NOTICE OF PRIVACY PRACTICE
The Holyoke Health Center is required by law to maintain the privacy of your
health information and to provide you with notice of its legal duties, privacy
practices with respect to your health information, and abide by the terms of
the privacy notice currently in effect. If you have questions about any part
of this notice or if you want more information about our privacy practices,
please contact the Health Information Manager at 413-420-2216.
Uses and Disclosures of Health Information:
1. Treatment. We keep a record of each patient visit that
includes your treatment, test results, diagnosis, medications, therapies, progress
and response to care. We share this Health Information with all the health care
professionals involved in your care. We may disclose medical information about
you to people outside the health center such as specialists, home care agencies,
health educators, and other health professionals involved in your care.
2. Payment. We may use and disclose medical information about
you so that we can bill and be paid by you, your insurance company, or third
party payer for the services you receive at the Holyoke Health Center.
3. Health Care Operations. We may use medical information
to evaluate and improve the quality of care and services we provide, to train
and monitor staff and students, and to manage the operation of the Holyoke Health
We may also use your health information to remind you of appointments, to describe
or recommend treatment alternatives, and to provide information about health-related
benefits and programs.
4. Required by Law. Sometimes we must report some of your
health information to legal authorities, such as law enforcement officials,
court officials, or government agencies. For example, we may have to report
abuse, neglect, domestic violence or certain physical injuries, or to respond
to a court order.
5. Public Health. We may be required to report your health
information to authorities to help prevent or control disease, injury, or disability.
This may include using your medical record to report certain diseases, injuries,
birth or death information, information of concern to the Food and Drug Administration,
or information related to child abuse or neglect. We may also have to report
to your employer certain work-related illnesses and injuries so that your workplace
can be monitored for safety.
6. Health oversight activities. We may disclose medical information
to health oversight agencies for activities authorized by law. These activities
are necessary for the government to monitor the health care system, government
programs, and compliances with civil rights law.
7. Activities related to death. We may disclose your health
information to coroners, medical examiners and funeral directors so they can
carry out their duties related to your death, such as identifying the body,
determining cause of death, or in the case of funeral directors, to carry out
funeral preparation activities.
8. Organ and Tissue donation. We may disclose your health
information to people involved with obtaining, storing or transplanting organs,
eyes or tissue of cadavers for donation purposes.
9. Research. Under certain circumstances, and only after a
special approval and authorization process, we may use and disclose your health
information to help conduct research. Such research might try to find out whether
a certain treatment is effective in curing an illness.
10. To avoid a serious threat to health or safety. As required
by law and standards of ethical conduct, we may release your health information
to the proper authorities if we believe, in good faith, that such release is
necessary to prevent or minimize a serious and approaching threat to your or
the public’s health or safety.
11. Military, National Security, or Incarceration/Law Enforcement Custody.
If you are involved with the military, national security or intelligence activities,
or you are in the custody of law enforcement officials or an inmate in a correctional
institution, we may release your health information to the proper authorities
so they may carry out their duties under the law.
12. Workers’ Compensation. We may disclose your health
information to the appropriate persons in order to comply with the laws related
to workers’ compensation or other similar programs. These programs may
provide benefits for work-related injuries or illness.
13. Communication with Family. Health professionals, using
our best judgment, may disclose to a family member, close personal friend, or
other person you identify, health information relevant to that person’s
involvement in your care or payment of your care. You have the right to object
to this disclosure.
14. Appointment Reminders and Treatment Alternatives: We may
use or disclose your health information to provide you with appointment reminders
(such as phone messages and letters to remind you of your appointments) or information
about treatment alternatives or other health-related benefits and services that
may be of interest to you.
NOTE: Except for the situations listed above, 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
Your Health Information Rights
You have several rights with regard to your health information. If you wish
to exercise any of the following rights, please contact the Health Information
Manager at 413-420-2216. Specifically, you have the right to:
1. Inspect and copy. With a few exceptions, you have the right
to make an appointment to inspect and obtain a copy of your health information.
However, this right does not apply to psychotherapy notes or information gathered
for judicial proceedings, for example. In addition, we may charge you a reasonable
fee if you want a copy of your health information.
2. Amend. If you believe your health information is incorrect,
you may ask us to correct the information. You may be asked to make such requests
in writing and to give a reason as to why your health information should be
changed. However, if we did not create the health information that you believe
is incorrect, or if we disagree with you and believe your health information
is correct, we may deny your request. If we deny your request for amendment,
you have the right to file a statement of disagreement with us and we may prepare
a rebuttal to your statement and will provide you with a copy of any such rebuttal.
Please contact our Health Information Manager if you have questions about amending
your medical record.
3. Request Restrictions. You have the right to ask for restrictions
on how your health information is used or disclosed for 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. We are not required to agree to the restrictions that
you request. If we agree, we will comply with your request unless the information
is needed to provide you with emergency treatment. You must make your request
in writing to the Health Information Manager.
4. Request Confidential Communications. You have the right
to ask that we communicate your health information to you in a certain way or
place. For example, you may wish to receive information about your care in a
special, private room or that we only contact you at work or through the mail.
We must accommodate reasonable requests.
5. Accounting of Disclosures. You have the right to ask for
a list of the disclosures of your health information we have made during the
previous six years, but the request cannot include dates before April 14, 2003.
This does not include disclosures made to you or for treatment, payment, and
health care operations. We must comply with your request for a list within 60
days, unless you agree to a 30-day extension, and we may not charge you for
the list, unless you request such list more than once per year. You must submit
your request in writing to the Health Information Manager.
6. Paper Copy of this Notice. You have the right to a paper
copy of this notice. You may ask us to give you a copy of this notice at any
time. To obtain a paper copy of this notice, ask at the patient reception desk.
7. Complain. If you believe your privacy rights have been
violated, you may file a complaint with us and with the Federal Department of
Health and Human Services. We will not retaliate against you for filing such
a complaint. To file a complaint with either entity, please contact our Health
Information Manager, who will provide you with the necessary assistance and
We reserve the right to change the privacy practices described in this
notice, in accordance with the law. Changes to our privacy practices would apply
to all health information we maintain. If we change our privacy practices, you
will receive a revised copy.
Again, if you have any questions or concerns regarding your privacy rights
or the information in this notice, please contact our Health Information Manager
This Notice of Medical Information Privacy is Effective 11/20/03.