Uses and Disclosures of Protected Health Information
Our Duty to Safeguard Your Protected Health Information
Individually identifiable health information about your past, present, or future
health or condition, the provision of health care to you, or payment for the
health care is considered "Protected Health Information" (PHI). We are
required to extend certain protections to your PHI, and to give you this
notice about our privacy practices that explains how, when, and why we
may use or disclose your PHI. We will use or disclose only the minimum
necessary PHI, except where we are legally required to do otherwise.
We are required to follow the privacy practices described in this Notice,
though we reserve the right to change our privacy practices and the
terms of this Notice at any time. If we do so, we will post a new notice
in our Business Office. You may request a copy of the new
Notice from the Business Office.
How We May Use or Disclose Your Protected Health Information
Manchester Community Health Center uses PHI about you for treatment,
payment and health care operations.
Treatment - Manchester Community Health Center may disclose your
PHI to doctors, nurses, laboratories and other health care personnel
involved in providing your health care. For example, if you are seen in
the Emergency Department at the hospital, we may disclose your PHI
to healthcare providers treating you there.
Payment - Manchester Community Health Center may disclose your
PHI in order to bill and collect payment for your health care services.
For example, we may disclose your PHI to your insurance company
or another 3 rd party entity or individual responsible for the payment
of your care.
Health Care Operations - We may use your health information and
disclose it outside MCHC for our health care operations. For example,
an audit of the facility might be conducted for cost management review
or for a review of quality of care.
Contacting You- We may use and disclose health information to reach
you about appointments and other matters. We may contact you by mail,
telephone or e-mail. We may leave voice messages at the telephone number
you give and we may respond to your e-mail.
Other Instances When We Might Reveal Health Information
When Required By Law - We may disclose PHI when a law requires
that we report information about suspected abuse, neglect or domestic
violence, or relating to suspected criminal activity, or in response to a
court order. We must also disclose PHI to authorities that monitor
compliance with these privacy requirements. A civil or criminal proceeding
involving you may also requires us to disclose PHI about you by a court or
administrative order. We may also be required to report or disclose private
health information to a Workers Compensation claims carrier.
For Public Health Activities - We may disclose PHI when we are
required to collect information about disease or injury, or to report vital
statistics to public health authorities. We may also be required to disclose
PHI for notification of sexually transmitted diseases or reactions to drugs
or other devices associated with your treatment.
For Health Oversight Activities - We may disclose PHI to oversight
agencies responsible for health center licensure or accreditation as well
as entities charged with oversight of the health system, inspection,
compliancewith state and federal laws or the investigation of unusual
incidents or accidents.
Relating to Decedents - We may disclose PHI relating to an individual's
death to coroners, medical examiners or funeral directors and to organ
procurement organizations relating to organ, eye or tissue donations or
transplants.
For Research Purposes - In certain circumstances, and under the
supervision of an institutional review board, we may include your
PHI in a data pool toassist medical or psychiatric research. This
pool will not contain information that individually identifies you.
This data pool is a source of information that we use to evaluate
the services that Manchester Community Health Center
provides to the community.
To Avert Threat to Health or Safety - In order to avoid a serious threat
to health or safety, we may disclose PHI as necessary to law enforcement
or other persons who can reasonably prevent or lessen the threat of harm,
including situations regarding a crime victim, death from criminal conduct
or other criminal conduct relating to you.
For Specific Government Functions - In certain situations, we may
disclose PHI: of military personnel or veterans; to correctional facilities;
to government programs relating to eligibility and enrollment; and for
national security reasons.
You have the right to request restriction on uses and disclosures of
your information - You have the right to ask that we limit how we use or
disclose your PHI. To request a restriction you must make the request in
writing to the Privacy Officer of this health center. The request MUST state
what information you wish restricted and who you want this information
restricted from. Although we will work with you to protect your information
we cannot accommodate all requests and are not legally bound to accept
all requests, where disclosure may be legally required, and therefore reserve
the right to reject a request for a restriction. Unless we have specifically
agreed to your request we will not be able to accommodate it. If we do
agree to the restriction we will be bound by our agreement except in the
case of a legal requirement, emergencies or if the information is otherwise
necessary to treat you.
You have a right to inspect and obtain a copy of your health records -
Although your health record is the physical property of this health center,
the information contained in it belongs to you. Unless your access is
restricted for clear and documented treatment reasons, you have the
right to see your PHI. Your request must be made in writing. We will
respond to your request within 30 days. If we deny your access, we
will give you written reasons for the denial and explain any right to have
the denial reviewed. There may be a fee for copies and we are
permitted to withhold certain information from your records, such as
psychotherapy notes.
You have a right to request an amendment to your health record -
If you believe that there is a mistake or missing information in our record
of your PHI, you may request, in writing, that we correct or add to the
record. We willrespond within 60 days of receiving your request.
We may deny the request,if we determine that the PHI is: (i) correct
and complete; (ii) not created by usand/or not part of our records, or,
(iii) not permitted to be disclosed. Any denial will state the reasons for
denial and explain your rights to have the request and denial, along
with any statement in response that you provide, appended to your
PHI. If we approve the request for amendment, we will change the
PHI and so inform you.
You have a right to obtain an accounting of disclosures of your
health information - You have a right to receive a listing as to what, when,
to whom, and for what purpose your PHI was released for purposes other
than treatment, payment, and healthcare operations. This list will not include
disclosures made for national security purposes, to law enforcement officials
or correctional facilities or those disclosures made before April 2003.
We will respond to your written request within 60 days.
You have a right to receive confidential communications -
You have a right to request, in writing, that we send you information at an
alternative address or by alternative means and may choose how we contact
you. We will agree to your request so long as we are reasonably able to
do so.
You have a right to a paper copy of this notice.
You have a right to provide an authorization for the use of your
health information not otherwise described in this notice -
Any authorization you grant to us to use your health information may be
withdrawn at any time so long as notice is given in writing. Further details
of your rights in regard to an authorization will be detailed in the
authorization form itself.
For More Information or to Report a Problem
We are required by law to protect the privacy of your information,
provide this notice about our information practices, and follow the
information practices that are described in this notice.
If you have any questions or complaints, please contact:
Edward G. George
Privacy Officer:
Manchester Community Health Center
1415 Elm Street
Manchester , NH 03101
(603) 626-9500
If you are concerned that we have violated your privacy rights, or you
disagree with a decision we made about access to your records, you
may contact the person listed above. You also may send a written
complaint to the US Department of Health and Human Services.
The person listed above can provide you with the appropriate address
upon request. There will be no retaliation for filing a complaint.
We may change our policies at any time. Before we make a significant
change in our policies, we will change our notice and post the new
notice in the waiting area and in each examination room.
You can also request a copy of our notice at any time.
For more information about our privacy practices, contact the
person listed above.
We are required by law to protect the privacy of your information, provide
this notice about our information practices, and follow the information
practices that are described in this notice.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION.
This notice consists of two (2) total pages and must be considered in
its entirety.