| INDIVIDUAL CLIENT RIGHTS
You have the following rights regarding
the health information we remain 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 mental health 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 only contact
you 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 release of mental
health 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. You may obtain a copy of the Notice by contacting the
Board office.
Requests marked with
a star(*) must be in writing. Contact the ADAMHS Board Privacy Officer
with your request.
To exercise any of
your described in this paragraph, please contact the Board Privacy
Officer at the address or phone number listed below.
Michael J. Ruhe, Client Rights
Officer
835 N. Locust Street
Ottawa, Ohio 45875
419-523-0027
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