Your Health Information: Your Rights & Our Responsibilities

Notice of Privacy Practices

Your Health Information: Your Rights & Our Responsibilities
This handout (.pdf) explains how your medical information may be used or shared—and how you can access it. Please read it carefully.

Your Rights

You have the right to:

• Get a paper or electronic copy of your medical record
• Ask us to fix information you think is wrong
• Request private communications (like calling a different phone number or using a different address)
• Ask us not to share certain information
• See a list of who we’ve shared your info with
• Get a copy of this notice at any time
• Pick someone to act on your behalf (such as a legal guardian)
• File a complaint if you believe your privacy has been violated

Your Choices

In certain situations, you can choose how we share your information. For example, you can tell us to:

• Share information with your family or close friends
• Share info in an emergency or disaster situation
• Include your name in a hospital directory
• We will follow your wishes whenever we can. If you're unable to tell us your preference (for example, in an emergency), we may still share information to help you or to protect others.
• We will not share your information for these reasons unless you give us written permission:
• Marketing
  • Selling your information
  • Sharing most mental health notes
  • Fundraising: We may contact you, but you can ask us not to.

How We Use & Share Your Information

• We may use or share your health information in the following ways:
• To treat you – Sharing with doctors, nurses, or specialists involved in your care
• To run our organization – Improving services or contacting you as needed
• To bill for services – Sending information to your health plan for payment

Other Ways We May Share Your Information

• We may also share your health info to:
• Prevent disease or help with public health and safety
• Report side effects, recalls, abuse, or neglect
• Support health research
• Follow state and federal laws
• Respond to organ donation or death-related requests
• Help with workers’ comp, law enforcement, or government functions
• Respond to court orders or legal actions
• We only share what is allowed or required by law.

Our Responsibilities

We are required to:

• Keep your health information safe and private
• Tell you quickly if a data breach occurs
• Follow the terms of this notice
• Only share your information when allowed—and only with your permission when required
• Let you change your mind about permissions at any time (in writing)

Need to File a Complaint?

If you believe your privacy rights have been violated, you can:
Contact us by calling 1- 845-486-3725 Compliance Warmline or online at
File a complaint with the U.S. Department of Health & Human Services:
Call: 1-877-696-6775
Online:
We will not retaliate or punish you for making a complaint.

Changes to This Notice

We may update this notice. The newest version will always be available in our office and on our website.

Download a PDF version of this information