NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH 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 the Center's Privacy Officer at: (701) 873-4445

For a printer friendly PDF of this notice, please click here.

WHO WILL FOLLOW THE PRIVACY PRACTICES DESCRIBED IN THIS NOTICE

This Notice of Privacy Practices (Notice) describes the privacy practices of Coal Country Community Health Center and its workforce members (including employees, contractors, physicians, nurses, other licensed or certified personnel, volunteers, and front desk, billing and administrative personnel) who have a need to use your health information to perform their jobs. It also applies to any individuals authorized to enter information into your record. Your other health care providers may have different policies regarding their use and disclosure of your health information created at their location.

ABOUT YOUR HEALTH INFORMATION

We understand that health information about you and your health is personal, and protecting your health information is important to us. We create a record of the care and services you receive at Coal Country Community Health Center. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by Coal Country Community Health Center, whether made by CCCHC personnel or other health care providers, whether stored and transmitted electronically or by other means. We are required by law to:

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that we may use and disclose health information. Following each category is an explanation. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

ADDITIONAL USES AND DISCLOSURES OF HEALTH INFORMATION:

SPECIAL SITUATIONS

YOUR PRIVACY RIGHTS

You have the following rights regarding health information we maintain about you:

CHANGES TO THIS NOTICE

We reserve the right to change this Notice at any time. We reserve the right to make the revised or changed Notice effective for all health information we have about you as well as any information we receive in the future. We will post a copy of the current Notice at CCCHC. The Notice will contain the effective date on the first page, in the top right-hand corner. If we amend this Notice, we will offer you a copy of the current Notice in effect. You may request a copy of the current Notice each time that you visit CCCHC for services or by calling us and requesting that the current Notice be sent to you in the mail.

FOR MORE INFORMATION, TO FILE A COMPLAINT OR TO REPORT A PROBLEM

If you believe that your privacy rights have been violated, please let us know promptly so we can address the situation. You may file a complaint with CCCHC and/or with the Secretary of the federal Department of Health and Human Services. All complaints must be submitted in writing.

To file a complaint with the Center, send a written complaint to the Center's Privacy Officer at:

Coal Country Community Health Center
1312 Highway 49 North
Beulah, ND 58523
Attention: Privacy Officer

If you would like to discuss a problem without submitting a formal complaint, you may contact the Privacy Officer by telephone at (701) 873-4445; or by facsimile at (701) 873-4199.

OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will stop the uses and disclosures allowed by that permission, except to the extent that we have already acted in reliance on your permission. For example, we are unable to take back any disclosures we have already made with your permission.

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE

We will ask you to sign an acknowledgment that you received this Notice.

This notice is effective September 23, 2013