Notice of Privacy Practices

UNDERSTANDING YOUR HEALTH RECORD/INFORMATION:

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. This information is often referred to as your health or medical record. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. Your record serves as:

• A basis for planning your care and treatment
• A means of communication among the many health professionals who contribute to your care
• A legal document describing the care you received
• A means by which you or a third-party payer can verify that 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 the nation
• A source of data for facility 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 ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosures to others.

YOUR HEALTH INFORMATION RIGHTS:

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you.

• You have the right to inspect or obtain a copy of your health record (except where restricted by law) upon your written request.
• You have the right to request an amendment of information in your health record that you believe is incorrect or incomplete. Any requests for amendments to health information must provide the reason for the amendment. We can process your request more quickly if you prepare the form called Requests for Amendment of Health Information.
• You have the right to obtain an accounting of disclosures of your health information. This is a list of the disclosures of your information; however, we are not required to agree to a requested restriction.
• You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can request that we only contact you at work or by mail.
• You have the right to revoke your authorization to use or disclose health information, except to the extent that action has already been taken. Any request must be made in writing.

FOR MORE INFORMATION OR TO REPORT A PROBLEM:

If you have questions and would like additional information, you may contact the Executive Director at (301) 745-3777. If you believe your privacy rights have been violated, you can file a complaint in writing with our Executive Director at 201 S. Cleveland Avenue, Hagerstown, MD 21740 or with the U.S. Secretary of Health and Human Services, Office of Civil Rights. There will be no retaliation for filing a complaint.

CHANGES TO THIS NOTICE:

We reserve the right to change our practices and amend our notice of privacy practices, effective for all protected health information we maintain for now and the future. An amended Notice shall be available to you in paper form upon request.

Effective Date:  March 23, 2004

Walnut Street Community Health Center, Inc. does business as Family Healthcare of Hagerstown (FHH).  This health center receives funding through Health and Human Services (HHS) and is a grantee under 42 U.S.C. 254b. FHH has Federal Public Health Services (PHS) deemed status related to certain health or health-related claims under 42 U.S.C. 233(g)-(n).  This includes medical malpractice claims for itself and its covered individuals.  FHH is a nonprofit organization under section 501(c)3 of the IRS Code.  Family Healthcare is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) with an award totaling $1.8 million.  The contents of this presentation are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. This institution is an equal opportunity provider and employer.