| CORTLANDT HEALTHCARE
NOTICE OF PRIVACY PRACTICES
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:
If you have any questions about this Notice, please contact our
Privacy Officer/Compliance Officer at the number listed at the end
of this Notice.
Each time you visit a healthcare provider, a record of your visit
is made. Typically, this record contains your symptoms, examination
and test results, diagnoses, treatment, a plan for future care or
treatment, and billing-related information. This Notice applies
to all of the records of your care generated by your health care
provider.
Our Responsibilities
Cortlandt Healthcare is required by law to maintain the privacy
of your health information and to provide you with a description
of our legal duties and privacy practices regarding your health
information. The current Notice will be posted on the bulletin board
and will include the effective date.
We are required to abide by the terms of this Notice and notify
you if we make changes to this Notice, which may be at any time.
Changes to the Notice will apply to your medical information that
we already maintain as well as new information received after the
change occurs. If we change our Notice, it will be posted on the
bulletin board and redistributed to you if you are a current resident.
This Notice will also serve to advise you as to your rights with
regard to your medical information.
How We May Use and Disclose Medical Information About
You.
The following categories describe examples of the way we use and
disclose medical information:
1. For Treatment: We may use medical information
about you to provide, coordinate and manage your treatment or services.
We may disclose medical information about you to other doctors,
nurses, technicians, medical students, or other personnel who are
involved in your care. [For example: a laboratory may need to know
information about you to run a test or to provide treatment.]
We may also provide a subsequent healthcare provider with copies
of various reports that should assist him or her in treating you.
Your medical information may be provided to a physician to whom
you have been referred so as to ensure that the physician has appropriate
information regarding your previous treatment and diagnosis.
2. For Payment: We may use and disclose medical
information about your treatment and services to bill and collect
payment from you, your insurance company or a third part payer.
For example, we may need to give your insurance company information
before it approves or pays for the health care services we recommend
for you. The insurance company may use that information in connection
with making a determination of eligibility or coverage for insurance
benefits, reviewing services provided to you for medical necessity,
and undertaking utilization review activities. [For example, obtaining
approval for a hospital stay may require that your relevant protected
health information be disclosed to the health plan to obtain approval
for the hospital admission.]
3. For Health Care Operations: We may use or disclose,
as needed, your health information in order to support our business
activities. These activities may include, but are not limited to,
quality assessment activities, employee review activities, licensing,
marketing and fundraising activities, and conduction or arranging
for other business activities. [For example, we may disclose your
protected health information to medical school students that see
residents at our Facility.]
4. Business Associates: There are some services
provided in our organization through contracts with business associates.
[Examples include billing services, transcription services, radiology,
and certain laboratory tests.] When these services are contracted,
we may disclose your health information to our business associate
so that they can perform the job that we have asked them to do and
bill you or your third-party payer for services rendered. To protect
your health information, however, we require the business associate
to appropriately safeguard your information through a written contract.
Other Permitted and Required Uses and Disclosures That
May Be Made With Your Consent, Authorization or Opportunity to Object.
We also may use and disclose your health information as set forth
below. You have the opportunity to agree or object to the use or
disclosure of all or part of your health information in these instances.
If you are not present or able to agree or object to the use or
disclosure of the health information (such as in an emergency situation),
then your physician [health care provider] may, using professional
judgment, determine whether the disclosure is in your best interest,
In this case, only the information that is relevant to your health
care will be disclosed.
1. Directory: Unless you object, we will use and
disclose in our facility directory your name, the location at which
you are receiving care, your condition (in general terms), and your
religious affiliation. All of this information, except religious
affiliation, will be disclosed to people that ask for you by name.
Members of the clergy will be told your religious affiliation.
2. Individuals Involved in Your Care or Payment for Your
Care: Unless you object, we may release medical information
about you to a friend or family member who is involved in your medical
care or who helps to pay for your care. In addition, we may disclose
medical information about you to an entity assisting in a disaster
relief effort so that your family can be notified about your condition,
status and location.
3. Future Communications: We may communicate to
you via newsletters, mailings or other means regarding [treatment
options; information on health-related benefits or services, disease-management
programs, wellness programs; to assess your satisfaction with our
services; as part of fund raising efforts; for population based
activities relating to improving health or reducing health care
costs; for conducting training programs or reviewing competence
of health care professionals; or other community based initiatives
or activities in which our facility is participating. If you are
not interested in receiving these materials, please contact our
Privacy/Compliance Officer [or designated person]
4. Marketing: We may use your PHI in marketing
tools as long as the information has been de-identified. However,
we will obtain consent prior to using any PHI that is not de-identified
for marketing purposes.
Other Permitted and Required Uses and Disclosures That
May Be Made Without Your Authorization or Opportunity to Object
We may use or disclose your health information in the following
situations, without your authorization or without providing you
with an opportunity to object. These situations include:
1. As required by law. We may use and disclose
health information to the following types of entities, including
but not limited to:
a. Food and Drug Administration
b. Public Health or Legal Authorities charged with preventing or
controlling disease, injury or disability
c. Correctional Institutions
d. Workers Compensation Agents
e. Organ and Tissue Donation Organizations
f. Military Command Authorities
g. Health Oversight Agencies
h. Funeral Directors, Coroners and Medical Directors
i. National Security and Intelligence Agencies
j. Protective Services for the President and Others
k. Authority that receives reports on abuse and neglect
2. Law Enforcement/Legal Proceedings: We may disclose
health information for law enforcement purposes as required by law
or in response to a valid subpoena.
3. State-Specific Requirements: The facility will
abide by any state specific reporting requirements
Your Health Information Rights
Although your health record is the physical property of Cortlandt
Healthcare that compiled it, you have the right
to:
1. Inspect and Copy: You have the right to inspect
and copy medical information that may be used to make decisions
about your care. Usually, this includes medical and billing records,
but does not include psychotherapy notes or information compiled
in reasonable anticipation of, or
for use in, a civil, criminal, or administrative action or proceeding.
We may deny your request to inspect and copy in certain very limited
circumstances, if you are denied access to medical information;
you may request that the denial be reviewed. The person conducting
the review will not be the person who denied your request. We will
comply with the outcome of the review.
2. Amend: If you feel that medical information
we have about you is incorrect or incomplete, you may request in
writing to amend the information. You have the right to request
an amendment for as long as the information is kept by us. We may
deny your request for an amendment and if this occurs, you will
be notified in writing of the reason for the denial.
3. An Accounting of Disclosures: You have the
right to request in writing an accounting of our disclosures of
medical information about you except for certain circumstances,
including disclosures for treatment, payment, health care operations
or where you specifically authorized a disclosure.
4. Request Restrictions: You have the right to
request a restriction or limitation on the medical information we
use or disclose about you for treatment, payment or health care
operations, You also have the right to request a limit on the medical
information we disclose about you to someone who is involved in
your care or the payment for your care, like a family member or
friend. For example, you could ask that we not use or disclose information
about a procedure that you had.
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 will emergency treatment.
5. 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. We will agree
to the request to the extent that it is reasonable for us to do
so. For example, you can ask that we use an alternative address
for billing purposes.
6. A 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. Even if you have agreed to receive this
notice electronically, you are still entitled to a paper copy of
this notice.
To exercise any of your rights, please obtain the required forms
from the Privacy Officer/Compliance Officer and submit your request
in writing.
Complaints
If you believe your privacy rights have been violated, you may file
a complaint with the facility or by contacting the Secretary of
the Federal Department of Health and Human Services. All complaints
must be submitted in writing.
You will not be penalized for filing a complaint.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by
this Notice or the laws that apply to us will be made only with
your written permission. If you provide us permission to use or
disclose medical information about you, you may revoke that permission,
in writing, at any time. If you revoke your permission, we will
no longer use or disclose medical information about you for the
reason covered by your written authorization. However, we are unable
to take back any disclosures we have already made with your permission
and we are required to retain or records of the care that we provided
to you.
CORTLANDT HEALTHCARE PRIVACY OFFICER:
PAUL HARRIS – 914-739-9150
110 Oregon Road, Cortlandt Manor, NY 10567
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