Your Information. Your Rights. Our Responsibilities
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information.
Get an electronic or paper copy of your medical record:
You can ask to see or get an electronic or paper copy of your medical record and other health information that we have about you. As us how to do this.
We will provide a copy or a summary of your health information usually within 30 days of your request. We may charge a reasonable cost-based fee.
Ask us to correct your medical record:
You can ask us to correct health information about you that you think is incorrect or incomplete. As us how to do this.
We may say "no" to your request, but we will tell you why in writing within 60 days.
Request confidential communications:
You can ask us to contact you in a specific way (for example: home or office or cell phone) or to send mail to a different address.
We will say "yes" to all reasonable requests.
Ask us to limit what we share:
You can ask us to not use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your health care.
Get a list of those with whom we have shared information:
You can ask for a list (or an accounting) of the times we have shared your health information for 6 years prior to the date you ask, who we have shared it with, and why.
We will include all of the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you have asked us to make). We will provide one accounting or list a year for free, but will charge a reasonable cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice:
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically . We will provide you with a paper copy promptly.
Choose someone to act for you:
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has the authority and can act for you before we take any action.
File a complaint if you feel your rights are violated:
You can complain if you feel we have violated your rights by contacting us using the information at the bottom if this page.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:200 Independence AvenueS.W. Washington, D.C. 202011-877-696-6775
or visit their website
We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
Share information with your family, close friends, or others involved in your care.
Share information in a disaster relief situation.
Include your information in a hospital directory.
If you are not able to tell us your preferences, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
Sale of your information.
Most sharing of psychotherapy notes.
We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
How do we typically share your health information? We typically share your health information in
the following ways:
We can use your health information and share it with other professionals who are treating you.
For example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization:
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
For example: We use health information about you to manage your treatment and services.
Bill for your services:
We can use and share your health information to bill and get payment from health plans or other entities.
For example: We give information about you to your health insurace plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways - usually in ways that contribute to the public good such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
For more information click here.
Help with public health and safety issues:
We can share information about you for certain situations such as:
- preventing disease
- helping with product recalls
- reporting adverse reactions to medications
- reporting suspected abuse, neglect, or domestic violence
- preventing or reducing a serious threat to anyone's health or safety
We can use or share your information for health research.
Comply with the law:
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
Respond to organ and tissue donation requests:
We can share health information about you with organ procurement organizations.
Address workers' compensation, law enforcement, and other government requests:
We can use or share health information about you for:
- workers' compensation claims
- law enforcement purposes or with a law enforcement official
- health oversight agencies for activities authorized by law
- special government fucntions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions:
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
NOTE: Except for the situations listed in this notice, we must obtain your specific written authorization for any other release of your health information.
If you sign an authorization form, you may withdraw your authorization at any time, as long as your withdrawal is in writing. If you wish to withdraw your authorization, please submit your written withdrawal to the Health Information Department.
Holyoke Health Center, Inc.230 Maple StreetPO Box 6260Holyoke, MA 01041-6260(413) 420-2200; TTY 413-534-9472