NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR PROTECTED HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY

Saratoga County Public Health is committed to maintaining the confidentiality of your Protected Health Information (PHI).  In providing your care, we will create records regarding your treatment and the services we provide to you.  We are required by law to maintain the confidentiality of your Protected Health Information.

This notice will provide you with information on how we may use and disclose your Protected Health Information.

This notice applies to all records maintained by this agency containing your Protected Health Information.  We reserve the right to revise or amend this privacy notice.  Any changes will be effective for Protected Health Information we maintain about you at that time.  Our agency will post a copy of our revised notice in our office and you may request a copy by calling our office at (518) 584-7460.

If you have questions regarding this notice, you may contact the Assistant Director of Patient Services at (518) 584-7460 during normal business hours.

WAYS WE MAY BE USING AND DISCLOSING YOUR PROTECTED HEALTH INFORMATION

The following are ways in which we may use and disclose your Protected Health Information:

TREATMENT:  Our agency may use your PHI to provide treatment to you.  We may allow or disclose information to agency nurses access to your medical record to provide ordered care.  In addition, we may disclose information to others who may assist in your care such as therapist and home health aides and home health aide agencies.

PAYMENT:   Our agency may use and disclose PHI for billing and payment for services and supplies you may receive.  Examples of such use and disclosure may include:  contacting your health insurance provider to verify coverage and to obtain payment.  We may also release information to you or other third party individuals to obtain payment.

HEALTH CARE OPERATIONS:  Our agency may use and disclose your PHI to conduct business.  For example we may use and disclose your information to evaluate the quality of care you received or monitor our compliance with state and federal regulations.

APPOINTMENT REMINDERS:  Our agency may use and disclose your PHI to contact you to remind you of visits and/or appointments.

BUSINESS ASSOCIATES:  Our agency may use or disclose information to a person or entity we contract with to perform some of our functions for us and who need access to the information to perform those functions.  For example:  a billing service, attorney, and auditor.

HEALTH RELATED BENEFITS:  Our agency may use or disclose your PHI to facilitate your discharge.

RELEASE OF INFORMATION TO FAMILY/FRIENDS:  Our agency may use or disclose your PHI to a friend or family member that is assisting in your care or helping you pay for your health care.

USES AND DISCLOSURES OF PHI WITHOUT AN AUTHORIZATION:  Our agency may use or disclose your PHI as required by law and by government agencies, such as to respond to a court order or subpoena and for public health information.

USES AND DISCLOSURES OF PHI WITH AN AUTHORIZATION
: In addition, our agency will obtain a signed authorization for any uses or disclosures not for treatment, health care operations, and payment and will use the information as stated in the authorization.  All such requests will be looked at on a case-by-case basis to limit the release of information to the minimum amount necessary.  You have the right to cancel an authorization at any time, except to the extent that this agency or another company or individual has already relied on the information.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION (PHI):  You have the following rights regarding the PHI that our agency maintains about you.  You may contact the agency’s HIPAA Compliance Coordinator at (518) 584-7460 to obtain the appropriate form needed to exercise any of these rights.

CONFIDENTIAL COMMUNICATIONS:  You have the right to request our agency to communicate with you about your PHI in a particular manner or at a certain location.  You must make such a request in writing to the agency HIPAA Compliance Coordinator.  We will respond to you in writing within 30 days of receiving your written request.

REQUESTING RESTRICTIONS:  You have the right to request a restriction on the uses and disclosure of your PHI.  We are not required to agree with your request.  You may make your request in writing to the agency’s HIPPA Compliance Coordinator.

RIGHT TO INSPECT AND COPY YOUR PROTECTED HEALTH INFORMATION (PHI)
:  You have the right to inspect and obtain copies of your PHI in your medical record.  Medical records are the property of this agency.  You must make your request in writing to the agency’s HIPAA Compliance Coordinator.  You may inspect your record within 48 business hours of receipt of your request.  Our agency may charge a fee for the cost of copying and postage.  You will be informed of the amount prior to the copying.  Our agency may deny your request.  We will inform you in writing of the reason for the request denial.

RIGHT TO AMEND YOUR PROTECTED HEALTH INFORMATION (PHI):  You have the right to ask us to amend your health PHI if you believe it is incorrect or incomplete.  You must specify who made the entry, date of entry, reason for change and what it should read.  You may request a “Request for Amendment of Medical Record” form from the agency HIPAA Compliance Coordinator.  We will respond to you within 60 days of receipt of your written request.  If we approve your request we will make the change to your PHI and inform you of the change in writing.  Our agency may deny your request if your PHI is accurate and complete; not created by our agency; not part of the PHI kept by us; or not allowed to be disclosed.  You will receive written notification of the reason for the denial and will become part of your agency record.

RIGHT TO ACCOUNTING OF DISCLOSURES:  You have the right to request a list of situations in which our agency has given out your PHI.  The list may not include:  disclosures we made so that you could receive treatment; disclosures made to receive payment for the care we provided to you; disclosures made in order to operate our business; disclosures made to you or people you choose; disclosures to law enforcement or authorized governmental agencies; disclosures made prior to April 14, 2003; or disclosures made in accordance with your authorization.  You must submit a written request to the agency HIPAA Compliance Coordinator.  We will respond within 60 days of receipt of your written request.  Your request must state a time period that may not be longer than 6 years and not include dates prior to April 14, 2003.  The list will include:  date of the disclosure to person/agency disclosed to; description of information; and reason for disclosure.  The first list you request within a 12-month period will be free.  If you request another list within the same 12-month period, you may be charged a fee.  You will be informed in advance of the fee and you will be given a chance to cancel or change your request.

RIGHT TO A COPY OF OUR NOTICE OF PRIVACY PRACTICES:  You have a right to a copy of our Notice of Privacy Practices at any time.  You may request a copy from the agency’s HIPAA Compliance Coordinator at (518) 584-7460.

RIGHT TO FILE A COMPLAINT:  If you believe your privacy rights have been violated, you may file a written complaint to the agency’s HIPAA Compliance Coordinator at Saratoga County Public Health, 31 Woodlawn Avenue, Saratoga Springs, NY  12866-2198.  You may also file a complaint with the Office of Civil Rights, US Department of Health and Human Services.  You will not be penalized for filing a complaint.

Notice of Privacy Practices (04/03)

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