This notice describes how medical information about you may be used and disclosed and how you may obtain access to this information. “Protected Health Information” (PHI), discussed in this notice, is information about you that may identify you and that relates to your past, present, and future health care services. At the Hilltown Community Health Centers, Inc. (HCHC) we are committed to the highest possible standards of care and access to your information is given only to the employees who need it to fulfill their jobs. We invite you to review this information carefully and contact us with any questions. There is also additional background information about this Notice in the waiting rooms of the Worthington and Huntington Health Centers. This notice is effective April 14, 2003.
Notice of Privacy Practices for Protected Health Information
1.Uses and Disclosures of Protected Health Information
There are two categories for the use and disclosure of our patients’ PHI: (1) information that we can use and disclose without the patient’s prior consent; and (2) information that we cannot use or disclose without the patient'’ prior authorization.
A.Patients’ Prior Consent Not Required
(1)Treatment - We may use and disclose your health information to provide, coordinate and manage your health care and any related services. For example, your medical information may be shared among health care professionals providing you treatment.
(2)Payment - We may use and disclose your health information to obtain payment for services we provide you.
(3)Health Care Operations - We may use and disclose your health information for our routine operations. This may include quality assessment activities, employee review activities and licensing.
(4)Other Permitted Uses and Disclosures - There are a number of other specified purposes for which we may disclose a patient’s PHI without the patient’s prior consent (but with certain restrictions). Examples include public health activities; situations where there may be abuse, neglect or domestic violence; in connection with health oversight activities; in the course of judicial or administrative proceedings; in response to law enforcement inquiries; in the event of death; where organ donations are involved; in support of research studies; where there is a serious threat to health and safety; in cases of military or veterans’ activities where national security is involved; for determinations of medical suitability; for government programs for public benefit; for workers’ compensation proceedings; when our records are being audited; when medical emergencies occur.
B. Patient’s Prior Authorization Required
For purposes other than those mentioned above, we are required to ask for our patients’ written authorizations before using or disclosing any of their PHI. If we request an authorization, any of our patients may decline to agree; and if a patient gives us an authorization, the patient has the right to revoke the authorization and by doing so, stop future uses and disclosures of the patient’s PHI that the authorization covered. An example of the situation where the patient’s prior authorization would be required would be if we wish to conduct a marketing program that would involve the use of PHI.
2. Your Rights
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
A. You have the right to inspect and copy your protected health information. This means you, in the presence of an HCHC employee, may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that your physician and the practice used for making decisions about you.
We may deny your request only in very limited circumstances. If you are denied access to your medical or billing records, you may request that the denial be reviewed.
B. You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purpose of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Please discuss any restriction you wish with your physician. Your physician is not required to agree to a restriction that you may request.
C. You have the right to request to receive confidential communications from us by alternative means or at an alternative location. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. Please contact our Privacy Officer to determine if you have questions about amending your medical record.
D. You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in the Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations.
E. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
3. Complaints
If a patient believes that we have violated the patient’s rights as to the patient’s PHI under HIPAA and the Regulations, or if a patient disagrees with a decision we made about access to the patient’s PHI, the patient has the right to complete our complaint form and deliver it to our Privacy Officer listed below. Our Privacy Officer is required to investigate, and if possible, to resolve each such complaint, and to advise the patient accordingly. The patient also has the right to send a written complaint to the U. S. Department of Health and Human Services at the address shown on the complaint form. Under no circumstances will any patient be retaliated against by HCHC for filing a complaint.
4. Our Responsibilities
We are required by law to protect the privacy of our patients’ PHI, to provide this notice about our privacy practices, and follow the privacy practices that are described in this notice. We reserve the right to make changes to our privacy practices that will apply to all the PHI we maintain. A new notice will be available on request before any significant change is made.
Privacy Officer
Hilltown Community Health Centers, Inc.
58 Old North Road
Worthington, MA 01098
Tel. 413-238-5511 ext. 116
Fax: 413-923-9355
HUNTINGTON HEALTH CENTER
73 Russell Rd.
Huntington MA 01050
P: 413-667-3009
F: 413-667-8746
E-fax: 413-923-9355
WORTHINGTON HEALTH CENTER
58 Old North Rd.
Worthington, MA 01098
P: 413-238-5511
F: 413-238-5358
E-fax: 413-923-9355
GATEWAY FAMILY CENTER /
SOCIAL SERVICES
9 Russell Road, Route 20 Huntington MA 01050
P: 413-667-2203
F: 413-667-2225
GATEWAY SCHOOL-BASED
HEALTH CENTER
Gateway Regional Middle/High School
12 Littleville Road
Huntington, MA 01050
P: 413-667-0142
F: 413-667-0145
Hilltown Community Health Centers, Inc., is a non-profit organization and
a partner agency of the United Way of Hampshire County.
HCHC is funded in part through a grant from the
U.S. Department of Health and Human Services.
We are an equal opportunity provider.
Send discrimination complaints to Secretary of Agriculture, Washington, DC 20250.
Treatment - We may use and disclose your health information to provide, coordinate and manage your health care and any related services. For example, your medical information may be shared among health care professionals providing you treatment.
