Clients of Alcohol and Drug Programs
Ohio Revised Code and The Ohio Department of Alcohol and Drug Addiction Services require that every alcohol and drug treatment program has a documented
client's rights policy, a client grievance procedure and a policy for maintaining, for at least two years from resolution, records of client grievances
that include, at a minimum, the following:
(a) Copy of the grievance.
(b) Documentation reflecting process used and resolution/remedy of the grievance.
(c) Documentation, if applicable, of extenuating circumstances for extending the time period for resolving the grievance beyond twenty-one calendar
The rights of clients for each program shall include, but not be limited to, the following:
The right to be treated with consideration and respect for personal dignity,
autonomy and privacy.
The right to receive services in the least restrictive, feasible environment.
The right to be informed of one's own condition.
The right to be informed of available program services.
The right to give consent or to refuse any service, treatment or therapy.
The right to participate in the development, review and revision of one's own
individualized treatment plan and receive a copy of it.
The right of freedom from unnecessary or excessive medication, unnecessary
physical restraint or seclusion.
The right to be informed and the right to refuse any unusual or hazardous
The right to be advised and the right to refuse observation by others and by
techniques such as one-way vision mirrors, tape recorders, video recorders,
television, movies or photographs.
The right to consult with an independent treatment specialist or legal counsel at
one's own expense.
The right to confidentiality of communications and personal identifying
information within the limitations and requirements for disclosure of client
information under state and federal laws and regulations.
The right to have access to one's own client record in accordance with program
The right to be informed of the reason(s) for terminating participation in a
The right to be informed of the reason(s) for denial of a service.
The right not to be discriminated against for receiving services on the basis of
race, ethnicity, age, color, religion, sex, national origin, disability or HIV
infection, whether asymptomatic or symptomatic, or AIDS.
The right to know the cost of services.
The right to be informed of all client rights.
The right to exercise one's own rights without reprisal.
The right to file a grievance in accordance with program procedures.
The right to have oral and written instructions concerning the procedure for
filing a grievance.
If you believe your rights have been violated, you may file a grievance with the following:
The agency in which you received services
The Mental Health and Recovery Services Board of Stark County
The Ohio Department of Alcohol and Drug Addiction Services
The Ohio Legal Rights Services
The U.S. Department of Health and Human Services, civil rights regional office in Chicago
Health Insurance Portability and Accountability Act (HIPAA)
The following information is available for you to understand how your medical information may be used and disclosed and how you can access your medical
information as required by the Health Insurance Portability and Accountability Act.
NOTICE OF PRIVACY PRACTICES
Effective: April 14, 2003
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.
If you have any questions about this Notice,
please contact MHRSB Privacy Officer, Patti Fetzer at (330)430-3945 or firstname.lastname@example.org
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION
At the Mental Health and Recovery Services Board of Stark County, we understand that health information about you and your health is personal. We are
committed to protecting health information about you and safeguarding that information against unauthorized use or disclosure. We are required by law
to: 1) assure health information that identifies you is kept private; 2) give you Notice of our legal duties and privacy practices with respect to
health information about you; and 3) follow the terms of the Notice that is currently in effect. This Notice will tell you about the ways in which we
may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of
your health information. The Notice applies to all of the records that we have related to your care.
WHY WE COLLECT PERSONAL HEALTH INFORMATION
We collect personal information to:
Determine eligibility for health care coverage
Provide benefits and pay claims
Conduct our service evaluation programs
Provide other information for planning and improving mental health and substance abuse services in the community
We may also be required to collect and keep certain information so that we meet legal and regulatory requirements. We keep this information after a
client's health care coverage ends.
PERSONAL INFORMATION WE COLLECT
We ask people seeking benefits to provide certain information when they complete an enrollment form. This information may include, for example:
Name, address, phone
Date of birth
Social Security number
We may also receive personal information about you from others, such as:
Health care providers (doctors, clinics, hospitals)
ADAMH Boards that provide coverage to our clients
Business partners (companies with whom we have arrangements to assist us in providing products and services)
Other government agencies (criminal justice system, child welfare, juvenile justice, etc.)
The information we collect from others may include, for example, eligibility, claims and payment information. We create and maintain a record of your
enrollment in the public mental health and/or drug addiction and substance abuse system of the State of Ohio, and maintain records of payment for
treatment you receive in the public system. From time to time, we also receive information from your treatment provider related to your diagnosis,
treatment and progress in recovery, and any major unexpected emergencies or crises you may experience that help the Board to plan for and improve the
quality of services for the regions citizens.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
When you receive services paid for in part or in full by the Mental Health and Recovery Services Board of Stark County, we may use your personal
information for such activities as conducting our normal Board business known as health care operations. If the services we paid for were mental
health, alcohol or other drug services, we may also use your personal information for billing for such services.
If you have a guardian or a power of attorney, we will provide the information to your guardian or attorney in fact.
Examples of how we use your information include:
Payment for Mental Health or Alcohol or Other Drug Services
We keep records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment for
your services from Medicaid, insurance or other sources. For example, we may disclose personal information about the services provided to you to
confirm your eligibility for Medicaid and to obtain payment from Medicaid.
Health Care Operations
We use personal information to train staff, manage costs, conduct required business duties, and make plans to better serve you and other community
residents who may need mental health or substance abuse services.
Other Services We Provide
We may also use your personal information to:
Review and evaluate the quality, effectiveness, and efficiency of the services you have received;
Conduct program and fiscal audits of programs that have provided you with services;
Investigate major unusual incidents, report these kinds of incidents and take steps to protect your health and safety;
Prepare reports required by the Ohio Department of Alcohol and Drug Addiction Services, the Ohio Department of Mental Health, and the Ohio
Department of Job and Family Services;
Contact you for assistance in passing levies, unless you notify the MHRS Board of Stark County that you do not wish to be contacted for these
Sharing Your Personal Information
There are limited situations in which we are permitted or required to disclose personal information without your signed authorization. These situations
To protect victims of abuse, neglect or domestic violence;
To reduce or prevent a serious threat to public health and safety;
For health oversight activities such as investigations, audits, and inspections;
For local, state, federal agencies to monitor your services;
For lawsuits and similar proceedings;
For public health purposes, such as reporting communicable diseases, work-related illnesses or other diseases and injuries, as permitted by law;
reporting births and deaths and reporting reactions to drugs and problems with medical devices;
When required by law;
When requested by law enforcement as required by law or court order, except as limited by laws regarding disclosure of alcohol and other drug
To coroners, medical examiners and funeral directors;
For organ and tissue donation;
For workers compensation or other similar programs, if you are injured at work and are covered by workers compensation or other similar programs;
For specialized government functions such as intelligence and national security.
All other uses and disclosures not described in this notice, require your signed authorization. You may revoke your authorization at any time with a
SAFEGUARDING YOUR PERSONAL INFORMATION
We maintain physical, electronic and procedural safeguards that comply with applicable federal and state laws and regulations to guard your personal
information against unauthorized use or disclosure. Any third party processor or consultant used by the Board has signed an agreement with us requiring
such entity to maintain the confidentiality of your personal information. We also restrict access to your personal information to those employees who
need to know the information in order to perform their job duties. The Board maintains policies and procedures that prohibit employees and agents of
the Board from using, disclosing, transferring, providing access to or otherwise divulging client health information to any person or entity other than
to the individual who is the subject of the information.
INDIVIDUAL CLIENT RIGHTS
You have the following rights regarding the health information we maintain about you:
Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for payment or health care
operations. We will consider all requests for restrictions carefully but are not required to agree to any requested restrictions.*
You also have the right to request a limit on the health information we disclose about you to a family member who is involved in your care if you are
receiving alcohol or other drug services and have previously agreed to limited disclosure to such a family member. We will comply with any restrictions
you request regarding disclosure to such a family member.*
Right to Request Confidential Communications
You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask
that we contact you only at work or by mail.
Right to Inspect and Copy
. You have the right to access the personal information we collect, upon request. Under certain circumstances, we may not share information that we
collected for example, if the information is the subject of a lawsuit or legal claim, or if information may present a danger to you or someone
else. Fees may apply to copied information.*
Right to Amend
. You have the right to request corrections or additions to your personal information. You must give the reasons for wanting the change.*
Right to An Accounting of Disclosures
. You have the right to request an accounting of disclosures made of your personal information that were not related to our business operations or
your authorization. Under certain circumstances, we may not share information that we collected; for example, if the information is the subject of
a lawsuit or legal claim, or if release of the information may present a danger to you or someone else. Your request must state the period of time
desired for the accounting, which must be within the six years prior to your request. The first accounting is free, but a fee will apply if more
than one request is made in a 12-month period.*
Right to a Paper Copy of Notice
. You have the right to a paper copy of this Notice. Although this Notice is available at our Web site http://www.starkmhrsb.org, you may obtain a copy of the Notice by contacting the Board
Requests marked with a star (*) must be made in writing.
Contact the Mental Health and Recovery Services Board of Stark County Privacy Officer with your request.
To exercise any of your rights described in this document, contact Patti Fetzer, Privacy Officer, mental Health and Recovery Services Board of Stark
County, 800 Market Ave. N, Suite 1150, Canton, OH 44702
CHANGES TO THIS NOTICE
We reserve the right to change this Notice at any time. We reserve the right to make the revised or changed Notice effective for health information
we already have about you as well as any information we receive in the future. We will post a copy of the current Notice at the Board Office. The
Notice will contain, on the first page in the top center, the effective date. In addition, each time there is a change in the Notice, you will
receive a copy by mail at the last known address we have in our plan enrollment file.
If you have a complaint about our privacy policies and procedures or you believe your privacy rights have been violated, you may file a complaint with
the Board or with the Secretary of the Department of Health and Human Services. To file a complaint with the Board, contact the Privacy Officer at the
address below. We will investigate all complaints and will not retaliate against you for filing a complaint. If you wish to file a complaint with the
Secretary, you may send the complaint to:
7500 Security Blvd., C5-24-04
Baltimore, MD 21244