REVIEW CAREFULLY. This notice details the privacy practices of Heritage
Case Management (HCM), including how health information about you may
be used and disclosed and how you can get this information.
of this Notice
Heritage Case Management has always maintained the privacy of your personal
information. The law now requires that we maintain the privacy of your
personal information and that we give you this notice detailing our
privacy practices, legal duties and your rights concerning your private
health information. HCM is required to follow the practices described
in this Notice as long as this Notice is in effect. This Notice will
take effect on April 14, 2003 and will remain in effect until it is
replaced. HCM reserves the right to revise or change this Notice at
any time. If there is a significant change in HCMs privacy practices
you will receive a copy of that change. A copy of the current notice
is available on this, the HCM website, www.heritagecasemgt.com.
You may request additional copies of this Notice at any time.
have any questions regarding this Notice, please contact our HIPPA Privacy
Officer, Ilene A. Peace at the telephone number or address listed below.
and Disclosures of Your Health Information
HCM uses and discloses your personal health information for purposes
of treatment/ services, payments and case management operations and
requires your written authorization to do so. You may revoke any such
authorization at any time.
HCM may use or disclose your personal health information to a
physician or other healthcare provider, which is providing treatment
/ services to you.
Your medical information may be used or disclosed to determine and
remit proper payment for covered services.
Management Operations: HCM may use or disclose your personal health
information in connection with the administration of your Plan of
Support, including such operations as professional review, coordination
of services, audit services and other administration activities.
Required by Law: HCM may use or disclose your health information
when it is required to do so by law.
HCM does not use or disclose your personal health information for
marketing purposes nor does it sell your information for any purpose.
Rights Regarding Health Information About You
You have the following rights regarding the personal health information
we maintain about you:
to Inspect and Copy: You have the right inspect and copy your
health information which HCM maintains.
to Amend: If you feel your health information maintained by HCM
is incorrect or incomplete, you may ask to amend the information by
contacting the HCM HIPPA Privacy Officer. Your request may be denied
if it does not include a reason to support the request.
to an Accounting of Disclosures: You have the right to request
an "accounting of disclosures" if any such disclosure was
made for any purpose other than treatment/services, payment or case
management operations. You must submit this request in writing to
the HCM HIPPA Privacy Officer.
to Request Restrictions: You have the right to request a restriction
or limitation on the health information we use or disclose about you
for treatment/services, payment or case management services. This
request must be submitted in writing to the HCM HIPPA Privacy Officer.
to Request Confidential Communications: You have the right to
request that we communicate with you concerning your health information
only in certain ways or at certain locations. You must submit this
in writing to the HCM HIPPA Privacy Officer.
you believe your privacy rights have been violated by HCM, please file
a written complaint to:
A. Peace, HIPAA Privacy Officer
Heritage Case Management
4 Chenell Drive, Suite 101
Concord, NH 03301
the Secretary of the Department of Health and Human Services.
You will not be penalized or retaliated against for filing a complaint.