Notice of Privacy Practices
NOTICE OF PRIVACY PRACTICES
MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE CLIENT RECORDS
The confidentiality of alcohol and drug abuse client records maintained by MHSSO is protected by Federal law
and regulations. Generally, the program may not say to a person outside the program that a client attends
the program, or disclose any information identifying a client as an alcohol or drug abuser Unless:
(1) The client consents in writing:
(2) The disclosure is allowed by a court order; or
(3) The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research,
audit, or program evaluation.
Violation of the Federal law and regulations by a program is a crime. Suspected violations may be reported to
appropriate authorities in accordance with Federal regulations. Federal law and regulations do not protect any
information about a crime committed by a client either at the program or against any person who works for the
program or about any threat to commit such a crime. Federal laws and regulations do not protect any
information about suspected child abuse or neglect from being reported under State law to appropriate
State or local authorities.
We make a record of the care we provide and may receive such records from others. We use these records to provide or enable other health care providers to provide quality care, to obtain payment for services provided, and for administrative and operational purposes. The clinical record is the property of Mental Health Services of Southern Oklahoma. If you have any questions about this notice, please contact: the Privacy Officer for Mental Health Services of Southern Oklahoma at (580) 223-5070.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
For Treatment. We use clinical information about you to provide your clinical care. We disclose clinical
information to our employees and others who are involved in providing the care you need. For example,
we may share your clinical information with physicians or other healthcare providers who will provide services
which we do not provide. We may share your clinical information with a pharmacist who needs it to dispense
a prescription to you or a laboratory that performs a test. We may also disclose clinical information to
members of your family or others who can help with your care.
For Payment. We use and disclose clinical information about you to obtain payment for the services
you receive. For example, a bill may be sent to you and/or to a third-party payor, such as an insurance
company, health plan or the State.
For Health Care Operations. We may use and disclose clinical information about you to operate this mental
health center. For example, we may use and disclose this information to review and improve the quality
of care we provide, or the competence and qualifications of our professional staff. We may use and
disclose clinical information about you to get the Oklahoma Department of Mental Health and Substance
Abuse Services, the Oklahoma Health Care Authority (Medicaid) or your health plan to authorize services
or referrals. We may also share your clinical information with our business associates, such as a billing
service, that perform administrative services for us. We have a written contract with each business
associate that contains terms requiring them to protect the confidentiality of your information.
Appointment Reminders. We may use and disclose information to contact and remind you about appointments.
If you are not home, we may leave appointment information on your answering machine or in a message left
with the person answering the phone.
Sign-in Sheet. We may use and disclose information about you by having you sign in when you arrive at our
office. We may also call out your name when we are ready to see you.
Notification and Communication with Family. We may disclose your clinical information to notify or
assist in notifying a family member, your personal representative, or another person responsible for your
care about your location, your general condition, or in the event of your death. In the event of a disaster,
we may disclose information to a relief organization so that they may coordinate these notification efforts.
We may also disclose information to someone who is involved with your care. If you are able and available
to agree or object, we will give you the opportunity to object prior to making these disclosures, although we
may disclose information in a disaster even over your objection if we believe it is necessary to respond to
the emergency circumstances. If you are unable and unavailable to agree or object, our health
professionals will use their best judgment in communication with your family and others.
Required by Law. We may use and disclose information about you as required by law. For example,
in certain circumstances, we may be required to disclose information for the following purposes:
To report information related to victims of abuse, neglect or domestic violence;
To assist law enforcement officials in their law enforcement duties;
To respond to judicial and administrative proceedings or, in the course of judicial proceedings,
if you have waived your rights to confidentiality under Oklahoma law; and,
To help health oversight agencies during the course of audits, investigations, inspections, licensure,
and other proceedings, subject to the limitations imposed by federal and Oklahoma law.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose clinical information about
you in response to a court or administrative order. If the lawsuit is a negligence action, your information may
be disclosed without a court order. We may also disclose information about you in response to
a subpoena, discovery request, or other lawsuit process by someone else involved in the dispute, but only
if efforts have been made to tell you about the request or to obtain an order protecting the
Public Health and Safety. Your clinical information may be used or disclosed for public health activities such
as assisting public health authorities or other legal authorities prevent or control disease, injury, or disability,
or for other health oversight activities. Your information may be disclosed to appropriate persons in order
to prevent or lessen a serious and imminent threat to the health and safety of a particular person or the
Specialized Government Functions. We may disclose your clinical information for military or national security
purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.
Coroners/Funeral Directors. We may disclose your clinical information to coroners in connection with their
investigations of death or to funeral directors to enable them to carry out their lawful duties.
Organ or Tissue Donation. We may disclose your clinical information to organizations involved in procuring,
banking or transplanting organs and tissues.
Workers’ Compensation. Your clinical information may be used or disclosed as necessary in order to comply
with laws and regulations related to workers’ compensation.
Change of Ownership. In the event that MHSSO is sold or merged with another organization, your clinical
information will become the property of the new owner, although you will maintain the right to request that
copies of your information be transferred to another provider.
Marketing. We may contact you to give you information about products or services related to your treatment,
case management or care coordination, or to direct or recommend other treatments or health-related
benefits and services that may be of interest to you. We may also encourage you to purchase a product
or servicewhen we see you. We will not use or disclose your clinical information for marketing
purposes without your written authorization.
Research. We may use your clinical information for research purposes when an institutional review board
or privacy board has reviewed the research proposal and established protocols to ensure the privacy
of your clinical information and has approved the research.
By Oklahoma law we are required to notify you . . . that your health information used or disclosed as
described in this Notice of Privacy Practices may include records which may indicate the presence of a
communicable or venereal disease which may include, but are not limited to, diseases such as hepatitis,
syphilis, gonorrhea and the human immunodeficiency virus, also known as Acquired Immune Deficiency
WHEN WE MAY NOT USE OR DISCLOSE YOUR PERSONAL HEALTH INFORMATION
Except as described in this Notice of Privacy Practices, MHSSO will not use or disclose clinical information
which identifies you without your written authorization. If you do authorize MHSSO to use or disclose
your clinical information for another purpose, you may revoke your authorization in writing at any time.
YOUR PROTECTED HEALTH INFORMATION RIGHTS
You have the right:
· To a paper copy of this Notice of Privacy Practices.
· To request restrictions on certain uses and disclosures of your protected health information by
written request specifying what information you want to limit and what limitations on our use or
disclosure of that information you wish to have imposed. We reserve the right to accept or reject
your request and will notify you of our decision.
· To request that you receive protected health information in a specific way or at a specific
location. For example, you may ask that we send information to your work address. We will
comply with all reasonable requests submitted.
· To obtain access to or a copy of your protected health information, with limited exceptions.
A reasonable fee may be charged for making copies. Under current Oklahoma law, fees of 25¢ per
page and $5.00 per film are allowed. We may also charge for postage if the copies are to be mailed.
If we deny your request for access or copies, you will be informed of your rights to appeal our decision.
· To request that we amend your protected health information that you believe is incorrect
or incomplete. Your request to amend must be in writing and include the reasons you believe
the information is inaccurate or incomplete. We are not required to change your protected health
information and if we do not, we will provide you with information about this Center’s denial
and how you can disagree with the denial. You also have the right to request that we add to your
record a statement of up to two hundred and fifty (250) words concerning any statement or item
you believe to be incomplete or incorrect.
· To receive an accounting of disclosures made of your protected health information by MHSSO
unless the disclosures were for purposes of treatment, payment, clinical care operations,
certain government functions, or pursuant to your written authorization. You have the right
to revoke your authorization to use or disclose protected health information except to the extent
that this use or disclosure has already occurred.
IF YOU WOULD LIKE TO HAVE A MORE DETAILED EXPLANATION OF THESE RIGHTS, OR IF YOU WOULD LIKE TO EXERCISE ONE OR MORE OF THESE RIGHTS, CONTACT OUR PRIVACY OFFICER AT THE NUMBER LISTED ON THE FIRST PAGE OF THIS NOTICE OF PRIVACY PRACTICES.
OBLIGATIONS OF MHSSO
We are required to maintain the privacy of your confidential protected health information,
provide you with this notice of our legal duties and privacy practices with respect to your
protected health information, abide by the terms of this notice, notify you if we are unable to
agree with a requested restriction on how your information is used or disclosed, accommodate
reasonable requests you make to communicate protected health information by alternative
means or alternative locations and obtain your written authorization to use or disclose your
protected health information for reasons other than those listed above and permitted under law.
We reserve the right to change or amend this Notice of Privacy Practices at any time in the future.
After an amendment is made, the revised Notice of Privacy Practices will apply to all protected
health information that we maintain. A copy of any Revised Notice of Privacy Practices will be
made available to you at each appointment.
You will not be penalized for filing a complaint. Complaints about this Notice of Privacy Practices
or how MHSSO handles your protected health information should be directed to:
MENTAL HEALTH SERVICES OF SOUTHERN OKLAHOMA
ATTN: PRIVACY OFFICER
2530 S. Commerce, Ardmore, OK 73401 (580) 223-5070
If you are not satisfied with the manner in which this office handles a complaint, you may submit
a formal complaint to:
The Department of Health and Human Services
Office of Civil Rights
Herbert H. Humphrey Building, Room 509 F
200 Independence Avenue, S.W.
Washington, D.C. 20201