Patient Rights and Responsibilities
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.
This notice is effective as of August 14, 2023, and replaces all other versions.
Community Health Programs, Inc. (CHP) respects the privacy and confidentiality of your health information. This notice describes how medical information about you may be used and how you can get access to this information. CHP strongly believes in safeguarding the privacy of our patients’ protected health information (PHI). PHI is information that:
- Identifies you (or can reasonably be used to identify you); and
- Relates to your physical or mental health condition, the provision of health care to you, or the payment for that care.
I. Our Responsibilities
We are required by law to keep your medical information confidential and to provide you with notice of our legal duties and privacy practices; we must follow the privacy practices described in this notice. If we make material changes to our privacy policies or practices, we will revise this notice and post it in our practices, mobile health units, and on our website (chpberkshires.org).
II. Our Uses and Disclosures
A. We typically use or share your health information in the following ways:
1. For Treatment. We can use your health information to provide you care and share it with other professionals who are treating you for coordinating your continuing care. This may include other providers, nurse practitioners, social workers, therapists, dentists, nurses, as well as lab technicians, dieticians, specialists, or others involved in your care, both within and outside CHP. For example, a pharmacist will need certain information to fill a prescription ordered by your provider.
2. For Payment. We can use and share your health information to bill and get payment from health plans or other entities. For example, a bill for services may be sent to your insurance company.
3. For Health Care Operations. We can use and share your health information to run our practice, improve your care, and contact you when necessary. For example, we may use your health information to send you a newsletter that provides information on our services and information about treatment alternatives.
4. We may share your information with our business associates. These are outside entities that perform various activities for us, such as hosting our electronic medical record system, providing information technology services, or performing audits for us, but in these cases, we will have a written contract with those outside entities that require them to protect and secure your information and limit the use of your information to just what is needed.
5. CHP is a part of an organized healthcare arrangement with Berkshire Health System. This allows the sharing of your information for your coordinating your care and treatment, and health care operations and payment activities, such as quality assessment and improvement activities and utilization review.
6. We participate in health information exchanges (HIEs), including the Massachusetts Health Information Highway (Mass HIway) and the Berkshire Fallon Health Collaborative, an Accountable Care Organization (ACO) partnership plan. HIEs are also considered business associates since information is shared with these external entities for improving and coordinating your care to provide you with a better patient experience.
B. Other ways in which we are allowed or required to share your information
1. Required by Law. We may use and disclose information about you if we are required by law to do so, such as reporting lead screening results.
2. Persons Involved in Your Care or Payment for Your Care. We may disclose health information about you to a family member, close personal friend or other person you have told us that we can share information with about you. These disclosures are limited to information relevant to the person’s involvement in your care or in arranging payment for your care and will only be made to those individuals you have told us that we may communicate with about you.
3. Public Health and Public Policy. We can share health information about you for certain situations, such as:
• Preventing disease;
• Helping with product recalls;
• Reporting adverse reactions to medications;
• Reporting suspected abuse, neglect, or domestic violence;
• Averting a serious threat to your health or safety or the health or safety of someone else;
• To an employer if an employee was seen at the request of the employer for a possible work-related illness or injury;
• For workers’ compensation purposes, as permitted by law;
• For health oversight activities, such as audits, inspections, licensure, or civil, administrative, or criminal investigations.
• To a school when proof of immunization is required by law and requested by the patient, parent, or legal guardian;
• Preventing or reducing a serious threat to anyone’s health or safety;
• In judicial or administrative proceedings and for law enforcement purposes.
4. Other Special Situations:
• We can share health information with a coroner, medical examiner, or funeral director when an individual dies;
• If you are a member or veteran of the armed forces, we may use and disclose your health information as required by military command authorities or for eligibility for benefits;
• We may share information for national security and intelligence activities;
• We may share information on an inmate of a correctional institution or under the custody of a law enforcement official to that institution or official for certain purposes;
• We may use or share limited information about you for fundraising purposes for CHP’s own benefit, but you have the right to opt out of receiving these communications;
• We may communicate with you face-to-face for the marketing of products or services offered by us or third parties, and we may provide you with a promotional gift of nominal value;
• We may share information about you with an organization assisting in disaster relief efforts.
C. Your written permission or authorization is needed for any other use or disclosure:
1. We will obtain your written authorization prior to making any use or disclosure other than those described above. These include uses and disclosures of psychotherapy notes (as defined in 45 CFR §164.501), uses and disclosures made for marketing purposes, or disclosures that constitute a sale of protected health information require your written authorization.
2. A written authorization is designed to inform you of a specific use or disclosure (other than those described above) that we plan to make of your health information. The authorization describes the particular health information to be used or disclosed and the purpose of the use or disclosure. Where applicable, the written authorization will also specify the name of the person to whom we are disclosing the information. The authorization will also contain an expiration date or event.
3. You may revoke a written authorization previously given by you at any time, but you must do so in writing. If you revoke your authorization, we will no longer use or disclose your health information for those purposes specified in the authorization except where we have already acted in reliance on your authorization.
4. Some information in your medical record is considered by state and/or federal law to be highly confidential, such as human immunodeficiency virus (HIV) status or testing results, sexually transmitted diseases, genetic test results, or alcohol and drug abuse records. In order to disclose this information, we must have your specific permission.
III. Your Rights
1. Right to Request Restrictions. You have the right to request in writing that we restrict the way we use or disclose your health information for treatment, payment, or healthcare operations. However, we are not required to agree to the restriction except under limited circumstances. For example, we must agree to your request to restrict disclosures about you to your health plan for purposes of payment or healthcare operations that are not required by law if the information pertains solely to a healthcare item or service for which you have paid us in full out of pocket. If we do agree to a restriction, we will honor that restriction except in the event of an emergency.
2. Right to Request Confidential Communications. You have the right to request in writing that we communicate with you concerning your health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. We will accommodate your reasonable request.
3. Right of Access to Protected Health Information. You have the right to inspect and obtain a copy of your health information that is contained in a designated record set for as long as we maintain this record, which is 20 years after your discharge or after your final visit. A “designated record set” contains medical and billing records and any other records that we use for making medical or billing decisions about you. You must submit this request in writing to the Privacy Officer. By law, you do not have the right to inspect or copy the following records:
a. psychotherapy notes;
b. information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and
c. PHI that is subject to law that prohibits its access.
4. Right to Request Amendment. You have the right to request that we amend your health information. Your request must be made in writing to the Privacy Officer and must state the reason(s) for the requested amendment. We may deny your request, and if we do, we will give you a written denial notice, including the reasons for the denial. You have the right to submit a written statement disagreeing with the denial, which will be included in your health record.
5. Right to an Accounting of Disclosures. You have the right to request an accounting or listing of certain disclosures of your health information. You must submit your request in writing to the Privacy Officer and include the specific time frame for the accounting. The accounting will include the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; and a brief statement of the purpose of the disclosure. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs for completing the accounting. Your right to an accounting does not apply to disclosures made:
a. for purposes of treatment, payment, or health care operations;
b. with your written permission;
c. to you or persons involved in your care; or
d. for national security or intelligence purposes or to correctional institutions or law enforcement officials who have custody of you.
6. Copy of This Notice. You can ask us for a paper copy of this notice at any time at the front desk, or by contacting the Privacy Officer, even if you have agreed to receive the notice electronically.
7. Notification of Breaches of Your Health Information. We will let you know promptly if a breach occurs that may have compromised the privacy of security of your unsecured information.
8. Right to Complain if You Believe Your Privacy Rights Have Been Violated. If you believe that we may have violated your privacy rights, you may file a complaint by contacting the Privacy Officer by writing to the following address:
Community Health Programs, Inc.
444 Stockbridge Rd.
Great Barrington, MA 01230
You may also send a written complaint to the U.S. Department of Health and Human Services at the following address:
Office for Civil Rights
U.S. Department of Health and Human Services
Government Center, J.F.K. Building, Room 1875
Boston, MA 02203