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Notice of Privacy Act | Patient Complaint or Compliment Form
Notice
of Privacy Act
Effective: April 14, 2003
This
notice describes how medical information about you may be used and
disclosed, and how you can get access to this information. Please
review this carefully.
Manet
Community Health Center, Inc. is a federally qualified community
health center with 5 practice sites. This joint notice applies to
all Manet CHC sites as used in this statement.
At Manet Community Health Center, your privacy is a priority!
PATIENT
PRIVACY
At Manet Community Health Center, your privacy is a priority.
This office has always recognized the importance of privacy; this
new federal law formalized practices that have been followed routinely.
The following is a summary of your rights regarding the privacy
of your healthcare information.
Protected Health Information
Protected health information (PHI) is any information about your
past, present or future health care, or payment for that care
that could be used to identify you.
Members of our workforce and our business associates may only
access the minimum amount of protected health information that
they need to complete their assigned tasks.
USE
AND DISCLOSURE OF PHI
When you visit a Manet CHC facility, we use and disclose your
protected health information to treat you, to obtain payment for
services and to conduct normal business known as health care operations.
We may also share information with a contracted business associate
who must meet our privacy requirements. Examples of how we use
and disclose your information include:
-
Treatment – We document each visit and/or admission. This
documentation may include:
-
Payment – We document the services and supplies you receive
at each visit or admission so that you, your insurance company
or another third party can pay us. We may tell your health plan
about upcoming treatment or services that require its prior approval.
-
Health Care Operations – Medical information is used to
improve the services we provide, to train staff and students,
and for business management, performance improvement and customer
service.
We may also use information to:
-
Recommend treatment alternatives
-
Tell you about health benefits and services
-
Communicate with other business associates for treatment, payment
or health care operations
-
Send appointment reminders
-
Communicate with family or friends involved in your care with
your permission
-
Contact you about support for the Manet CHC Fundraising*
Services followed by an asterisk (*) are optional.
Tell the front desk personnel or fundraiser (if contacted) that
you do not wish to participate.
There are limited times when we are permitted or required to
disclose medical information without your signed permission.
These situations include the following:
-
For public health activities such as tracking diseases or medical
devices
-
To protect victims of abuse or neglect
-
For federal and state health oversight activities such as fraud
investigations
-
For judicial or administrative proceedings
-
If required by law or for law enforcement
-
To coroners, medical examiners and funeral director
-
For organ donation
-
To avert serious threat to public health or safety
-
For specialized government functions such as national security
and intelligence
-
To workers’ compensation if you are injured at work
-
To a correctional institution if you are an inmate
-
For research following strict review to ensure protection of information
Other uses and disclosures not previously described may only
be done with your signed authorization. You may revoke your
authorization, in writing, at any time.
OUR
RESPONSIBILITIES
Manet Community
Health Center is required by law to maintain the privacy of your
medical information, provide this notice of our duties and privacy
practices, and abide by the terms of the notice currently in effect.
We reserve the right to change privacy practices and make the
new practices effective for all the information we maintain. Revised
notices will be posted in our facilities and will be available
from your health care provider.
YOUR
RIGHTS
You have
the right to:
- Request
that we restrict how we use or disclose your medical information
(we are not required to abide by your request)
- Request
that we use a specific telephone number or address to communicate
with you
- Inspect
and copy your medical information (fees could apply)*
- Request
amendment to your medical information (reason required)*
- Receive
an accounting of how your medical information was disclosed (excludes
disclosures for treatment, payment, health care operations and
some required disclosures; fees may apply)*
- Obtain a
paper copy of this notice even if you receive it electronically
- Register
a complaint – see back of brochure
- Opt out
of our inpatient list or fundraising requests
* Request must be in writing
TO
CONTACT US
If you have
questions about this notice, contact the privacy officer. If you
would like to exercise your rights or if you feel your privacy
rights have been violated, contact the privacy office:
Manet Community
Health Center, Inc.
Administrative Office
110 West Squantum Street
North Quincy, MA 02171
Telephone: 617-376-3000
All complaints
will be investigated and you will not suffer retaliation for filing
a complaint. You may also file a complaint with the secretary
of health and human services in Washington, D.C.
MEMBERS
OF OUR ORGANIZED HEALTH CARE ARRANGEMENT (OHCA)
All Manet CHC sites:
Houghs Neck
1193 Sea Street
Quincy, MA 02169
Hull
180 George Washington Blvd
Hull, MA 02045
North Quincy (Admin Office & Medical Center)
110 West Squantum Street
North Quincy, MA 02171
Quincy Medical Center
114 Whitwell Street, 2nd Floor (B Wing)
Quincy, MA 02169
Snug Harbor
9 Bicknell Street
Quincy, MA 02169
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