As a result of your receiving services at WORK Inc. we obtain personal health information about you. By law, we must protect the privacy of your health information. This notice is intended to explain:
- When the agency may use and share your health information
- What your rights are regarding your health information
The agency may use or share your health information under the following circumstances:
- When required by law
- For billing activities, such as checking if you are eligible for services, submitting claims for payment and paying your health-care providers for services rendered
- To operate our programs
- To coordinate the treatment and services you get from your healthcare providers
- With other health agencies (such as Medicare, Medicaid, DMR, DMH, DPPC) for oversight activities authorized by law, including abuse investigations
- With other government agencies that give you benefits or services
- To prevent or respond to an immediate and serious health or safety emergency
Except as described above, WORK Inc. will not use or share your health information with anyone without your written permission. You may cancel your permission at any time, as long as you tell us in writing.
You have the right:
- To read your health information and get a copy of your records. You must ask for this in writing. If you need assistance with this, please contact one of the agency staff. 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 request. If you request copies of your informa-tion, we may charge a fee for the costs of the copying, mailing, or other supplies associated with your request.
- To ask WORK Inc. to change your health information if you think it is inaccurate or incomplete. You must tell us in writing which health information you want us to change and why. 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.
- To ask WORK Inc. to limit its use or sharing of your health information. You must send us written notification that specifies how and when we may share your information.
- 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, to your family, or guardian. We will respond within 60 days of receiving your written request. We will provide the list to you at no charge, but 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. To obtain a list of when and with whom the agency has shared your health information, you must send us a written request.
- If you give us permission to use or disclose your information, you may withdraw or cancel that permission, in writing, 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 permission.
- 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.
- You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.