Middle Flint Behavioral Healthcare Notice Of Privacy Practices
P. 0. Drawer 1348, Americus, GA 31709
This notice describes how information about you may be used and disclosed and how you can get access to this information. If you have any questions about this notice, contact the Privacy Officer at 229-931-2470. Please review carefully.
OUR PLEDGE REGARDING YOUR INFORMATION
At Middle Flint Behavioral HealthCare (Middle Flint BHC), an agency of Middle Flint Community Service Board, we are committed to treating and using protected health information about you responsibly. This Notice of Privacy Practice describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective today, and applies to all protected health information as defined by federal regulations. Upon request, Middle Flint BHC will provide you with a revised Notice by posting copies at its facilities, publication on Middle Flint BHC’s website, in response to a telephone or facsimile request to the Privacy Office, or in person at any facility where you receive services from Middle Flint CSB. By law we are required to follow this Notice
UNDERSTANDING YOUR HEALTH INFORMATION
Each time you visit Middle Flint BHC, a record of your visit is made. Typically, this record contains your diagnoses, treatment, and a plan for future care of treatment. This information, often referred to as your health or medical record, serves as a basis for planning your care and treatment.
Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where and why others may access your health information, and make more informed decisions when authorizing disclosure to others.
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of Middle Flint CSB, the information belongs to you. You have the right to:
- Inspect or receive a copy of your protected health information. A reasonable, cost-based fee for copying, postage and labor expense may apply. Under federal law, you may not inspect or copy information compiled in anticipation of, or for use in, a civil, criminal, or administrative proceeding, or protected health information that is subject to a federal or state law prohibiting access to such information.
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522.
- Request communications of your health information by alternative means or at alternative locations.
- Request amendment of your protected health information, as provided in 45 CFR 164.528.
- Receive an accounting of disclosures other than treatment, payment or healthcare operations, disclosures made to you, family members or friends involved in your care, or for national security, intelligence or notification purposes, as provided in 45 CFR 164.522.
- Revoke your authorization to use or disclose health information unless that action has already been taken.
- Obtain a paper copy of this notice of privacy practices upon request.
If you believe your privacy rights have been violated, you can file a written complaint to the Privacy Officer at Middle Flint Behavioral HealthCare, P. O. Drawer 1348, Americus, GA 31709 telephone 229-931-2470, facsimile 229-931-2474, to the United States Secretary of Health and Human Services. You may also contact the Division’s Privacy Coordinator by telephone at 404-657-6423, facsimile 404-657-6424, or by mail to 2 Peachtree Street NW, Room 22.240, Atlanta, Georgia 30303-3142 for further information about the complaint process or this notice.
PLEASE ASK RECEPTIONIST IF YOU WANT A COPY OF THIS NOTICE
