that has been used for treatment, payment, and
operations. In addition, DHMH does not have to list
disclosures made to you, based on your written authorization,
provided for national security, to law enforcement officials
or correctional facilities. There will be no charge for
up to one such list each year.
Notice:
You have the right
to receive a paper copy of this Notice and/or an electronic
copy by email upon request.
For
More Information
This document is
available in other languages and alternate formats that meet
the guidelines for the Americans with Disabilities Act. If you
have questions and would like more information, you may
contact the facility, program, or local health department
where you receive DHMH services.
To
Report a Problem about our Privacy
Practices
If you are a
resident of a DHMH facility and believe your privacy rights
have been violated, you may file a complaint.
- You can file a
complaint with the Department of Health and Mental Hygiene,
Resident Grievance System Central Office at
1-800-RGS-7454.
- You can file a
complaint with the Secretary of the U.S. Department of
Health and Human Services, Office of Civil Rights. You
may call the Department of Health and Mental Hygiene for the
contact information.
DHMH will take no
retaliatory action against you if you make such
complaints.
Effective Date:
This notice is
effective on April 14, 2003.
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