Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can gain access to this information. Please review it carefully. If you have any questions about this notice, please contact our Privacy Officer at 845-225-2700, x 159.

We are committed to your Privacy

At CoveCare Center, we are committed to maintaining the privacy and confidentiality of your health information.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

You have the right to:

Get an electronic or paper copy of your medical record.

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request.
• We may charge a reasonable, cost-based fee for either of the above

Ask us to amend your medical record.

• You can ask us to amend health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60
• If we say “no,” you can write a letter that explains your side of the We will add that letter to your medical record.

Request confidential communications.

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable

Ask us to limit what we use or share.

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care or our ability to be reimbursed.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information.

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice.

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you.

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health
• We will make sure the person has this authority and can act for you before we take any

File a complaint if you feel your rights are violated.

• You can complain if you feel we have violated your rights by contacting us at 845-225- 2700, x159 or by sending a letter to Privacy Officer, CoveCare Center, 1808 Route Six, Carmel, NY 10512.
• You can file a complaint with the S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by

visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

• We will not retaliate against you for filing a

Your Choice

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care, if you do not object.
• Share information in a disaster relief
• You can indicate your choices by completing an authorization, commonly referred to as a consent. This is especially important when you’re asking us to share information about alcohol/drug treatment, mental health, or confidential HIV/AIDS-related treatment.
• The form enables you to specify individuals or entities with whom you want your information shared and specifically what information to share.
• You have the right to revoke (withdraw) this authorization at any time except when we have already shared your information based on the consent you gave You are also not able to revoke your authorization if it was obtained for the purpose of receiving payment from your insurance company.
• You can choose to write a letter specifying the information we can no longer share and the person, organization, facility, or program we should no longer share your information with. You can also use our Revocation of Authorization for   Release of Information form on our website.

Please be as specific as you can in writing your revocation. Please indicate the name and address of the person(s) we are currently sharing this information with and include the date, or approximate date, you signed your authorization. Please address your written request to:

CoveCare Center Medical Records
1808 Route 6
Carmel, NY 10512

Your request won’t be effective until we receive it and verify that you have provided the information we need to comply with your revocation request.

• CoveCare Center may condition your treatment on your refusal to sign this consent.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we won’t share your information unless you give us written permission:

• Marketing
• Sale of your
• Most sharing of psychotherapy

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again and we must comply with your request.

Our Uses and Disclosures.

We typically use or share your health information for treatment, payment, and healthcare operations.

Treat You.

We can use your health information and share it with other professionals who are treating you.

Examples:

• A doctor treating you asks another doctor about your overall health
• We share information with a pharmacy that is filling your

 

Bill for your services.

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

 

Run our organization.

We can use and share your health information to run our business operations and the operations of our related treatment entities.

Example: We use health information about you to manage your treatment and services.

 

We use or share your health information to contribute to the public good.

We are allowed or required to share your information in other ways. Many of these contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information

see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

 

Help with public health and safety issues.

We can share health information about you for certain situations such as:

• Preventing
• Helping with product
• Reporting adverse reactions to
• Reporting suspected abuse, neglect, or domestic
• Preventing or reducing a serious threat to anyone’s health or

 

Do research.

We can use or share your information for health research.

 

Comply with the law.

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

 

Respond to organ and tissue donation requests.

We can share health information about you with organ procurement organizations.

 

Work with a medical examiner or funeral director.

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests.

We can use or share health information about you:

• For workers’ compensation
• For law enforcement purposes or with a law enforcement
• With health oversight agencies for activities authorized by
• For special government functions such as military, national security, and presidential protective services.

Respond to lawsuits and legal actions.

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

 

We share your information to analyze our data and improve services to our clients.

We will share your Protected Health Information with third party “business associates” that perform various activities for the agency. Whenever an arrangement between CoveCare Center and a business associate involves the use or disclosure of your Protected Health Information, we will have a written contract that contains terms that will protect the privacy of your Protected Health Information.

Your Protected Health Information may be accessed by participating providers in the Coordinated Behavioral Health Services Independent Practice Association (cbhsinc.org) when the participating providers have a treating relationship with you.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and offer you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For More Information See: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

 

Revised 1/1/2022