Notice of Privacy Practices (HIPAA)

Genesee County Department of Mental Health

Effective Date: 4/15/2003

Notice of Privacy Practices (HIPAA)
(Short Form)

THIS NOTICE DESCRIBES HOW INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. Our Commitment to You: We at Genesee County Mental Health Services (GCMHS) understand that the information we collect about you and your health is personal. Keeping your health information confidential and secure is one of our most important responsibilities. We keep a record of the care and services you receive at this facility. We need this record to provide you with quality care and to comply with certain legal requirements. We are committed to protecting your health information and to following all state and federal laws regarding the protection of your health information.

We are required by law to:

  • make sure that health information that identifies you is kept private
  • give you this notice of our privacy practices with respect to health information about you
  • follow the terms of the notice that is currently in effect

2. How we may use and disclose health information about you: For some activities, we must have your written authorization to use or disclose your health information. However, the law permits GCMHS to use or disclose your health information for the following purposes without your authorization:

  • For Treatment and Payment for Treatment
  • For Health Care Operations
  • For Other Government Agencies Providing Benefits or Services
  • When Required by Law
  • To Avert a Serious Health or Safety Threat
  • For Public Health Risks
  • For Health Oversight Activities
  • In response to Lawsuits and Disputes
  • For Law Enforcement, Coroners, Medical Examiners and Funeral Directors
  • Organ Donation
  • For National Security and Protection of the President
  • For the Military

3. Your Health Information Rights: You have the following rights regarding health information we have about you:

  • RIGHT to request an opportunity to Inspect and Obtain Copies
  • RIGHT to request an opportunity to Amend your health information
  • RIGHT to receive a List of Disclosures we have made
  • RIGHT to request Restrictions in the Disclosure of your health information
  • RIGHT to request Confidential Communications from us to you
  • RIGHT to a full and complete Paper Copy of this Notice

If you would like to exercise one or more of these rights, ask the Receptionist or your Therapist, or contact the Clinical Director at 585-344-1421.

If you do not object - and the situation is not an emergency - and disclosure is not otherwise prohibited by stricter laws, we are permitted to release your health information under the following circumstances:
To Individuals Involved in Your Care: We may release your health information to a family member, other relative, friend, or other person who you have identified to be involved in your health care or the payment of your health care.
To Family: We may use your health information to notify a family member, a personal representative or a person responsible for your care, of your location, general condition, or death.
To Disaster Relief Agencies: We may release your health information to an agency authorized by law to assist in disaster relief efforts,

4. What is NOT Covered under this Notice

  • Confidential HIV Related Information:
    Under New York State Law, confidential HIV- related information (information concerning whether or not you have had an HIV- related test, or have HIV infection, HIV-related illness, or AIDS, or which could indicate that a person has been potentially exposed to HIV), cannot be disclosed except to those people you authorize in writing to have it.
  • Alcohol or Substance Abuse Treatment Information:
    If you have received alcohol or substance abuse treatment from an alcohol/substance abuse program that receives funds from the United States government, federal regulations may protect your treatment records from disclosure without your written authorization.

5. For More Information or to Report a Problem:
If you have any questions about this notice or if you believe your privacy rights have been violated, you may request information or file a complaint with any or all of the agencies listed below. There will be no penalty or retaliation for filing a complaint:

Genesee County Mental Health Services
5130 East Main St. Rd. - Suite 2
Batavia, NY 14020
Director
Call: 585-344-1421
Fax: 585-344-8554		 Office for Civil Rights
Phone: 866-OCR-PRIV (866-627-7748)
or TDD 877-521-2172
886-788-4989 TTY.
NYS Office of Mental Health
Buffalo Field Office
737 Delaware Avenue - Suite 200
Buffalo, NY 14209
Director
Call: 716-885-4219
Fax: 716-885-4096		 Secretary of Health and Human Services
200 Independence Avenue, SW
Federal Center for Deaf and Hearing
Washington, D.C. 20201
Impaired: 1-800-877-8339
Toll Free Phone: 877-696-6775