Notice of Privacy Practices
Effective Date of this Notice 4/13/03
Effective Date of First Revision of this
Effective Date of Second Revision of this Notice 7/03/03
Effective Date of Third Revision of this Notice 8/01/03
Effective Date of Fourth Revision of this Notice 10/31/03
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Please review it carefully.
If you have any questions about this notice, please contact our Agency Compliance
Officer – David McCluskey - at 207-945-4240.
Health Information (PHI) is information, including demographic information,
that may identify you and relates to health care services provided to you, the
payment of health care services provided to you, or your physical or mental
health condition, in the past, present or future. The contents of this
information may include information we have created and recorded about you and information that we have received about you from another health
care providers, such as a hospitals, doctors, or therapists. This Notice of Privacy Practices describes
how we may use and disclose your PHI. It also describes your rights to access
and control your PHI. As a health care
provider, we are required by Federal Law to maintain the privacy of PHI and to
provide you with this notice of our legal duties and privacy practices. We are required to abide by the terms of this
Notice of Privacy Practices, but reserve the right to change this Notice at any
time. Any change in the terms of this Notice will be effective for all PHI that
we are maintaining at that time. If a change is made to this Notice, a paper
copy of the revised Notice will be provided to all individuals receiving
services from Community Care at that time.
Your Rights Regarding Your Medical Information
Community Care has implemented procedures, as described
by federal law, that allows you several rights.
Right To See And Get Copies Of Your Health Information
In most cases,
you have the right to look at or get copies of information that we have. If we
don’t have your information but we know who does, we will tell you how to get
it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request.
If we do, we will tell you in writing our reasons for the denial and how you
can have the denial reviewed. If you request copies of your information, we may
charge a fee for the cost of the copying, mailing, or other supplies associated
with your request.
Right To Correct Or Update Your Medical Information
If you believe that there is a mistake in your
information or that a piece of information is missing, you have the right to
request that we correct the existing information or add the missing
information. That request must be made in writing and you must provide a reason
for the change. We will respond within 60 days of receiving your request. We
may deny your request if it does not include a reason to support the request.
We may deny your request if the information in your record is correct and
complete, not created by us, not allowed to be looked at and copied for you, or
not a part of our records. Our written denial will tell you the reasons for the
denial and how to file a written statement of disagreement, should you choose
to submit one.
Right To Get A List Of The Disclosures We Have Made
You have the
right to get a list of instances in which we have disclosed your information.
This list will not include uses or disclosures that you have already consented
to, such as those made for treatment, payment or health care operations made
directly to you, your family or in our site directory. This list also won’t
include uses and disclosures we may have made for national security purposes,
to corrections or law enforcement personnel, or before the effective date of
this notice. We will respond within 60 days of receiving your written request and will include disclosures
made in the last six years, but not before the effective date of this notice,
unless you request a shorter time. We will provide the list to you at no
charge. If you make more than one
request in the same year, we may charge you a fee for each additional request. We
will notify you of the cost involved, and you may choose to withdraw or change
your request at that time.
Right To Request Limits On Uses And Disclosures Of Your Medical Information
You have the right to ask that we limit how we use and
disclose your information. We will consider your written request, but are not
legally required to accept it. If we accept your request, we will abide by it
except in emergency situations. You may not limit the uses and disclosures that
we are legally required or allowed to make.
Right To Choose How We Send Medical Information To You
You have the right to ask that we send information to you
at an alternate address or by alternate means to ensure confidentiality. We
must agree to your request so long as we can easily provide it in the format
and manner you requested.
Right To A Paper Copy Of This Notice
You have the right to a paper copy of this notice, and may ask us to give you one at any
time. You may also obtain a copy of this notice at our website, www.communitycareme.org.
Right To Withdraw Your Authorization To Use Or Disclose Your Medical Information
If you give us permission to use or disclose your
information, you may withdraw or cancel that permission at any time. If you
withdraw your permission, we will no longer use or disclose medical information
about you for the reasons covered by your written authorization. You understand
that we are unable to take back any disclosures we have already made with your
Required Uses and Disclosures
We are required to provide you, your personal
representative (except in certain circumstances) or your guardian (dependent on
state law) with a copy of your information upon your request. We are required to provide your information to the Secretary of Health
and Human Services of The United States Government upon his or her request for
the purposes of investigation and matters relating to complaints concerning
Community Care’s practices, policies and/or procedures under the Privacy Rule.
Permitted Uses and Disclosures
Treatment, Payment and Health Care Operations
Federal law allows a health
care provider to use and disclose PHI, for the purposes of treatment, payment
and health care operations, without your consent or authorization. Examples of
the uses and disclosures that we, as a health care provider, may make under
each section are listed below:
Treatment refers to the
provision and coordination of health care services by a therapist,
psychiatrist, mental health professional, social worker, psychologist, nurse,
case manager, or other mental health treatment professionals responsible for
your care. For example, assessments
completed by your therapist will be documented within your record. As a member of a larger treatment team,
information on your assessment such as diagnosis and initial treatment plan may
be shared with the entire treatment team.
Payment refers to the
activities of a health care provider such as obtaining
or providing reimbursement for the provision of health care, determining eligibility or
coverage, billing, claims
management, collection activities, review of health care services with respect
to medical necessity, coverage under a health plan, appropriateness of care, or
justification of charges, and utilization review activities, including
pre-certification and preauthorization of services and concurrent and
retrospective review of services. For
example, we may collect your name, social security number, diagnosis, treatment
location, and type of procedure in order to complete a claim form. We may then send that claim form to your
insurance company so that we may receive payment from them for the services we provided.
Health Care Operations.
Health Care Operations refers to the basic business
functions necessary to operate as a health care provider. Examples of uses and disclosures under this
section include: conducting quality assessment and improvement activities, including
outcomes evaluation and development of clinical guidelines; protocol
development; reviewing the competence or qualifications of staff; evaluating
staff performance; conducting training programs in which students, trainees, or
practitioners in areas of health care learn under supervision to practice or
improve their skills as health care providers; accreditation, certification,
licensing, or credentialing activities; legal services and auditing functions,
including fraud and abuse detection and compliance programs; and other related
functions that do not include treatment. For example, we may review information in your record to see if you and other clients at
Community Care are meeting their treatment goals. We will then analyze this information and
makes changes to the way we provide care. We may read your treatment plans and those of others we are treating at
Community Care to ensure that your therapist and other treatment professionals
are completing the treatment plans in a timely manner. We may review your record, and many others at
Community Care, to help us prepare for a forthcoming licensing or accreditation
Other Uses and Disclosures Allowed Without Authorization
We will allow our business associates to use your health information if needed.
For example: Some functions
are provided by people or companies, known as business associates, who are not
employed by us. Community Care uses a
third party billing company to help us bill for services. Therefore, we provide
them information to complete a claim form. Community Care requires business associates to protect our clients’
health information through a Business Associate Agreement.
We will provide information about you for use in our site directory.
For example: Unless you tell us not to,
we will share your name and location in the facility with other people who ask
for you by name. We also may give your name and location to members of the clergy.
We will give information to:
A family member or friend
who is involved in your care, persons who help pay for your care, or an
organization assisting in disaster relief efforts so that your family can be
told about your condition and location.
We may provide your health information to coroners, medical examiners, and funeral directors.
For example, this could be
needed to identify a deceased person or allow funeral directors to carry out
We may share your health information with organ transplant organizations...
...or groups that manage, bank,
or transplant organ and tissue donations.
We may call you about appointments or treatment.
For example: To remind you about a scheduled appointment at
We may use your health information for fundraising activities.
For example: We may use
information about you to contact you in an effort to raise money for Community
We may use your health information for research purposes.
For example: We may use information about you if you
are a participant in a research study conducted by Community Care.
We will share health information about you to assist public health activities or as required by law.
For example, to: Prevent or control disease, injury,
or disability; report births, deaths, and child abuse or neglect; report
reactions to medications or problems with faulty products; notify people of
recalls of products they may be using; notify a person who may have been
exposed to a disease or may be at risk for getting or spreading a disease or
condition; or, notify an appropriate government authority if we believe a
patient has been the victim of abuse, neglect, or domestic violence.
We may use your health information for Worker’s Compensation.
For example: If you are injured on the job, we may
share information about you for workers’ compensation or similar programs that
provide benefits for work-related injuries or illness.
We may share your health information with a correction institution.
For example, if you are an inmate or in the custody of law enforcement, your information will be shared, to provide
you with health care, protect your health and safety, protect the health and
safety of others, or assist in the safety and security of the correctional
We will give your health information to law enforcement.
For example, we may share your health information as
needed in response to a court order, subpoena, warrant, summons, or similar
process; to identify or locate a suspect, fugitive, material witness, or
missing person; if we suspect you are a victim of an accident or crime; if
death occurs, which we believe may be the result of a crime; or, in an
emergency to report a crime committed on the premises; the location of the
crime or victims; or identity, description or location of the person who
committed the crime.
If you would like to file a complaint regarding Community Care’s privacy practices, policies or procedures
OR you think your rights under this notice have been violated, please feel free
to contact Community Care’s Privacy Officer, David McCluskey, at 207-945-4240. Mr. McCluskey will work
with you to resolve your complaint. You may also contact the Secretary of the United States Department of Health and
Human Services at 1-877-696-6775. You will not be penalized or otherwise retaliated against for filing a complaint.
Revision Dates: 5/13/03, 7/03/03, 8/01/03, 10/31/03