Introduction: At Cortland County Health Department (CCHD), we are committed to treating your health information responsibly. This Privacy Notice describes the personal information we collect, your rights regarding that information, and how and when we use or disclose that information. This Notice is effective February 13, 2003, and applies to all protected health information as defined by federal regulations.

Understanding Your Health Record/Information: Each time there is contact between you and CCHD, a record of the contact is made. This record may contain your symptoms, evaluations, examinations, test results, diagnoses, treatment, and a plan for follow-up or treatment. This information serves as a:

• Basis for planning your care and treatment,
   
• Means of communication among the many health professionals who contribute to your care,
   
• Legal document describing the care you received,
   
• Means for you or your insurance company to verify that services billed were actually provided,
   
• A tool in educating health professionals,
   
• A source of public health information for improving the public's health
   
• A source of data for our planning,
   
• A tool by which we can improve the service we render and the outcomes we achieve.

Your Health Information Rights: Although your health record is the physical property of CCHD, the information belongs to you. Within the limits 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 an amendment to your health record by completing a written request on a Health Department form providing the reason for the change,
   
• 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 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: CCHD 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 health information by alternative means or at alternative locations.

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 clinics and offer home care patients the opportunity to read the changes.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

For More Information or to Report a Problem

If have questions and would like additional information, you may contact CCHD's Privacy Officer at 607-753-5028.

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

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201

Examples of Disclosures for Treatment, Payment
and Health Operations

Treatment: Information in your medical record will be used to determine your course of treatment. We will provide your other health care providers/facilities with copies of various reports that should assist in providing your care.

Payment: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, supplies used, and/or other information requested by the third party payor.

Health Operations: Members of the professional staff, members of the quality improvement team (from CCHD or from your insurance provider), representatives from regulatory agencies (such as the New York State Department of Health), and health care students studying at CCHD, may use information in your health record to assess the care and outcomes in your case and others like it. This information is used to improve the quality and effectiveness of the healthcare and service we provide.

Business associates: There are some services provided in our organization through contracts with business associates. Examples include auditors, software vendors, billing services, and vendors providing home equipment/supplies. 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.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location and general condition. We may contact you to provide appointment reminders.

Coordination of Services: We may give information to other agencies that is needed for them to provide services to you such as Meals on Wheels, Social Services, transportation providers, medical supply vendors.

Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, products and product defects.

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.

Public health: As required by law, we may disclose your health information to public health or other authorities charged with preventing or controlling disease, injury, or disability or collecting essential data.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena/court order.

Insurance Company and County Attorney: We may disclose health information to the Health Department's insurance company and county Attorney if there is a potential legal or liability issue.

Government Oversight: State and Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

Pharmacy, laboratory, and radiology services (for "MOMS" patients only): Your name, the first five numbers of your social security number, your date of birth, your due date, and your Medicaid billing information will be distributed to pharmacies, laboratories, and radiology services where you may go to obtain prescriptions or services.

Communication with family (Hospice & Certified Home Health Agency only): Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.

Home Health Aide Care Plans (Hospice & Certified Home Health Agency only): Plans listing what services and care should be provided by home aides will be left in your home.

For Hospice only:
(1) Marketing/fundraising: We may periodically send mailings to family members or caregivers of patients previously served to inform them of hospice events or memorial opportunities.
(2) American Red Cross: We may disclose diagnosis and prognosis in order to bring a family member home.

Healthy Women's Partnership (HWP): If you need childcare or transportation, your name, address, and phone number will be given to the provider of such services.