Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get acces to this information. Please review it carefully.

If you have any questions about this notice, please contact our Client Rights Officer or the Privacy Officer at the telephone numbers and addresses listed at the bottom of this page.

This notice has been prepared by Shawnee Mental Health Center, Inc. It tells how Protected Health Information about you can be created, shared, protected and maintained. You have the right to the confidentiality of your medical information and the right to approve or refuse the release of specific information except when the release is required by law. If the practices described in this notice meet your expectations, there is nothing that you need to do.

Who Will Follow This Notice
This notice describes Shawnee Family Health Center, Inc.'s (SFHC) practice regarding the use of your medical information and that of:

  • Any health care professional authorized to enter information into your medical record.
  • All departments and units of the mental health center that you may visit.
  • Any member of a volunteer group that we allow to help you while you are a client of the mental health center.
  • All employees, staff, and other personnel who may need access to your information.
  • All entities, sites and locations of the mental health center follow the terms of this notice and may share medical information with each other for treatment, payment or health care operations as described in this notice.

Our Pledge Regarding Medical Information
We understand that medical information about you and your health is personal. Protecting medical information about you is important. We create a record of the care and services that you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by SMHC, Inc., whether made by health care professionals or other personnel. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

  • Maintain the privacy of protected health information;
  • Keep medical records that identify private information about you;
  • Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
  • Follow the terms of the notice that is currently in effect.

What is my Protected Health Information?
Anything from the past, present, or future about your mental or physical health or condition that is spoken, written, or electronically recorded, and is created by or given to anyone providing care to you, such as, a health plan, a public health authority, your employer, your insurance company, your school or university, or anyone who processes health information about you.

What can be done with my information if I authorize its discolsure for other purposes

With your permission, we can share you Protected Health Information for reasons other than to diagnose you and to administer and pay for your treatment. For example, you might agree to allow us to share your Protected Health Information with a drug company so that your eligibility for reduced cost medications or free medication samples may be determined.

Can I revoke my authorization?

Yes. You can revoke your authorization. You must do this in writing and bring it to us so that we can stop sharing your Protected Health Information. We are permittedto share your Protected Health Information until we receive your revocation in writing.

Are there any circumstances when my information can be shared without my written authorization?

Yes. Your Protected Health Information can be shared without your prior written authorization

1. With other medical and mental health providers if the sharing is for the purpose of facilitating continuity of care for you;

2. In an emergency;

3. When required by law according to specific requirements;

  • For public health activities
  • To protect victims of abuse, neglect or domestic violence
  • For health oversight activities
  • For judicial and administrative proceedings
  • For law enforcement purposes
  • To a coroner/medical examiner
  • To a funeral director
  • For organ/eye/tissue donation
  • For research purposes
  • To avert serious threats to health or safety
  • To facilitate specialized government functions
  • To correctional institutions for specific reasons
  • For Workers Compensation

What about any other uses of my medical information?

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time.If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to 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 provide you.

What will you do to protect my health information?

We will maintain the privacy of your Protected Health Information as required by law. At your request, we will provide you with a Privacy Notice containing our legal responsibilities and privacy practices regarding Protected Health Information.

We will follow the terms of the Privacy Notice currently in effect.

We reserve the right to change the terms contained in this Privacy Notice. If we do this, it will affect all Protected Health Information maintained by us. We will notify you that we have changed the Privacy Notice by posting it at our offices and by providing a copy to you at your request. The effective date of the Privacy Notice is listed on the front page of the notice at the top.

What can I do if I have questions or want to complain about the use and disclosure of my Protected Health Information?

All questions or comments concerning our privacy policies may be sent to:

Katy Lewis, Client Rights Officer
901 Washington Street, Portsmouth, OH 45662


Secretary of U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Washington, D.C. 20201

We will not penalize or retaliate against you for complaining about the use or disclosure of your Protected Health Information.

Shawnee Family Health Center, Inc. is not responsible for the misuse or re-release of your Protected Health Information by another individual, agency or entity.

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