Notice of Privacy Practices

 Empowered For Excellence Behavioral Health is required by law to provide you with this Notice. This notice describes how medical information about you may be used and disclosed and how you can get access to this information.   

 Each Time EFEBH provides a service to you, a record of your visit is made containing health and financial information. Typically, this record contains information about your condition, the treatment we provide and payment for the treatment.  

•  For Treatment
  • We may use or disclose health information about you to provide you with medical treatment. 
  • We may disclose health information about you to doctors, nurses, therapists or other EFEBH personnel who are involved in your care at EFEBH.
  • We may also disclose health information about you to people outside of EFEBH who may be involved in your medical care after you leave EFEBH. This may include family member or whomever you tell us we can disclose information to by a signed release of information form. 

• For Payment
  • We may use and disclose health information about you so that the treatment and services you receive at EFEBH may be billed to you, an insurance company or a third party. 
  • We may also tell your health plan about treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
• For Health Care Operations
• We may use and disclose health information about you for our day-to-day health care operations.  This is necessary to ensure that all client’s receive quality care.  
• We may also combine health information about many clients to help determine what additional services we should offer, what services should be discontinued, and whether certain new treatments are effective.  
• Health information about you may be used by EFEBH for business development and planning, cost management analyses, insurance claims management, risk management activities, and in developing and testing information systems and programs.  
• Other aspects of health care operations that may require use and disclosure of your health information include accreditation, certification, licensing and credentialing activities, review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.  
• Your health information may be used and disclosed for the business management and general activities of EFEBH including resolution of internal grievances, customer service and due diligence in connection with a sale or transfer of EFEBH.  
• In limited circumstances, we may disclose your health information to another entity subject to HIPAA for its own health care operations. 
• We may remove information that identifies you so that the health information may be used to study health care and health care delivery without learning the identities of residents.  

 When it come to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. 

• Request access or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. 
• Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete. 
• Request to amend your health record must be in writing.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days
• Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. 
• We will say “yes” to all reasonable requests. 
• Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. 
  • We are not required to agree to your request, and we may say “no” if it would affect your care. 
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. 
  • We will say “yes” unless a law requires us to share that information.
• Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. 
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. 
• Get a copy of this privacy notice 
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
• Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. 
• We will make sure the person has this authority and can act for you before we take any action.

 How else can we use or share your health information?  

 We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. 

• Help with public health and safety issues
  • Prevention or control of disease, injury or disability
  • Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease
• Comply with the law 
• We will share information about you if state or federal laws require it.
• Work with a medical examiner or funeral director
• We can share health information with a coroner, medical examiner, or funeral director when cause of death is being reported on an individual.
• Address workers’ compensation, 
• We may disclose health information for workers’ compensation claims 
• Law enforcement and other government requests
• For law enforcement purposes or with a law enforcement official 
• In response to a court order, subpoena, warrant, summons, or similar process
• To identify or locate a suspect, fugitive, material witness, or missing person
• About you, the victim of a crime if, under certain limited circumstances, we are able to obtain your agreement
• About a death we believe may be a result of criminal conduct
• About criminal conduct at EFEBH
• Health oversight agencies for activities authorized by law 
• These activities may include audits, investigations, inspections, and licensure. 
• These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. 
• Reporting Abuse, Neglect or Domestic Violence
  •  Notifying the appropriate government agency if we believe a client has been a victim of abuse, neglect, or domestic violence. 

 Other Uses 

• Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission.  
• If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time.  
• If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization.  
• You understand that we are unable to take back any disclosures we have already made with your permission
• That we are required to retain our records of the care that we provided to you.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information. 
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. 
• We must follow the duties and privacy practices described in this notice and give you a copy of it. 
• Unless you give us written permission EFEBH will not share psychotherapy notes
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. 

Changes to the Terms of This Notice 

EFEBH can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Questions or Concerns

• You can complain if you feel we have violated your rights 
• We will not retaliate against you for filing a complaint.

Contact: 

Melissa M. Buzza, Compliance Officer 

3170 W. Central Ave., Suite B, Toledo, OH 43606

Phone: 567-316-7253 

Email: mbuzza@efebh.org

Hours: 8:00 am – 4:30 pm

Secretary of the US Department of Health and Human Services

200 Independence Avenue, S.W. 

Washington, D.C. 20201

Toll Free Call Center 1-877-696-6775

This Notice of Privacy Practices applies to the following organization: 

This is applicable to all EFE locations