The Health Insurance Portability and Accountability Act of 1996

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Understanding Your Health Record / Health Information

Each time you visit Cold Spring Healing Arts (CSHA), a record of the visit is made. This record contains your symptoms, examination, test results, diagnoses, treatment, and a plan for future care or treatment. This information is called your medical record. It is a:

Plan of your care and treatment;

Way to communicate among the many health professionals caring for you;

Legal document describing the care your received;

Way you or an insurance company can verify that services were actually provided;

Tool in educating health professionals;

Source of data for medical research;

Source of information for public health officials charged with improving the health of the nation;

Source of data for facility planning and marketing; and

Tool to help CSHA assess and continually work to improve the care it delivers.

Understanding what is in your record, and how your health information is used, helps you to:

Ensure its accuracy;

Better understand who, what, when, where, and why others may access your health information; and

Make more informed decisions when giving permission to others to view the information.

Your Health Information Rights

Your health record is the physical property of CSHA, but the information belongs to you. You have the right to:

Request limits of certain uses and disclosures of your information;

Obtain a paper copy of the Notice of Health Information Practices upon request;

Inspect and copy your health record;

Request amendments to your health record;

Request a record of disclosures of information from your health record;

Request your health information be communicated by other means or at other locations; and

Revoke any authorization to use or disclose your health information except to the extent that action has already been taken with that information.

Our Responsibilities

Cold Spring Healing Arts is required to:

Keep your health information private;

Provide you with a notice (this document) of CSHA’s legal duties and privacy practices with respect to information it collects and maintains about your;

Follow the terms of this notice;

Notify you if CSHA is unable to agree to a limit requested by you on the use or disclosure of your health information; and

Try to meet reasonable requests you may have to communicate health information by other means or at other locations.

CSHA reserves the right to change its practices and to be sure the new practices keep all health information safe. Should CSHA’s health information practices change, it will post a revised notice on this web page throughout its facilities, and will have copies available for you to take with you. CSHA will apply any changes to all health information regardless of when created or received.s

CSHA will not use or disclose your health information without your permission, except as described in this notice or allowed by law.

For More Information or to Report a Problem

If you have questions or would like additional information, you may contact the CSHA Privacy Officer at 845-236-2275.

If you believe your privacy rights have been violated, you can file a complaint with the Secretary of the United States Department of Health and Human Services or contact the CSHA Privacy Officer at the number above. You will not be penalized for filing a complaint.

Examples of Disclosures for Treatment, Payment, and Health Operations

CSHA will use your health information for treatment.
For example: Information obtained by a member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your health care provider will document in your record their expectations of the members of your health care team. Members of your health care team will record the actions they took and their observations. In that way, your health care provider will know how you are responding to treatment. CSHA will also provide your health care provider with copies of various reports that will help in treating you once you leave CSHA.

CSHA will use your health information for payment.
For example: A bill or other information may be sent to you or an insurance company in order for CSHA to obtain payment. The information on or with the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

CSHA will use your health information for regular health care business.
For example: Members of the staff may use information in your health record to assess the care and results to compare it to others with the same condition or receiving the same care. This information will then be used to continually improve the quality and effectiveness of the health care and service we provide.

Other Uses and Disclosures

Business associates: Additional disclosures of your health information may be made to outside parties known as business associates. There are some services provided to CSHA through contracts with these business associates. Examples include certain laboratory tests and a typing service that types medical reports. CSHA may disclose your health information to a business associate so that it can perform the job it has to do. To protect your health information, CSHA requires the business associate to protect your information at all times.

CSHA directory: Unless you tell CSHA that you object, CSHA will place your name, general condition, and religious affiliation in a directory and give that information to people who ask for your by name, including members of the news media.

Family notification: CSHA may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care of your general condition.

Communication with family: Health professionals, using their best judgment, may disclose health information to a family member, other relative, close personal friend, or any other person you identify, about that person’s role in your care or payment related to your care.

Marketing: We will ask your permission to contact you regarding information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fundraising: We will ask your permission to contact you as part of a fundraising or public relations effort.

Food and Drug Administration (FDA): CSHA may disclose to the FDA health information about adverse events caused by food, supplements, products and product defects, or information to help with product recalls, repairs, or replacement.

Workers’ compensation: CSHA may disclose health information as directed by, and as necessary to comply with, laws relating to workers’ compensation or other similar programs established by law.

Public health: As required by law, CSHA may disclose your health information to public health agencies or authorities charged with preventing or controlling disease, injury, or disability, or to report a suspected case of abuse or neglect.

Correctional institution: Should your be an inmate of a correctional institution, CSHA may disclose to that institution or its agents health information necessary for your health and the health and safety of other individuals.

To avert a serious threat to health or safety: CSHA may use or disclose health information about you when necessary to prevent a serious threat to your health or safety or the health or safety of another person. Any disclosure would only be to someone able to prevent the threat.

Appointment reminders: CSHA may contact you to remind you of your appointments.
Law enforcement: CSHA may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Health oversight agencies: Federal law allows your health information to be released to an appropriate health oversight agency, or attorney, provided that a work force member or business associate of CSHA believes in good faith that CSHA engaged in unlawful conduct or has otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.

The Department of Health and Human Services (DHHS): Under privacy standards, CSHA must disclose your health information to DHHS upon request so that DHHS may determine our compliance with those standards.

Lawsuits and disputes: If you are involved in a lawsuit or dispute, CSHA may disclose health information about you in response to a subpoena, court order, or administrative order. Information will be disclosed to someone else involved in the dispute only after efforts have been made to tell you about the request or to obtain an order protecting the information requested. As required by law, CSHA will disclose health information about you when required to do so by federal, state, or local law.

Military and veterans: If you are a member of the armed forces, CSHA may release health information about you as required by military command authorities. CSHA may also release information about foreign military personnel to appropriate foreign military authorities.

Information rights are provided by 45 CFR 164.522-164.528 of the Health Insurance Portability & Accountability Act of 1996.

Effective Date: 14 April, 2003 Copyright