Notice of Privacy Practices

It is our duty to safeguard your protected health information.

To request restrictions on uses/disclosures:

You have the right to ask that we limit how we use or disclose your PHI . We will consider your request, but are not legally bound to agree to the restriction. To the extent that we agree to any restrictions on our use/disclosure of the PHI , we will put the agreement in writing and abide by it except in emergency situations. We cannot agree to limit uses/ disclosure that are required by law.

How We May Use and Disclose Your Protected Health Information

We use and disclose Personal Health Information ( PHI ) for a variety of reasons. We have a limited right to use and/or disclose your PHI for purposes of treatment, payment, and for our health care operations. For uses beyond that, we must have your written authorization unless the law permits or requires us to make the use or disclosure without your authorization. If we disclose your PHI to an outside entity in order for that entity to perform a function on our behalf, we must have in place an agreement from the outside entity that it will extend the same degree of privacy protection to your information that we must apply to your PHI . However, the law provides that we are permitted to make some uses/disclosures without your consent or authorization. The following describes and offers examples of our potential uses/disclosures of your PHI.

Uses and Disclosures of PHI Requiring Authorization

For uses and disclosures beyond treatment, payment and operations purposes we are required to have your written authorization, unless the use or disclosure falls within one of the exceptions described below. Authorizations can be revoked at any time to stop future uses/disclosures except to the extent that we have already undertaken an action upon your authorization.

Uses and Disclosures of PHI from Client Records Not Requiring Consent or Authorization

The law provides that we may use/disclose your PHI from client records without consent or authorization in the following circumstances:

When required by law:

We may disclose your PHI when a law requires that we report information about suspected abuse, neglect or domestic violence, duty to warn, relating to suspected criminal activity, or in response to a court order. We must also disclose PHI to authorities that monitor compliance with these privacy requirements.

How to Complain About Our Privacy Practices

If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed below. You also may file a written complaint with the Office of Civil Right of the U.S. Department of Health and Human Services at 233 N. Michigan Avenue, Suite 240, Chicago, IL 60601 or (Voice Phone) 312-886-2359 (TDD) 312-353-5693 (FAX) 312-886-1807 . We will take no retaliatory action against you if you make such complaints.

If you have questions about this notice about our privacy practices, please contact:

James Sherman
Privacy Officer
SAFY of America
10100 Elida Road
Delphos , Ohio 45833
Telephone: 419-695-8010