Effective Date: January 1, 2003

What is HIPAA?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a new federal guideline, which requires health care providers to inform patients of their right to health record privacy.

Your medical information is personal and private and Riverhills Healthcare (RHI) is committed to protecting your confidentiality. We need your medical record to provide you with quality care, but we have certain obligations regarding how we use and disclose your information. This notice will tell you about the ways in which we may use and disclose medical information about you. This notice will also tell you about your rights to privacy.

For Payment of Services:
We may use and disclose medical information about you so that the treatment and services you receive at this office may be billed to and payment may be collected from you, an insurance company or a third party. An example would be when we need to disclose your information to receive prior approval for a specific treatment.

For Health Care Operations:
We may use and disclose medical information about you for office operations. These uses and disclosures are necessary to run the office and make sure that all of our patients receive quality care. For example, we may need your information to review our treatment and services and to evaluate our staff.

Appointment Reminders:
We may use your information to contact you as a reminder of an upcoming appointment.

Individuals Involved with Your Care or Payment for Your Care:
We may release medical information about you to a friend, physician or family member who is involved with your medical care. We may also give information to someone who helps pay for your care.

As Required by Law:
We may disclose your medical information when required to do so by federal, state or local law (e.g., when we are appointed by a court to evaluate you).

To Avert a Serious Threat to Health or Safety:
Your medical information may be disclosed if necessary to prevent a serious threat to your health and safety or the health and safety of another person. The disclosure would only be to someone who could prevent that threat.

As a Result of You Waiving Your Rights to Confidentiality:
This may occur, for example, if you file a lawsuit.

Special Situations

Public Heath Risks:
- Your medical information may be disclosed for public health activities such as:
- To report abuse or neglect, with your permission
- To prevent spread of or to control a disease, injury or disability
- To report reactions to medications or problems with products
- To notify patients of any recalls of products they may be using
- To notify a person of a risk of spreading or contracting a disease after exposure
- To report child abuse or neglect

Lawsuits and Disputes:
We may have to disclose your medical information in response to a court or administrative order.

Law Enforcement:
If asked by a law enforcement official, we may release your medical information:
- In response to a court order, subpoena, warrant or similar process
- To identify or locate a suspect, fugitive, material witness or missing person
- About the victim of a crime if we are unable to obtain the person’s agreement
- About a death we believe may be the result of criminal conduct
- About criminal conduct at the office
- In emergency circumstances to report a crime, the location of a crime or   victims, or the identity, description or location of the person who committed   the crime.

Right to Inspect and Copy:
You have the right to request access to, inspect and copy your medical information. This includes medical and billing information, but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to: Thomas Frerick, Privacy Officer, 111 Wellington Place, Cincinnati, OH 45219. If you request a copy we may charge a fee for the costs of copying, mailing or other supplies related to your request.

Our standard policy is to release a copy of your chart to your current provider upon obtaining a separate signed release form. We may deny your request to inspect and copy in certain limited areas. If you are denied access to medical information, you may request that the information be sent to another health care provider.

Right to Amend:
You have the right to ask us to amend or change any information you feel is incorrect or incomplete. You have the right to ask for this amendment for as long as the information is kept in this office. An amendment request must be made in writing, including the reason you are requesting the amendment. You may be denied if it is not in writing or does not include a reason for the request. In addition, we may deny your request if you ask us to amend information that:

- Was not created by us
- Is not part of the medical information kept by or for this office
- Is not part of the information which you would be permitted to inspect and copy
- Is accurate and complete

Right to an Accounting of Disclosures:
You have the right to an “accounting of disclosures of.” This is a list of the disclosures we have made of your medical information for reasons other than what was stated above. To request this list you must again request it in writing. Your request must state a time period and cannot include dates before April 2003. The first list you request within a 12-month period will be free. For an additional list, you may be charged a fee for providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request.

Right to Request Restrictions:
You have a right to request a restriction or limitation on your medical information. This includes the amount of information we provide to a friend, family member or one involved with your care or payment of treatment. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency care. To request restrictions, the request must be in writing and include: what information you want to limit, whether you want to limit our use, disclosures or both and to whom you want the limits to apply. (Example: disclosures to your spouse)

Right to Request Confidential Communications:
You also have the right to request that we communicate with you about your medical matters in a certain way. For example, you may request us to contact you only at work and not at home. Again, your request must be made in writing and express how or where you want to be contacted. We will honor all reasonable requests and not ask for a reason.

Right to a Paper Copy of this Notice:
You have the right to a paper copy of this notice. You may request a copy at any time. If you are accessing this policy on Riverhills Healthcare, Inc.’s web site, you may print a copy of it.

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with this office or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint in good faith.

Other Uses of Medical Information

If at any time, your medical or billing information has been requested by outside entities or you wish to disclose your information to outside entities, such as new physicians, law firms, research organizations, etc., a separate specific authorization will need to be completed. If at any time, you want to authorize disclosure of any type of psychotherapy records, this also will require a separate authorization.

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

All written requests can be made to:

Barb Hopke
Privacy Officer
Riverhills Healthcare, Inc.
111 Wellington Place
Cincinnati, OH 45219