529 S. Elizabeth St.

Lima, OH 45804

419-222-5120

CLIENT RIGHTS

You have the following rights regarding the health information we maintain 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.  Although this Notice is available at our website www.wecarepeople.org, you may obtain a copy of the Notice by contacting the Board Office. 

Requests marked with a star (*) must be made in writing. Contact the ADAMH  Board Privacy Officer with your request. To exercise any of your rights described in this paragraph, please contact the Board Privacy Officer at the address or phone number listed below. 
                              
Kelly Monroe   
529 S. Elizabeth Street   Lima, OH  45804
kelly@mhrsb.org

If you are in crisis call 1-800-567-HOPE (4673) or text 741 741.