NOTICE OF
PRIVACY PRACTICES
OF THE
ALLEGANY COUNTY DEPARTMENT OF SOCIAL SERVICES
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.
The Allegany County Department of
Social Services (Department) provides many different services to you. It
provides public assistance benefits, pays for health care, processes electronic
bills, performs other administrative services for public assistance programs, arranges
for the provision of health care and provides preventive services for children,
adults and families. All health
information in our possession is maintained confidentially by the Department. Effective April 14, 2003, when the
Department provides health care, pays for care or processes certain electronic
health information, we are required by law to provide you with this notice of
privacy practices to let you know how your health information is used and
disclosed.
Your Health
Information Rights:
Unless otherwise required by law, your
health record is the physical property of the Department, but the information
in it belongs to you and you have a right to have your health information kept
confidential. You, or a person legally
authorized to act for you (e.g., parents of a minor, guardian, a health care
proxy), have a right to:
ü
get a paper copy of this notice of privacy practices upon
request;
ü
see or get a copy of your health information for a
reasonable fee; if your request for a copy is denied, you have the right to
seek a review of the denial;
ü
request amendments to your health information; the
Department will review all requests but does not have to agree to your request;
ü
request limits on certain uses and disclosures of your
information; the Department will look at all such requests but does not have to
agree to limitations you request;
ü
get a list of those to whom your health information has been
disclosed; this list will not include health information requested by you or
your representative, information used to operate the Department’s programs or
information given out for law enforcement purposes;
ü
request communications of your health information by
alternative means or at alternative locations;
ü
sign and revoke any special authorizations you have given to
use or disclose health information, except to the extent that disclosure has
already been taken.
You can exercise your rights by
contacting Patricia A. Schmelzer, Deputy Commissioner of Social Services and
Privacy Officer, Allegany County Department of Social Services and Privacy
Officer, County Office Building, 7 Court Street, Belmont, NY 14813, Telephone number: (585) 268-9622.
NOTE: Special rules apply which restrict your and others access
to psychotherapy notes, HIV/AIDS information, information compiled in
reasonable anticipation of or for litigation, and federally protected drug and
alcohol information. See any special
authorizations or consent forms which will specify what information may be
released and when, or contact the person listed above.
What Are Our Responsibilities to You?
We must maintain the privacy of your
health information, and give you this notice that tells you how we will keep
your health information private. We
must tell you if we are unable to agree to a limit on use or disclosure, which
you request. We will carry out
reasonable requests to communicate health information to you by special means
or at other locations and get your written permission to use or disclose health
information in ways other than those set out in this notice. We have the right
to change our practices regarding the health information we keep. If practices
are changed, we will tell you by sending you a new notice, or you may request
one at your next visit. Notices will be posted in our office at County Office Building, 7 Court Street,
Belmont, NY 14813.
How
Does the Program Use or Disclose Your Health Information?
For
Treatment:
Information is used and disclosed to provide you with medical services. For
example, a doctor may consult and share information with an off‑site
specialist to whom you have been referred for care.
For
Payment:
To pay your doctor, hospital and/or other health care providers.
For
Health Care Operations: Health information is used and disclosed for operational
reasons. For example, your information may be used to determine the quality of
care provided to you or others, to improve services and facilities, or to train
and evaluate staff.
For
Appointments and Health Related Benefits: With your permission, the
program may use and disclose information for appointment reminders, or
information about treatment alternatives and benefits.
For
Disclosures to Friends and Family: With your appropriate consent, the
program may disclose your health information to friends and family who are
involved in your care.
In certain
other situations, the program can use and disclose information without your
authorization:
For
Serious Threats to Health and Safety: Your health information may be
disclosed to avert a serious threat to public health and safety, as permitted
by law.
If
Required by Law or for Law Enforcement: The program may use and disclose
information as required by law. For example, for the mandatory reporting of
child abuse and neglect, for domestic violence, for judicial or administrative
proceedings if required by legal process, for certain law enforcement purposes
(e.g., to aid in locating a fugitive, to report crimes on our locations), for
workers compensation and for similar programs established by law.
For
Public Health Reasons: The program may use or disclose information for required
public health activities such as controlling disease or injury.
For
Health Oversight Reasons: Information may be disclosed when required to monitor the
level and quality of care you receive.
For
a Contracted or Affiliated Purpose: Our contractors, agents and partners
may be given health information if necessary for them to perform certain
services for us. For example, the program may share information with companies,
under written and signed Business Associate Agreements, attorneys and auditors,
if they agree to keep such information confidential in writing and have been
given permission by the Department to receive and use PHI for purposes stated
in any agreement or authorization to release PHI (If the PHI is owned by the
New York State Central Office – Office of Medicaid Management, such agreements
must be executed with the New York State Office of Medicaid Management).
For
Organ/Tissue/Blood Donation: Information may be disclosed to entities
engaged in the procurement, banking or transplantation of organ/tissue/blood
donations, if necessary, to ensure safe donations and transplants.
For
National Security and Military Purposes: As permitted by law, we may
share information with authorized federal officials engaged in national
security activities and also disclose information about Armed Forces personnel
and foreign military personnel to military authorities.
Inmates
and Correctional Facilities: The Department may disclose inmate and
detainee information to prison staff and law enforcement if necessary for
health care or for security reasons, as permitted by law.
Decedents:
Your
information can be disclosed to funeral directors, coroners and medical
examiners to enable them to carry out their lawful activities.
For
Product Monitoring and Recall: We may disclose information to those
required by the Food and Drug Administration to monitor and repair products.
For Workers' Compensation: We may
disclose information for this program.
For
Research:
With your consent, the program may use health information for research or when
a review board has approved research which poses minimal risk; your privacy is
ensured or when a research project is being prepared. No public disclosure of
your name will be made without your consent.
For More Information or to Report a
Problem:
If you have questions, need more
information or believe your privacy rights have been violated and you wish to
complain, you may contact:
Patricia A. Schmelzer, Deputy Commissioner
of Social Services and Privacy Officer at Allegany County Department of Social
Services, County Office Building, 7 Court Street, Belmont, NY 14813. The telephone number is: (585) 268-9622
A complaint form will be sent to you.
You may also complain to the Office for Civil Rights, Department of Health and
Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312,
New York, New York 10278, telephone number (212) 264‑3313, fax number
(212) 2643039, TDD (212) 264‑2355. You will not be retaliated against or
penalized for filing a complaint or assisting an investigation.
Allegany County Department of Social
Services
County
Office Building
7 Court
Street
Belmont,
New York 14813
Tel: (585) 268-9622