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Notice of Privacy Practices

Effective: April 14, 2003
Revised: Aug. 18, 2014

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 Lucas County Board of Developmental Disabilities (“Board”). This notice also describes the privacy practices of persons or entities that have signed a contract with the Board and that are acting as business associates and have promised to follow the same rules of confidentiality.

Privacy Promise

The 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 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:


We keep records of the care and services pro-vided to you within the Board. For example, your service and support specialist keeps notes on all contacts made in coordinating and arranging for services. If you see a nurse working for the Board, the nurse will keep records of any care you receive. Board staff may share your personal information while helping to develop your service plan.

If Board staff want to share your personal information with anyone who is not employed by the Board, you must give them written permission first. However, we may disclose your identity without your permission for your treatment or to obtain payment for services.

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.


We 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 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 Operations

We 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 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 Board
  • Recommend to you service alternatives and other possible benefits
  • Tell you about other service providers who may be able to help you
  • To allow the Board to review direct service contracts
  • To determine whether the waiting lists are being kept in accordance with Ohio law
  • Allow local, state and 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 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 or other fundraising activities, unless you notify the Board that you do not wish to be contacted for these purposes

More Information

For more information about the practices and rights described in this notice:

  • Visit our website at
  • Contact the Board at the phone number and address listed in this brochure

Sharing Your Personal Information

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

  • For treatment or to obtain payment for services
  • 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 Responsibilities

The 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 protected health information we maintain.

Current notices will be posted in the Board facilities and on our website:

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

Your Individual Rights

You have the right to:

  • Receive notifications of breaches of your unsecured protected health information.
  • 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.
  • Require restrictions on certain disclosures of protected health information to a health plan when you have paid out of pocket in full for the health care item or service.*
  • 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 in-formation. You must give the reasons for wanting the change.*
  • Request an accounting of certain disclosures of your personal information made by us or by Business As-sociates working for us. Your request must state the period of time desired for the accounting. You may ask for an accounting of disclosures made at least three years prior to your request and in some cases disclosures made for 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.

*These requests must be made in writing. Contact the Board Privacy Office for the appropriate form for your request.

Contact Us

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


Lucas County Board of Developmental Disabilities
1154 Larc Lane
Toledo, OH 43614

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

You also may file a written complaint with either

  • The Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue SW, Washington D.C. 20201 or call 1-877-696-6775
  • The Office for Civil Rights, U.S. Department of Health and Human Services at 200 Independence Avenue SW, Room 509F, HHH Building, Washington D.C. 20201, call OCR’s hotline at 1-800-368-1019, or e-mail
  • Attorney General for State of Ohio, 30 E. Broad Street, 17th Floor, Columbus, Ohio 43215 or visit

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