We will use or disclose your protected health information as needed to arrange for payment for service to you.  For example, information about your diagnosis and the service we render is included in the bills that we submit to your health insurance plan.  Your health plan may require health information in order to confirm that the service rendered is covered by your benefit program and medically necessary.  A health care provider that delivers service to you may need information about you in order to arrange for payment for its services. 

It may also be necessary to use or disclose protected health information for our health care operations or those of another organization that has a relationship with you.  For example, our quality assurance staff reviews records to be sure that we deliver appropriate treatment of high quality.  Your health plan may wish to review your records to be sure that we meet national standards for quality of care. 

It is our policy to obtain a general written permission from individuals, in the form of a Consent, to our disclosure of general health information for purposes of arranging services necessary to carry out our role as the Single Point of Access/Entry for case management and residential services for adults and children.  This general written permission will allow Onondaga Case Management Services, Inc., with the individual’s permission, to begin the process of helping create a community plan for services and ensuring access to appropriate services.

When indicated, it is also our policy to obtain specific written permission from individuals, in the form of an Authorization, before disclosing their health information to a specific health care provider for purposes of arranging treatment or services. 

Emergencies.  If there is an emergency, we will disclose your protected health information as needed to enable people to care for you. 

Disclosure to your family and friends.   If you an adult, you have the right to control disclosure of information about you to any other person, including family members or friends.  If you ask us to keep your information confidential, we will respect your wishes.  But if you don’t object, we will share information with family members or friends involved in your care as needed to enable them to help you.

Disclosure to health oversight agencies.  We are legally obligated to disclose protected health information to certain government agencies, including the federal Department of Health and Human Services. 

Disclosures to child protection agencies.  We will disclose protected health information as needed to comply with state law requiring reports of suspected incidents of child abuse or neglect. 

Other disclosures without written permission.  There are other circumstances in which we may be required by law to disclose protected health information without your permission.  They include disclosures made:

Disclosures with your permission.  No other disclosure of protected health information will be made unless you give written Authorization for the specific disclosure.

Right to request confidential communications.  You may request that communications to you, such as appointment reminders be made in a confidential manner.  We will accommodate any such request. 

Right to request restrictions on use and disclosure of your information.  You have the right to request restrictions on our use of your protected health information for particular purposes, or our disclosure of that information to certain third parties.  We are not obligated to agree to a requested restriction, but we will consider your request. 

Right to revoke a Consent or Authorization.  You may revoke a written Consent or Authorization for us to use or disclose your protected health information.  The revocation will not affect any previous use or disclosure of your information. 

Right to review and copy record.  You have the right to see records used to make decisions about you.  We will allow you to review your record unless a clinical professional determines that would create a substantial risk of physical harm to you or someone else.  If another person provided information about to our clinical staff in confidence, that information may be removed from the record before it is shared with you.  We will also delete any protected health information about other people.   

At your written request, we will make available a copy, an original, or both, of your record for you to inspect.  We may charge a reasonable fee for this service.  We will provide a form for you to make this request and will respond to this request within 10 days.  We will arrange with you a convenient time and place for you to review or inspect your record.  We may ask that a case manager or other professional staff be present while you review the record but do not require this in order for you to have access.

Right to "amend" record.  If you believe your records contains an error, you may ask us to amend it.  If there is a mistake, a note will be entered in the record to correct the error.  If not, you will be told and allowed the opportunity to add a short statement to the record explaining why you believe the record is inaccurate.  This information will be included as part of the total record and shared with others if it might affect decisions they make about you. 

Right to an accounting.  You have the right to an accounting of some disclosures of your protected health information to third parties.  This does not include disclosures that you authorize, or disclosures that occur in the context of treatment, payment or health care operations.  We will provide an accounting of other disclosures made in the preceding six years.  If requested by law enforcement authorities that are conducting a criminal investigation, we will suspend accounting of disclosures made to them.   

Right to a paper copy of this Notice.  You have the right to a paper copy of any Notice of Privacy Practices.

How to Exercise Your Rights

Questions about our policies and procedures, requests to exercise individual rights, and complaints should be directed to our Contact Person. 

Our Contact Person is Scott Ebner.  The Contact Person can be reached at 315-472-7363. 

Personal representatives.  A “personal representative” of a patient may act on their behalf in exercising their privacy rights.  This includes the parent or legal guardian of a minor.  In some cases, adolescents who are “mature minors” may make their own decisions about receiving treatment and disclosure of protected health information about them.  If an adult is incapable of acting on his or her own behalf, the personal representative would ordinarily be his or her spouse or another member of the immediate family.  An individual can also grant another person the right to act as his or her personal representative in an advance directive or living will. 

Disclosure of protected health information to personal representatives may be limited in cases of domestic or child abuse. 

If you have any complaints or concerns about our privacy policies or practices, please submit a Complaint to our Contact Person.  If you wish, the Contact Person will give you a form that you can use to submit a Complaint if you wish. 

You can also submit a complaint to the United States Department of Health and Human Services.  Send your complaint to:

We will never retaliate against you for filing a complaint.