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Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND SHARED WITH OTHERS, AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
Central New York Services,
Inc. is required
by law to keep your health information private, and to give you information
about how we handle your health information. We are also required to explain the
laws related to your information to you. If you have questions about any part of
this notice or if you want more information about how Central New York Services,
Inc. handles private health information, please contact:
The Program Director of
the Program you are in, or
Luann M.
Healy/Privacy Officer
Central New York Services, Inc.
518 James Street, Suite 240
Syracuse, NY 13203
Phone: 315-478-2453
Fax: 315-425-8917
Effective Date of This
Notice: April 14, 2003
I. How Central New
York Services, Inc. may Use or share Your Health Information
Central New York Services,
Inc. collects health information from you and stores it in a chart and on a
computer. This is your record. The record is the property of Central New York
Services, Inc., but the information in the record belongs to you. Central New
York Services, Inc. protects the privacy of your health information. The law
permits Central New York Services, Inc. to use or share your health information
in the following ways:
1. Services.
With your permission, information is used and shared to provide you with
services. For example, speaking with another agency where you may be receiving
other services, or speaking with other programs within CNYS, Inc.
2. Payment.
With your permission the program will use and share your health
information with others (for example, Medicaid or SSI) to receive payment for
services you receive.
3. Regular Health
Care Operations. Health information is used and shared so that we can better
understand how the programs are working. For example, your information may be
used to measure the quality of care provided to you or others, so that we can
improve the service.
4. Emergency
Care. The Program will help you get treatment in a medical/psychiatric
emergency. For example, we will call an ambulance and give the medical staff
information if you have a medical emergency.
5. Directory.
We may list your name, the programs you are in, your general medical condition
and your religious affiliation in our directory. For example, this information
may be provided to members of the clergy. This information, except your
religious affiliation, may be provided to other people who ask for you by name.
If you do not want us to list this information in our directory and provide it
to clergy and others, you must tell us and you will not be listed.
6. Notification
and communication with family/personal representatives. For example, we
may share your health information to tell a family member, your personal
representative or another person responsible for your care about your location,
your general condition or in the event of your death. If you able to make a
decision about this, we will ask if it is okay to share the information. If you
are not able or unavailable, our health professionals will use their best
judgment in sharing information with your family and other person
representatives.
7. Public health.
As required by law, we may share your health information with public health
authorities. For example, for preventing or controlling disease, injury or
disability; reporting child abuse or neglect; reporting domestic violence;
reporting to the Food and Drug Administration problems with products and
reactions to medications; and reporting disease or infection exposure.
8. Health
oversight activities. We may share your health information with
health agencies during audits, investigations, inspections, licensure and other
proceedings. For an example, when the Office of Mental Health does one of their
regular inspections of our programs.
9. Law enforcement.
We may share your health information with a law enforcement official. For
example, the police may request information in order to help solve a crime. A
judge might require information through a court order or subpoena.
10. Deceased
person information. We may share your health information with coroners,
medical examiners and funeral directors. For example, if a person dies suddenly
information may be released to the medical examiner.
11. Organ donation.
For example, we may share your health information with organizations involved in
organ donation, if you have decided to donate your organs when you die.
12. Public safety.
We may share your health information with persons in order to protect the health
or safety of a particular person or the general public. For example, if you have
been exposed to a disease, we may need to tell doctors, so that they can protect
your friends or family.
13. Specialized
government functions. As permitted by law, we may share your health
information with government officials for security reasons. For example, US
government may need to have information about people who have had contact with
someone they are searching for.
14. Worker’s
compensation. We may share your health information in order to
follow worker’s compensation laws. For example, if you are hurt while at work,
the insurance company may need information regarding your social security
number, address etc.
15. Marketing.
We may contact you to remind you of your appointment time, or to give you
information about other treatments or health-related services that may be of
interest to you. For example, we may call you to remind you of an appointment
with the doctor.
17. Fund-raising.
We may contact you about fund-raising activities for Central New York Services,
Inc. For example, we may send you a letter about an upcoming event.
18. Change of
Ownership. In the event that Central New York Services, Inc. is sold or
becomes part of another agency, your health information/record will become the
property of the new agency. For example, your charts will transfer over to the
new Agency.
II. When Central New
York Services, Inc. May Not Use or Share Your Health Information
Other than the items listed
above, Central New York Services, Inc. will not use or share your health
information without written permission. You can change your mind about written
permission that you have given at any time, and need only to tell us in writing
that you do not want to allow any further sharing of this information.
III. Your Health
Information Rights
NOTE: There may be times
when there are limitations and conditions to some of the following rights.
1. You have the
right to request that we not share your health information.
2. You have the
right to request that get your health information in a way that is helpful to
you. For example, if you are unable to come to our office, we may be able to
make some other arrangements for you. This request must be made in writing.
3. You have the
right to request to look at and copy your health information. This request must
be made in writing.
4. You have a right
to request that Central New York Services, Inc. fix any mistakes, or add any
missing information to your health information. Central New York Services, Inc.
will tell you what you can do if we refuse your request to change the
information.
5. You have a right
to receive a list of where your health information has been shared by Central
New York Services, Inc. Central New York Services, Inc. does not have to give a
listing of how information was shared in the following areas (see the list above
in Section 1): 1 (treatment), 2 (payment), 3 (health care operations), 5
(directory listings), 15 (certain government functions) and information provided
to you.
6. You have a right
to a paper copy of this Notice of Privacy Practices.
If you would like to have
more information about these rights, or if you would like to use one or more of
these rights, contact:
The Program Director of the
service, if you do not receive satisfactory follow up then contact:
Central
New York Services, Inc.
518 James Street, Suite 240
Syracuse, NY 13203
Attn: Luann M. Healy/Privacy Officer
Phone: 315-478-2453
Fax: 315-425-8917
IV. Changes to this
Notice of Privacy Practices
Central New York Services, Inc. has the right to change this Notice of Privacy
Practices at any time in the future. Until changes are made, Central New York
Services, Inc. is required by law to follow this current version of the Notice.
If a change is made, all
active clients of Central New York Services, Inc. will be given a new Notice of
Privacy Practices.
V. Complaints
Complaints about this Notice
of Privacy Practices or how Central New York Services, Inc. handles your health
information should be directed in writing to:
The Program Director of the
service you are complaining about. If you do not receive satisfactory follow-up
please contact:
Central
New York Services, Inc.
518 James Street, Suite 240
Syracuse, NY 13203
Attn: Luann M. Healy/Privacy Officer
Phone: 315-478-2453
Fax: 315-425-8917
If you are not satisfied
with the way this office handles a complaint, you may submit a formal complaint
to:
Department of Health and
Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
The Central New York Services, Inc. Notice of Privacy Practices is available
for download in two formats, MS Word Document, and Adobe Acrobat Document. Click
on the link for the version you would like.
Notice of Privacy Practices
in MS Word format.
 Notice of Privacy Practices
in Adobe Acrobat format.
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