• Basis for planning your care and treatment,

• Legal document describing the care you received,

• Means for you or your insurance company to verify that services billed were actually provided.

Your Health Information Rights: Although your health record is the physical property of CCMHD, the information belongs to you. Within the limitations set forth in state and federal regulations, you have the right to:

• Obtain a paper copy of this Privacy Notice,

• Request to inspect and copy your health record (the request must be written & a copying fee is charged),

• Request that we amend your health information if you believe it is inaccurate or incomplete,

• Obtain an accounting of disclosures of your health information,

• Receive communications of your health information by alternative means or at alternative locations,

• Request a restriction on certain uses and disclosures of your information (the Mental Health Department is not required to agree to the requested restrictions), and

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

Our Responsibilities: CCMHD is required to:

• Maintain the privacy of your health information,

• Provide you with this notice as to our legal duties and privacy practices,

• Abide by the terms of this notice,

• Notify you if we are unable to agree to a requested restriction, and

• Accommodate reasonable requests you may have to communicate mental health information by alternative means or at alternative locations, such as at work instead of at home.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Before we make a significant change, we will change our Privacy Notice and post the new notice in our clinic and offer clients the opportunity to read the changes.

Note: Health Information means any information, whether oral or recorded, that: (1) is created or received by a health care provider; and (2) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present or future payment for the provision of health care to an individual.

For More Information or to Report a Problem

If have questions and would like additional information, you may contact CCMHD’s Privacy Officer at 607-758-6100.

If you believe your privacy rights have been violated, you can file a complaint by calling the head of the department providing services to you or by calling CCMHD’s Privacy Officer; or you can write to the Office for Civil Rights. There will be no retaliation for filing a complaint with either CCMHD or the Office for Civil Rights. The address for the Office for Civil Rights is listed below:

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 509F, HHH Building

Washington, D.C. 20201

We will obtain your written authorization before using your health information or sharing it with others, however, there are some situations when we do not need your written authorization before using your health information or sharing it with others.

How We May Use and Disclose Your Health Information Without Your Written Authorization

1. Treatment: We may share your health information with employees and consultants at a County facility who are involved in taking care of you, and they may in turn use that information to diagnose or treat you.

2. Payment: We may use your health information or share it with others so that we obtain payment for your health care services. For example, we may share information about you with your health insurance company in order to obtain reimbursement after you have been treated.

3. Health Operations: We may use your health information or share it with others in order to conduct our normal business operations. For example, we may use your health information to evaluate the performance of our staff in caring for you, or to educate our staff on how to improve the care they provide for you.

4. Business associates: There are some services provided in our organization through contracts with business associates. Examples include software vendors and clinical laboratories. When these services are contracted, we may disclose your health information to our business associates. To protect your health information, however, we require the business associate to appropriately safeguard your information.

5. Notification: We may use or disclose information when we contact you with a reminder that you have an appointment for treatment or services.

6. Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

7. Law enforcement: We may disclose health information for law enforcement purposes in response to a valid subpoena/court order or otherwise required by law, such as in order to protect you or others .

8. Emergencies or Public Need: We may use your health information or share it with others when necessary to prevent a serious threat to your health or safety, or the health or safety of another person or the public.

9. Friends and Family Involved in Your Care: We may share your health information with a family member, relative, or close personal friend who is involved in your care or payment for that care if you agree.

10. Emergencies: We may use or disclose your health information if you need emergency treatment or if we are required by law to treat you but are unable to obtain your consent.

11. Communication Barriers: We may use or disclose your health information if we are unable to obtain your consent because of substantial communication barriers, and we believe you would want us to treat you if we could communicate with you.

12. As Required by Law: We may use or disclose your health information if we are required by law to do so. We also will notify you of these uses and disclosures if notice is required by law.

13. Public Health Activities: We may disclose your health information to authorized public health officials (or a foreign government agency collaborating with such officials) so they may carry out their public health activities.

14. Victims of Abuse, Neglect or Domestic Violence: We may release your health information to a public health authority that is authorized to receive reports of abuse, neglect or domestic violence.

15. Health Oversight Activities: We may release your health information to government agencies authorized to conduct audits, investigations, and inspections of our facility.

16. Military and Veterans: If you are in the Armed Forces, we may disclose health information about you to appropriate military command authorities for activities they may deem necessary to carry out their military mission.

17. Inmates and Correctional Institutions: If you are an inmate or you are detained by a law enforcement officer, we may disclose your health information, if necessary, to provide you with health care, or to maintain safety, security and good order at the place where you are confined.

18. Coroners, Medical Examiners and Funeral Directors: In the unfortunate event of your death, we may disclose your health information to a coroner or medical examiner.

19. Exception if Information Does Not Identify You: We may use or disclose your health information if we have removed any information that might reveal who you are.

How Someone May Act on Your Behalf

You have the right to name a personal representative who may act on your behalf to control the privacy of your health information. Parents and guardians will generally have the right to control the privacy of health information about minors unless the minors are permitted by law to act on their own behalf.