Annual RePORTS

Notice of Privacy Practices

For Individuals Served and/or Personal Representatives


Click here to download a pdf of our Notice of Privacy Practices

About Our Agency

MOKA, as a contract agency with the local Community Mental Health agencies, has been chosen to assist individuals to obtain various medical and mental health care services. In fulfilling this role we perform a variety of acts. Some of the time we provide health services. At other times, we may coordinate these services for you with another agency such as a hospital, school, Social Security offices, Department of Health and Human Services (DHHS), lawyers, or courts. We also submit information about you to get paid for your services. We will bill you, your insurance company, or any third party who may be paying. In any of these situations, we may need to access information about you or the health care services you receive.

Privacy Notice Introduction

When you contact or come to our agency, a record is usually made. These records may contain Protected Health Information (PHI) is all individually identifiable health information that is created or received by MOKA that relates to your past, present or future physical or mental health condition, the provision of health care services and payment for those services. Examples of identifiable health information includes: your name, address, telephone number, social security number, health insurance information, and date of birth; your diagnosis (the condition for which you are receiving treatment), information including how you say you feel, what health problems you have, treatments you may have been given, observation by health care providers, and your treatment plan and goals. How we use this information is explained in more detail in this notice.

General Privacy Information

We know that your health information is personal. We are careful about how we use your information and work hard to protect your privacy. We do not sell your protected health information and we take steps to protect your information from people who do not have the need and/or the legal right to see it.

We are required by Law to make sure that any PHI that identifies you is kept private, give you this Notice of our legal duties and privacy practices, and follow the terms of the current Notice.

We may make changes to this Notice in the future. If we make a change, it will become our current Notice. We will notify you in the event of a change to this Notice. Copies of the Notice can be obtained from any of our office locations. We will have you sign a statement telling others we gave you this Notice.

Uses for Treatment, Payment, and Operations

Routine disclosures are the ones we need to make as a part of serving you. We do not need any specific consent or permission from you for treatment, payment purposes, or for agency operations, this means:

Other uses and disclosures included within treatment, payment, and operations include:

We may also release your protected health information (PHI) to the local Community Mental Health agency that has authorized your treatment. The local Community Mental Health agency may release your information consistent with Federal and State Laws. If you would like a copy of the Community Mental Health Notice, please ask us.

Uses and Disclosure without Your Authorization

When required by law, we may also disclose some PHI. Such disclosures must also be consistent with law and regulation (e.g., 42 CFR Part 2). For example, we may provide limited information:

Privacy Rights & Your Rights Regarding Your Protected Health Information (PHI)

Another way you can express your concern is to contract the Secretary of Health and Human Services at 201 Independence Avenue SW, Washington DC, 20201, or by calling (202) 619-0257 or 1-800-696-6775.

E-Newsletter Sign Up

Our email newsletter contains the latest news, success stories, and events from MOKA. We respect your desire for privacy and will not make your email address available to third parties, and you will be able to unsubscribe at any time.

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