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Delaware County Community Services
Notice of Privacy Practices
Effective Date: April 14, 2003
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.
Delaware County Community
Services is required by law to maintain the privacy of your medical
information and to give you this notice of legal duties and privacy
practices with respect to medical information about you. This notice
may be revised at any time. Any revisions will be effective for
past, present or future medical information we have about you.
Delaware County Community Services is required to follow the terms
of the most current notice and will post it in all sites where
physical services are delivered. You will be able to request a copy
at these sites. In addition, each time you begin services or are
admitted to Delaware County Community Services, you will receive a
copy of the notice.
ALL EMPLOYED AND CONTRACT STAFF
WILL FOLLOW
THIS NOTICE
Uses and Disclosures
of Health Information:
For Treatment: To
your doctor and for referrals, appointment reminders and
coordination with programs that may be involved in your care such as
friend or family member, labs, pharmacy, medical equipment provider,
or meals on wheels.
For Payment: To the
insurance company. Copies of notes related to treatment and services
you received may be required to accompany the bill.
For Health Care
Operations: To run the Agency and to assess patient care such as
reviewing our treatment and services and to evaluate the performance
of staff in caring for you.
* If Applicable- may
contact the individual for appointment reminders or to give
information regarding treatment alternatives. May contact
individual to raise funds for the covered entity.
Special Situations –
Protected Health Information may be released without your consent:
As Required by Law and to
avert serious threat to health and safety: In response to court
order; To identify or locate a suspect, fugitive, material witness,
or missing person; In emergency circumstances to report details of a
crime, suspected crime, or about the victim of a crime if, under
certain limited circumstances, we are unable to obtain the person’s
agreement; National Security, intelligence activities and protective
services for the President or other officials; If you are a danger
to yourself or others.
Public Health Risks
- To prevent or control disease, injury or disability, to report
births and deaths, to report child abuse or neglect or domestic
violence when required or authorized by law, in the event of a
disaster.
Health Oversight
Activities – including audits, investigations, inspections, and
licensure activities as required by State or Federal Mandate.
Coroners, Medical
Examiners and Funeral Directors – For identification purposes,
to determine cause of death or as necessary to carry out their
duties.
Organ and Tissue Donation
- If a donor, to an organization that handles organ procurement.
Research
- If
reviewed by an independent review board
Military and Veterans
- As required by military command authorities.
Workers compensation
- as required to comply with laws relating to workers compensation.
(Exception to release
without consent- We will follow the provisions of 42 CFR Part 2
which severely restricts the release of protected health information
without your permission if the records are from substance abuse
treatment.)
Other Uses of Medical
Information not covered by this notice or applicable law
will be made only with your written permission. Permission may be
revoked by you in writing, at any time. Please understand that we
are unable to take back any disclosures we have already made with
your permission.
You have the right to:
-
Request a restriction
on the medical information we use or disclose about you. We
are not required to agree to your request. If we do
agree, we will comply with your request unless the information
is needed to provide you emergency treatment. A request for
restrictions must be made in writing to the Director and must
specify the information to be restricted, if restriction is for
use and/or disclosure, and who the restriction applies to.
-
Request Confidential Communications-You
have the right to request that we communicate with you about medical
matters in a certain way or at a certain location. Written request
must be submitted to the Privacy Officer/designee. We will not ask
you the reason for your request. We will accommodate all reasonable
requests. Your request must specify how or where you wish to be
contacted.
-
Inspect and copy medical
information (usually medical and billing records) that may be used
to make decisions about your care. Request must be in writing to
the attention of the Privacy Official. A fee of 75 cents per page
may be charged for the cost of copying, mailing or other supplies
associated with your request. We may deny your request to inspect
and copy in certain limited circumstances. A denial will be issued
in writing with instructions on how to request a review of the
denial.
-
Request an amendment if you feel
that medical information we have about you is incorrect or
incomplete. You have the right to request an amendment for as long
as the information is kept by or for the Agency. The written
request must be submitted to Privacy Officer/designee with a reason
that supports your request. Your request for an amendment may be
denied. You will receive the denial in writing with an explanation
and instructions on how to appeal the denial decision.
-
Receive an accounting of disclosures
for reasons other than treatment, payment or health care
operations. Requests must be in writing to the Privacy
Officer/designee and state a time period which may not be longer
than six years or include dates prior to April 14, 2003. The list
will be a paper copy and the first list you request within a
12-month period will be free. Additional lists may incur a cost.
You will be notified of the amount involved to give you the
opportunity to withdraw or modify your request before any costs are
incurred.
-
Receive a paper copy of this notice no
later than the date of the first service delivery, upon request, and
a new copy whenever it is updated.
Complaints:
If you believe that your privacy rights have been
violated, you have the right to complain without fear of reprisal or
retaliation. Complaints can be made to the Complaints
Officer/designee. (see below) Complaints can also be made to the
Department of Health and Human Services Secretary. The Complaints
Officer/designee will provide you with the appropriate address upon
request.
Complaint
Officers: |
