Notice of Privacy Practices

EFFECTIVE DATE OF NOTICE

September 23, 2013

THIS NOTICE DESCRIBES HOW MEDICAL, DENTAL, OR OTHER HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

HealthReach Community Health Centers (HRCHC) is required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of HRCHC’s legal duties and privacy practices with respect to your PHI, and to notify you in the event of a breach of any unsecured PHI HRCHC maintains about you. While required to abide by the terms of the Notice that is currently in effect, HRCHC reserves the right to change HRCHC’s privacy practices at any time and to make the new Notice provisions effective for all PHI that it maintains about you. If HRCHC’s privacy practices change, HRCHC will provide you with a revised Notice at your next visit.

Authorized Uses and Disclosures of Your Health Care Information

HRCHC may use and disclose your PHI, without your authorization, for purposes of treatment, payment, and healthcare operations. For example: HRCHC may use and disclose your PHI between HRCHC’s practice locations or with other health care providers and facilities involved in your care (including pharmacists and medical equipment suppliers), to develop a diagnosis and treatment plan, to coordinate your care, to arrange for referrals, and for other treatment-related purposes. HRCHC may also use and disclose your PHI to your insurance carrier, health plan or other third-party payors (e.g., Medicare, MaineCare) to secure payment on your behalf, and to determine your eligibility for coverage and benefits, unless you pay in full out of pocket for services provided to you and request in writing that your PHI not be disclosed to third-party payors. HRCHC may also use and disclose your PHI for health care operations purposes, such as quality review and improvement activities, risk management activities, training, and audit activities.

HRCHC participates in a state-designated, state-wide electronic health information exchange called HealthInfoNet. HealthInfoNet allows participating Maine hospitals, physicians, and other healthcare providers to share with each other on an as-needed basis certain limited health information about you for treatment and coordination of care purposes. Although HRCHC does not presently share your protected health information with HealthInfoNet, we may obtain your protected health information that may be available on HealthInfoNet. Health information stored on HealthInfoNet’s network may also be disclosed to governmental entities for certain required public health reporting purposes. Participating healthcare providers may only access your health information if they are involved in your care, need the information in order to provide you with medical care or healthcare services, and have an authorized computer ID and password. HealthInfoNet’s computer system will track all persons who electronically access your health information, and you can request an accounting of all such persons from HealthInfoNet. However, if you do not want your information disclosed to a health information exchange, you may opt out of having your information shared with other healthcare providers and facilities through the health information exchange. You may opt out of participating by contacting HealthInfoNet (www.hinfonet.org) and completing an Opt Out form. However, there are risks associated with a decision not to participate. If you choose to opt out, your treating healthcare providers may not have access to the most current and complete information about you when they need it to treat you or to coordinate your care in an urgent situation. Choosing to opt out could also affect the efficiency of the healthcare services you receive due to the time it takes to get paper copies of your medical records to your treating healthcare providers. If you choose not to participate at this time, you can always elect to participate at a later time. However, if you choose to participate at a later time, the only healthcare information that will be made accessible to participating HealthInfoNet providers will be healthcare information created after the time you choose to participate.

HRCHC may disclose your PHI to contractors performing services on HRCHC’s behalf when such contractors have agreed in writing to appropriately protect your PHI.

HRCHC may disclose information without your authorization as permitted or required by applicable law, including any of the following circumstances: to comply with public health reporting laws; to comply with mandatory abuse and neglect reporting laws; for health oversight activities by government agencies; to comply with court orders, governmental subpoenas, or other lawful processes; for certain research purposes approved by an Institutional Review Board; to a coroner, medical examiner, or funeral director for purposes authorized by law in the event of your death; to law enforcement officials to report gunshot wounds, crimes committed on HRCHC premises, or crimes committed against HRCHC personnel; to avert a serious threat to health or safety; or for Workers’ Compensation purposes.

HRCHC may disclose your PHI for specialized government functions when such disclosures are authorized or required by applicable law, including any of the following circumstances: to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by the National Security Act and related Executive Orders, for the provision of protective services to the President or other persons, or for the conduct of investigations, authorized under applicable federal law; to a correctional institution or a law enforcement official having lawful custody of an inmate or other individual, PHI about the inmate or other person when necessary (i) to provide health care to the inmate or person in custody, (ii) for the health and safety of the inmate or person in custody, (iii) for the health and safety of correctional personnel, (iv) for the health and safety of persons responsible for transporting the inmate or person in custody, (v) for law enforcement on correctional facility premises, and (vi) for administering and maintaining the safety, security and good order of the correctional institution; and, with respect to persons who are members of the Armed Forces and of foreign military personnel, HRCHC may disclose PHI for activities deemed necessary by appropriate military command authorities to assure the proper execution of a military mission.

HRCHC may use your information to contact you for appointment reminders, or confirm appointments by telephone unless you give us restrictions in writing. HRCHC may disclose your health information to notify, or assist in the notification of a family member, your personal representative or another person responsible for your care.

HRCHC may use your information to provide information about treatment alternatives or other health services. Unless you object, HRCHC may disclose limited information to family or friends as necessary for your care or treatment.

HRCHC may disclose your PHI to family members, relatives, or close personal friends involved in your care, involved in securing payment for your care, or for notification purposes, unless you or your personal representative notify us that you object to and wish to prohibit or restrict such disclosures.

HRCHC may use and disclose your PHI to public or private entities authorized by law to assist in disaster relief efforts for certain notification purposes, provided you have been given the opportunity to agree or to object to such uses and disclosures.

HRCHC may use your medical information to contact you in the effort to raise money for HealthReach Community Health Centers or our individual health centers. HRCHC will only release to our internal Development Office your name, address, phone number and email. HRCHC will not give the office any medical information about you. If you do not want your name on the list for fundraising requests, please write to us at: Development Office, HealthReach Community Health Centers, 10 Water Street, Suite 305, Waterville, Maine 04901.

Except as described above, HRCHC will not use or disclose your information, except with your written authorization.

When Your Authorization is Required

HRCHC is required to obtain your written authorization to use or disclose psychotherapy notes about you that are kept separate from the rest of your HRCHC medical record, unless an exception to the authorization requirement applies under applicable law.

HRCHC will obtain your written authorization for any use or disclosure of your PHI to sell or market products or services, except in limited circumstances (for example, in face-to-face marketing communications with you). HRCHC will also obtain your written authorization any disclosure of your PHI that involves a sale of your PHI, unless an exception applies under applicable law.

HRCHC will not photograph or video record you, or use or disclose any photographs and video recordings of you, for non-treatment related purposes, for marketing or public relations purposes, without your written authorization, unless the creation, use or disclosure of such photographs or video recordings are authorized by law (e.g., for HRCHC facility security surveillance purposes).

Special Protections for Certain Types of Protected Health Information

If HRCHC maintains information about you derived from mental health services provided to you by a HRCHC psychiatrist, psychologist, clinical nurse specialist, social worker or counseling professional, HRCHC will not disclose such mental health information to another health practitioner or facility outside of HRCHC or its organizational affiliates for a diagnostic, treatment or continuity of care purpose, without your written authorization, unless such disclosure is necessary in an emergency or is otherwise authorized or required by law. If a HRCHC licensed mental health facility, program or agency maintains mental health information about you, HRCHC will not use or disclose such mental health facility PHI about you except as authorized or required by applicable mental health confidentiality laws and regulations.

If HRCHC maintains any information regarding your HIV status (such as HIV test results or medical records containing HIV information), such information is afforded heightened protection under Maine law and HRCHC will maintain the confidentiality and privacy of such information, and will not use or disclose such information, except as specifically authorized or required by Maine’s HIV confidentiality laws.

If HRCHC possesses any substance abuse PHI about you that is subject to the heightened federal confidentiality protections afforded to certain substance abuse program records under 42 C.F.R. Part 2, or if HRCHC acquires such PHI from another provider or facility, HRCHC will maintain the confidentiality and privacy of such information, and will not use or disclose such information, except as specifically authorized or required by 42 C.F.R. Part 2. If HRCHC creates, acquires or maintains any substance abuse information about you that is not from a Part 2 substance abuse program, HRCHC will protect the confidentiality of such information and use and disclose such information in the same way HRCHC protects, uses, and discloses your other PHI.

Your Rights

You have the right to request restrictions on the use and disclosure of your information. If you request that HRCHC not disclose your PHI to a third-party payor health plan for purposes of carrying out payment or health care operations, and you have paid HRCHC in full out of pocket for services provided to you, HRCHC is required to honor your requested restriction. Otherwise, HRCHC is not required to agree to a requested restriction, and it is HRCHC’s policy not to agree to such restrictions unless HRCHC determines, in HRCHC’s sole discretion, that a compelling reason exists to do so.

You have the right to receive communications from HRCHC in a confidential manner and HRCHC will accommodate reasonable requests. If you would like HRCHC to use an address or telephone number other than your billing address to contact you, you must request so in writing.

You have the right to receive an accounting of certain disclosures of your health care information made by HRCHC in the six years prior to the date of your request if you did not specifically authorize those disclosures. The accounting will not include disclosures made directly to you, disclosures made to others pursuant to your written authorization, disclosures made to carry out treatment, payment, and health care operations for which your written authorization was not required, incidental uses and disclosures, and uses and disclosures for which an accounting is not required by law. However, you have the right to request an accounting of disclosures made for purposes of treatment, payment, or health care operations through an electronic health record during the three years prior to your request. To receive such an accounting, please contact HRCHC at the address given below, allowing up to 30 days to process this request.

You have the right to inspect and copy your information at reasonable times. If you wish to do so, you will be provided an opportunity to inspect your information within 30 days of receipt of your written request. If HRCHC needs extra time, it may extend the time once for an additional 30 days and we will provide you written notice of the extension. You have the right to receive your health information in the form and format of your choosing, if such information can be readily produced in such form and format, or in a readable hardcopy form, or in another format agreed to between you and HRCHC. If HRCHC maintains your PHI in an electronic health record, you have the right to obtain a copy of your health information in an electronic format and to direct HRCHC to transmit an electronic copy of your PHI directly to another clearly specified entity or person of your choice. In certain limited circumstances, you may be denied access to your health information and records. However, you may request that a decision denying you access to your PHI and records be reviewed. Please contact HRCHC’s Privacy Officer if you have questions about your right to access your PHI. You may be charged reasonable costs for copying your information, or for preparing any summaries that you request.

You have the right to request amendments, corrections and clarifications to PHI contained in your medical records. Your request must be in writing and you must provide a reason supporting your request. If you wish to do so, please submit the proposed amendment in writing to HRCHC at the address given below. If you are requesting a change to the PHI in your treatment record, we will place your requested amendment, correction or clarification in your record. HRCHC may add a response to your record, and will provide to you a copy of our response. If you are requesting a change in other records (that are neither medical nor billing records), HRCHC may deny your request. If your request is denied, we will notify you in writing and provide our reasons for the denial. You have the right to file a statement of disagreement with HRCHC and it may prepare a response to your statement. HRCHC will provide you with a copy of our response.

If you are a minor authorized by law to consent to health care services on your own behalf and you in fact consent to such services on your own behalf, HRCHC is required to protect the privacy of your PHI with respect to health care services you have consented to on your own behalf in the same way that HRCHC protects the privacy of an adult’s PHI, unless a special exception applies under the law. For example, HRCHC is authorized by law to notify your parent or guardian if, in the judgment of your HRCHC provider failure to inform your parent or guardian would seriously jeopardize your health or would seriously limit the ability of your HRCHC provider to provide treatment to you. Additionally, if you want HRCHC to bill your parent’s insurance for services provided to you, your parents will receive from their insurance company an Explanation of Benefits regarding the services provided to you by HRCHC and, as a result, the fact that you received services from HRCHC will not be confidential from your parents. However, if you do not want your parents to know that you are receiving services from HRCHC, you must notify HRCHC of that fact at the time services are provided to you so that arrangements can be made for payment of such services privately or out-of-pocket, or to determine your eligibility for free or discounted care.

You have the right to revoke your authorization at any time by giving written notice of revocation to HRCHC.

You have the right to a paper copy of this Notice of Privacy Practices upon request.

You have the right to complain to HRCHC and to the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated by HRCHC. To file a complaint, please contact HRCHC as set forth in this Notice. Nobody is permitted to retaliate against you for filing a complaint.

For further information about HRCHC’s privacy policies please contact:

Dawn Brady
Corporate Compliance Officer
HealthReach Community Health Centers
P.O. Box 624
Wilton, ME 04294
207.660.9939
Fax: 207.660.9901

HealthReach Community Health Centers complies with applicable Federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color,
national origin, age, disability, sex (including pregnancy and sex stereotyping), gender identity, sexual orientation, or any other characteristic protected by law.
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