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.

Authorization
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.

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.

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;

1. For public health activities
2. To protect victims of abuse, neglect or domestic violence
3. For health oversight activities
4. For judicial and administrative proceedings
5. For law enforcement purposes
6. To a coroner/medical examiner
7. To a funeral director
8. For organ/eye/tissue donation
9. For research purposes
10. To avert serious threats to health or safety
11. To facilitate specialized government functions
12. To correctional institutions for specific reasons
13. For Workers Compensation

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.

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.

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

Katy Lewis, Client Rights Officer
901 Washington Street, Portsmouth, OH 45662
(740)355-8620

or

Secretary of U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Washington, D.C. 20201
(202)619-0257

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.