HIPAA Privacy

Notice of Privacy Practices
Effective April 14, 2003

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

Our Organization

This notice describes the privacy practices of the Mercer County Board of DD (the DD Board).  This notice also describes the privacy practices of persons or entities which have signed a contract with the DD Board and which are acting as business associates, and have promised to follow the same rules of confidentiality.

If you want to know about the privacy practices of service providers who are not employed by the DD Board and who are not business associates, you should contact them directly.

Privacy Promise

The DD Board understands that your personal information needs to be kept private.  Protecting your personal information is important.  We follow strict federal and state laws that require us to keep your personal information confidential.

How We Use Your Personal Information

When you receive services from the DD Board, we may use your personal information for such activities as providing you with services, billing for services, and conducting our normal board business known as health care operations.  If you have chosen a personal representative and have agreed to let your personal representative obtain your personal information, we will provide the information to your personal representative.  If you have a guardian, we will provide the information to your guardian.

Examples of how we use your information include:

TreatmentWe keep records of the care and services provided to you within the DD Board.  For example, your service and support administrator keeps notes on all contacts made in coordinating and arranging for services.  DD Board staff may share your personal information while helping to develop your service plan.  If DD Board staff want to share your personal information with anyone who is not employed by the DD Board, you must give them written permission first.

Some personal records, including confidential communications with a mental health professional and substance abuse records, may have additional restrictions for use and disclosure under state and federal law.

PaymentWe keep records that include payment information and documentation of the services provided to you.  Your information may be used to obtain payment for your services from Medicaid, insurance, or other sources.  For example, we may disclose personal information about the services provided to you to confirm your eligibility for Medicaid and to obtain payment from Medicaid.  The DD Board may use your personal information to determine the amount and type of Medicaid services you need and send this information to the proper state department.

Health Care OperationsWe use personal information to improve the quality of care, train staff, manage costs, conduct required business duties, and make plans to better serve you and other individuals enrolled in the DD Board.  For example, we may use your personal information to evaluate the quality of treatment and services provided by our service staff.

Other Services We Provide

We may also use your personal information to:

  • Determine whether you are eligible for services from the DD Board;
  • Recommend to you service alternatives and other possible benefits;
  • Tell you about other service providers who may be able to help you;
  • Remind you of an appointment unless you tell the DD Board staff you do not wish to be reminded;
  • To allow the DD Board to review direct service contract;
  • Allow local, state, federal agencies to monitor your services;
  • To investigate incidents affecting health and safety, to report these kind of incidents, and to take steps to protect your health and safety;
  • To allow the DD Board to prepare reports required by the Ohio Department of Developmental Disabilities and the Ohio Department of Job and Family Services;
  • Contact you for assistance in passing levies, unless you notify the DD Board you do not wish to be contacted for these purposes.

More Information

For more information about the practices and rights described in this notice, contact the DD Board at the phone number and address at the bottom of this notice.

Sharing Your Personal Information

There are limited situations when we are permitted or required to disclose personal information without your signed authorization.  These situations are:

  • To protect victims of abuse, neglect, or domestic violence;
  • To reduce or prevent a serious threat to public health and safety;
  • For health oversight activities such as investigations, audits, and inspections;
  • For lawsuits and similar proceedings;
  • For public health purposes such as reporting communicable diseases, work-related illnesses, or other diseases and injuries permitted by law; reporting births and deaths, and reporting reactions to drugs and problems with medical devices;
  • When required by law;
  • When requested by law enforcement as required by law or court order;
  • To coroners, medical examiners, and funeral directors;
  • For organ and tissue donation;
  • For workers’ compensation or other similar programs if you are injured at work and are covered by workers’ compensation or other similar programs;
  • For specialized government functions such as intelligence and national security;

All other uses and disclosures, not described in this notice, require your signed authorization.  You may revoke your authorization at any time with a written statement.

Our Privacy Responsibilities

The DD Board is required by law to:

  • Maintain the privacy of your personal information.
  • Provide this notice that describes the ways we may use and share your personal information.
  • Follow the terms of the notice currently in effect.

We reserve the right to make changes to this notice at any time and make the new privacy practices effective for all information we maintain.

You may also request a copy of any notice from the DD Board Privacy Officer.

Your Individual Rights

You have the right to:

  • Request restrictions on how we use and share your personal information.  We will consider all requests for restrictions carefully but are not required  to agree to any restriction.*
  • Request that we use a specific telephone number or address to communicate with you.
  • Inspect and copy your personal information, including service, medical, and billing records.  Fees may apply.*
  • Request corrections or additions to your personal information.  You must give the reasons for wanting the change.*
  • Request an accounting of certain disclosures of your personal information made by us.  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.*
  • Request a paper copy of this notice even if you agree to receive it electronically.

Requests marked with a star (*) must be made in writing.  Contact the DD Board Privacy Officer for the appropriate form for your request.

Contact Us

If you would like further information about your privacy rights, are concerned your privacy rights have been violated, or disagree with a decision that we made about access to your personal information, please contact the DD Board.

Mercer County Board of DD

Shawn Thieman
4980 Mud Pike
Celina  OH  45822

We will investigate all complaints and will not retaliate against you for filing a complaint.

You also may file a written complaint to:

Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201

To find other methods of filing a complaint with HHS, visit www.hhs.gov/hipaa/filing-a-complaint/complaint-process.

Additionally, you may contact HHS at:

Toll-free:        (800) 368-1019
TDD toll-free:    (800) 537-7697


The Section of your Notice of Privacy Practices which addresses Sharing your Personal Information without authorization is amended to add the following language.

Disability Rights Ohio (DRO) filed a state-wide class action captioned Ball v. Kasich Case No. 2:16-cv-282 in the U.S. District Court for the Southern District of Ohio.  The suit was filed on March 31, 2016 against the Governor, Department of Developmental Disabilities, Department of Medicaid and Opportunities for Ohioans with Disabilities.  The Ohio Association of County Boards Serving People with Developmental Disabilities may become a defendant in the lawsuit.  The Plaintiffs are represented by DRO and other lawyers from Massachusetts, Illinois, Michigan and Washington D.C.

The action potentially affects all adults with DD.  The parties to the lawsuit, through their lawyers, have sought and will continue to seek documentation, including Protected Health Information, on individuals who are or who may be a part of this lawsuit, or who may have information relevant to this lawsuit or who are simply receiving services from DD Boards.  The DD Board will comply with requests for information and may provide Protected Health Information on any person served by the DD Board to the lawyers for any of the parties.  All information provided in connection with this lawsuit is covered by a protective order issued by the court which complies with HIPAA and other privacy regulations and which ensures that the information about any individual cannot be disclosed outside of the lawsuit without their permission.  At the conclusion of the lawsuit, all protected health information which was disclosed or retained by any party in the course of the lawsuit will be destroyed.

For further information on the lawsuit or the Protective Order, contact OACBDD.

To download a printable version of this notice, click here.