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NOTICE OF PRIVACY PRACTICES
FAMILY HEARING CENTER
1022 MAIN STREET, FISHKILL, NY 12524
(845) 897-3059
This notice will tell you about the ways we may use and share medical information about you. This includes your rights and certain duties we have regarding the use and disclosure of medical information.
The law requires us to:
- Keep your medical information private.
- Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.
- Follow the terms of the notice that is now in effect.
We have the right to:
- Change our privacy practices and the terms of this notice at any time, provided that the law permits the changes.
- Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.
Before we make an important change in our privacy practices, we will change this notice and make the new one available upon request.
Use and disclosure of your medical information
We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing
to us. All staff will be trained and will follow confidentiality requirements according to HIPAA and according to requirements contained in Art. 25 of the NYS Public Health Law, 10NYCRR 69-4 17, IDEA, Title 34 CFR and FERPA.
For treatment:
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, or other people who are taking care of you. We may also share medical information about you to other health care providers to assist them in treating you.
For Early Intervention children a written record (log) will be maintained in the child’s folder for all parties without routine access. This record will include the name of the party, the date of access, and the purpose of access.
Confidentiality will be maintained in accordance with federal and state Early Intervention Program requirements
For payment:
We may use and disclose your medical information for payment purposes.
For healthcare operations:
We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, training, and getting the accreditation, certificates, licenses, and credentials we need to serve you.
Records (files) will be locked in a file room during non-business hours. Records to be transported will be in a closed briefcase and locked in the car or in the home office when not in use.
You have the right to:
- Look at or get copies of your medical information. You may request that we provide copies in a format other than photocopies. We will use the format you request unless it is not practical for us to do so. You must make your request in writing. You may get the form to request access from this office, by calling us at (845)897-3059 (ask for Louise) or by stopping by our office, or by mail. Upon receipt of written release we will send the report within 10 working days or within 5 working days if a hearing is scheduled.
- Receive a list of all the times we or our business associates shared your medical information for purposes other than treatment, payment, and health care operations.
- Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).
- Request that we communicate with you about medical information by different means or to different locations. That request must be made in writing.
- Request that we change your medical information. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to the information you want changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change, and to include the changes in any future sharing of information.
- If you have received this notice electronically, and wish to receive a paper copy, you have the right to obtain a paper copy by making a request in writing to the office here.
If you have any questions about this notice or if you think that we may have violated your privacy rights, please contact us. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will not retaliate in any way if you chose to file a complaint.
February 2007
1022 MAIN STREET, FISHKILL, NY 12524
(845) 897-3059
This notice will tell you about the ways we may use and share medical information about you. This includes your rights and certain duties we have regarding the use and disclosure of medical information.
The law requires us to:
- Keep your medical information private.
- Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.
- Follow the terms of the notice that is now in effect.
We have the right to:
- Change our privacy practices and the terms of this notice at any time, provided that the law permits the changes.
- Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.
Before we make an important change in our privacy practices, we will change this notice and make the new one available upon request.
Use and disclosure of your medical information
We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing
to us. All staff will be trained and will follow confidentiality requirements according to HIPAA and according to requirements contained in Art. 25 of the NYS Public Health Law, 10NYCRR 69-4 17, IDEA, Title 34 CFR and FERPA.
For treatment:
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, or other people who are taking care of you. We may also share medical information about you to other health care providers to assist them in treating you.
For Early Intervention children a written record (log) will be maintained in the child’s folder for all parties without routine access. This record will include the name of the party, the date of access, and the purpose of access.
Confidentiality will be maintained in accordance with federal and state Early Intervention Program requirements
For payment:
We may use and disclose your medical information for payment purposes.
For healthcare operations:
We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, training, and getting the accreditation, certificates, licenses, and credentials we need to serve you.
Records (files) will be locked in a file room during non-business hours. Records to be transported will be in a closed briefcase and locked in the car or in the home office when not in use.
You have the right to:
- Look at or get copies of your medical information. You may request that we provide copies in a format other than photocopies. We will use the format you request unless it is not practical for us to do so. You must make your request in writing. You may get the form to request access from this office, by calling us at (845)897-3059 (ask for Louise) or by stopping by our office, or by mail. Upon receipt of written release we will send the report within 10 working days or within 5 working days if a hearing is scheduled.
- Receive a list of all the times we or our business associates shared your medical information for purposes other than treatment, payment, and health care operations.
- Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).
- Request that we communicate with you about medical information by different means or to different locations. That request must be made in writing.
- Request that we change your medical information. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to the information you want changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change, and to include the changes in any future sharing of information.
- If you have received this notice electronically, and wish to receive a paper copy, you have the right to obtain a paper copy by making a request in writing to the office here.
If you have any questions about this notice or if you think that we may have violated your privacy rights, please contact us. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will not retaliate in any way if you chose to file a complaint.
February 2007