Health Department - Privacy Statement

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

This information may be released to providers, health departments, schools, day care centers, community and state immunization data bases and others as required by law.

• We will not sell your medical information to a third party.
• You may be contacted for an immunization appointment reminder.
• Other uses of this information will be with your written authorization only.

Your rights :

1. Your information will be treated in a confidential manner.
2. You may inspect and receive a copy of your information.
3. You have a right to know if others have asked for your information.
4. You may request restrictions on the use of your information. Let us know in writing.
5. If you feel we have not treated your information confidentially, you may call to complain. Our number is 330-297-2163. Ask for Sue. Or you may call: 1-866-627-7748 (TTY: 1-866-788-4989). This is the Office of Civil Rights, Medical Privacy Division, US Department of Health and Human Services. Washington DC Their Email address is: www.hhs.gov/ocr
6. You will not be retaliated against for complaining.

Our obligations :

1. We will maintain the privacy of your information.
2. We will follow the intent of the privacy laws to the best of our ability.
3. If someone asks for your information, we will try to make sure they are authorized to receive it or check with you for permission to release it.
4. If you notice we made an error in your information, we will correct it.
5. We cannot correct the errors others have made.

* We reserve the right to change the terms of this statement without notice.

Effective Date: 04-13-2003

The Ravenna City Health Department thanks you for using our services. Please call us with any questions or comments.