Privacy Practice Notice

This notice describes how information about you may be used, disclosed and how you can get access to this information.
Please read it carefully.

At Community Health Net, we will treat and use protected health information about you with care. This notice of protected health information practices describes the information we collect, and how we use or disclose that information. This notice is effective 4-14-2003, and applies to all protected health information.

Each time you visit Community Health Net a record of your visit is made. Typically this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment.

This information, serves as a:

• Basis for planning your care and treatment
• Means of communication among the health professionals who contribute to your care
• Legal document describing the care you received
• Means by which you or a third party payer can verify services billed were actually provided
• A tool in educating health professionals
• A source of data for medical research
• A source of information for public health officials charged with improving the health of this state and the nation
• A source for our planning and marketing
• A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when allowing disclosure to others.

Your Health Information rights:
Although your health records are the physical property of Community Health Net, the information belongs to you.

You have the right to:

• Obtain a copy of this notice of information practices upon request
• Inspect and obtain a copy of your health record
• Amend your health record
• Obtain an accounting of disclosures of your health information
• Request communications of your health information by alternative means or at alternative locations
• Request a restriction on certain uses and disclosures of your information
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken

Our Responsibilities:
Community Health Net is required to maintain the privacy of your health information, provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you, and to abide by the terms of this notice. We will notify you if we are unable to agree to a requested restriction or amendments; and accommodate reasonable requests you may have to communicate health information by alternative means or alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change we will mail a revised notice to the address you’ve supplied us.

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, as allowable by law.

If you have questions and would like additional information, you may contact our office.

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Office for Civil Rights, we will not retaliate against you for filing a complaint, nor will filing a complaint have any affect or bearing on the quality of care you receive.