ONTARIO COUNTY

OFFICE FOR THE AGING
NOTICE OF PRIVACY PRACTICES

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.

The Office For the Aging provides many different services to you. All health information in our possession is maintained confidentially by the Office For the Aging. When the Office For the Aging assists you in obtaining benefits and/or services, we may share your health information with appropriate agencies. We are required by law to provide you with this notice of privacy practices to let you know how your health information is used and disclosed.

Effective Date of This Notice: April 14, 2003

Your Health Information Rights:
Unless otherwise required by law, your health record is the physical property of the Office For the Aging, but the information in it belongs to you and you have the right to have your health information kept confidential. You, or a person legally authorized to act for you, (e.g., parents of a minor child, guardian, healthcare proxy) have a right to:

• Get a paper copy of this notice of privacy practices upon request;
• See or get a copy of your health information for a reasonable fee; if denied you have the right to request a review of the denial;
• Request amendments to your health information;
• Request limits on certain uses and disclosures of your information;
• Get a list of disclosures of your health information;
• Request communications of your health information by alternative means or at alternative locations;
• Revoke any special authorizations to use or disclose health information, except to the extent that the disclosure has already been made.

You can exercise your rights by contacting Diane Biek, Sr. Human Service Worker, Office For the Aging, 3010 County Complex Drive, Canandaigua, NY, 14424 at 585-396-4040, e-mail address: onofa@co.ontario.ny.us.

NOTE: Special rules apply which restrict access to psychotherapy notes, HIV/AIDS information and federally protected drug and alcohol information. See any special authorizations or consent forms which will specify what information may be released and when, or contact the person listed above.

What Are Our Responsibilities to You?
We must maintain the privacy of your health information, and give you this notice that tells you how we will keep your health information private. We must tell you if we are unable to agree to a limit on the use or disclosure that you request. We will carry out reasonable requests to communicate health information to you by special means or at other locations and get your written permission to use or disclose health information in ways other than those set out in this notice. We have the right to change our practices regarding the health information we keep. If practices are changes, we will tell you by sending you a new notice, or you may request one at your next visit. Notices will be posted on our website: www.co.ontario.ny.us/aging and in our office at 3010 County Complex Drive, Canandaigua, NY, 14424.

How Does the Program Use or Disclose Your Health Information?
For Treatment: Information is used and disclosed to provide you with healthcare services. For example, we may talk with your doctor or other treatment provider about your care.

For Payment: The Office For the Aging may use and disclose your health information to others (for example, your insurance company, HMO, Medicaid or Medicare) .

For Health Care Operations: Health information is used and disclosed for operational reasons (for example, your information may be used to assess the quality of care provided to you or others, to improve services and facilities, or to train and evaluate staff).

For Appointments and Health Related Benefits: With your permission, we may use and disclose information for appointment reminders, or information about treatment and benefits.

For Disclosures to Friends and Family: We may disclose your health information to friends and family who are involved in your care, with appropriate consent.

In certain other situations, the (program or department) can use and disclose information without your authorization:

For Serious Threats to Health and Safety: Your health information may be disclosed to avert a serious threat to public health and safety, as permitted by law.

If Required by Law or for Law Enforcement: The Office For the Aging may use and disclose information as required by law. For example, for the mandatory reporting of child abuse and neglect, for domestic violence, for judicial or administrative proceedings if required by legal process, for certain law enforcement purposes (e.g. to aid in locating a fugitive, to report crimes on our locations) for worker's compensation and for similar programs established by law.

For Public Health Reasons: The Office For the Aging may use or disclose information for required public health activities such as controlling disease or injury.

For Health Oversight Reasons: Information may be disclosed when required to monitor the level and quality of care you receive.

For a Contracted or Affiliated Purpose: Our contractors, agents and partners may be given health information if necessary for them to perform certain services for us. For example, the Office For the Aging may share information with companies, attorneys and auditors if they agree to keep such information confidential.

For More Information or to Report a Problem: If you have questions, need more information or believe your privacy rights have been violated and you wish to complain or obtain a complaint form, you may contact:

• Diane Biek, Sr. Human Service Worker, Office For the Aging, 3010 County Complex Drive, Canandaigua, NY, 14424, at 585-396-4040, e-mail address: onofa@co.ontario.ny.us.

You may also complain to the Office for Civil Rights, Department of Health and Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312, New York, New York 10278; (telephone number) (212) 264-3313; (fax number) (212) 264-3039; (TDD) (212) 264-2355.

*You will not be retaliated against for filing a complaint or assisting in an investigation*