Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MENTAL HEALTH AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
The Southwest Mississippi Mental Health Complex (SMMHC) must by law keep your mental health information private and give you notice of its legal duties and privacy practices for your mental health information. If you have questions about any part of this notice or if you want more information about the privacy practices, please contact:
Compliance Officer
P.O. Box 768, McComb, MS 39649 -0768
(601) 684-2173 FAX (601) 249-4234
Effective Date of This Notice: April 14, 2003
I. How SMMHC May Use or Disclose Your Mental Health Information
SMMHC obtains mental health and other information from you and stores it in files and on a computer. This is part of your SMMHC record. The SMMHC record belongs to SMMHC, but the information in the medical record belongs to you. SMMHC keeps your mental health information private. The law allows SMMHC to use or disclose your mental health information for the following purposes:
1. Treatment. SMMHC will obtain or keep information about you regarding your mental health care treatment and options.
SMMHC will obtain some medical history and information about your mental health and treatment. SMMHC does use and keep this specific mental health information to make sure proper payment of benefits, and many times that the best benefits have been given to you within SMMHC guidelines.
2. Payment. SMMHC does obtain information about you and will use and disclose information about you to health care providers, business associates, and other covered entities in order to send and obtain payments for services you obtain from providers.
3. Regular Mental Health Care Operations. SMMHC will use and disclose your information as the law allows conducting an assessment of SMMHC systems and training. Example: SMMHC does plan for future SMMHC services by conducting needs assessments. Also, SMMHC does conduct medical reviews or administrative proceedings to check quality control of services available.
4. Information provided to you. SMMHC does allow individual request an opportunity to see the mental health information about themselves. This request may be denied if a licensed professional feels that this could be damaging to the individual receiving services.
5. Notification and communication with family. We may disclose your mental health information to tell a family member, your personal representative or another person responsible for your care about where you are, your general condition or if you die. If you are able and can agree or object, SMMHC will give you a chance to object prior to making this notification. If you are unable or cannot agree or object, our mental health professionals will use their best judgment in telling your family and others.
6. Required by law. As required by law, we may use and disclose your mental health information.
7. Public health. As required by law, we may disclose your mental health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
8. Health oversight activities. We may disclose your mental health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
9. Judicial and administrative proceedings. We may disclose your mental health information in the course of any administrative or judicial proceeding.
10. Law enforcement. We may disclose your mental health information to law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.
11. Deceased person information. We may disclose your mental health information to coroners, medical examiners, and funeral directors.
12. Organ donation. We may disclose your mental health information to organizations involved in procuring, banking or transplanting organs and tissues.
13. Research. We may disclose your mental health information to researchers doing research that has been approved by a SMMHC approved Privacy Board.
14. Public safety. We may disclose your mental health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
15. Specialized government functions. We may disclose your mental health information for military, national security, correctional institutions and government benefits purposes.
16. Worker's compensation. We may disclose your mental health information as necessary to comply with worker's compensation laws.
17. Marketing. We may contact you to remind you of appointments or to give you information about other treatments or mental health-related benefits and services that may be of interest to you.
II. When SMMHC May Not Use or Disclose Your Mental Health Information
Except as described in this Notice of Privacy Practices, SMMHC will not use or disclose your mental health information without your written authorization. If you do authorize SMMHC to use or disclose your mental health information for another purpose, you may take back your authorization in writing at any time.
III. Your Mental Health Information Rights
1. You have the right to request in writing restrictions on certain uses and disclosures of your mental health information. SMMHC does not have to agree to the restriction that you ask for.
2. You have the right to obtain your mental health information through a reasonable alternative means or at an alternative location. You must present an SMMHC form, which tells your specific request. There may be charges to obtain this information. You will be told in advance.
3. You have the right to see and copy your mental health information. This request must be in writing. There may be fees and charges for the time it takes to copy, prepare, supervise, and mail the information you ask for.
4. You have a right to request that SMMHC change your mental health information that is not correct or not complete. SMMHC does not have to change your mental health information and will give you information about SMMHC not changing the information. You will be told how you can disagree with the denial.
5. You have a right to obtain a list of disclosures of your mental health information made by SMMHC, except that SMMHC does not have to include disclosures for: 1 (treatment), 2 (payment), 3 (mental health care operations), 4 (information provided to you), and 5 (certain government functions) of Section I of this Notice of Privacy Practices.
6. You have a right to a paper copy of this Notice of Privacy Practices and can obtain this Notice in another format.
IV. Changes to this Notice of Privacy Practices
SMMHC reserves the right to change this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it keeps, including information that was created or received prior to the date of such change.
Until such change is made, SMMHC must by law comply with this Notice. Upon a material change of this Notice, SMMHC will send a new Notice with the changes and effective date of change to each current beneficiary.
V. Complaints
Complaints about this Notice of Privacy Practices or how SMMHC handles your mental health information should be sent to:
SMMHC
C/O Compliance Officer
P.O. Box 768
1701 White St
McComb, MS 39649
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to: