Ontario County Notice of Privacy Practice
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please Review it carefully.

Effective April 14, 2003, Ontario County must tell you how we use, share and protect your health information. Ontario County includes the offices of Public Health, Substance Abuse Services, Community Mental Health Services, Social Services and the Health Facility.

Your Health Information is Private
We are required to keep your information private, share your information only when we need to, and follow the privacy practices in this notice. We must make special efforts to protect the names of people who get HIV/AIDS or drug and alcohol services.

What Health Information Does Ontario County Have?
When you apply to any of the Ontario County programs listed above, you may provide us with information about your health. When we talk to your doctors, clinics, hospitals, managed care plans and other treatment providers, we also get information about your health, treatment and medications.

How Does Ontario County Use and Share Your Health Information?
We must share your information when:

• You or your representative requests your health information
• Government agencies request the information as allowed by law (such as when they perform audits)
• The law requires us to share your information
• We bill your insurance company, Health Maintenance Organization (HMO), Medicaid or Medicare for the health services we have provided to you
• We work with your doctor, hospital or other treatment provider to provide health services to you
• We review your health information to assure that you have received the best health care
• We contact you about important medical information
• We prevent or respond to serious health or safety problems for you or your community as allowed by federal and state laws

We must get your written permission to use or share your health information for any purpose not mentioned in this notice.

What Are Your Rights?
You or your representative has the right to:

• Get a paper copy of this notice
• See or get a copy of your health information. If your request is denied, you have the right to review the denial
• Ask to change your health information. We will look at all requests, but we may not always be able to make the changes you have requested.
• Ask to limit how we use and share your information. We will look at all requests, but do not have to agree to do what you ask.
• Ask us to contact you regarding your health information in different ways (for example, you can ask us to send you mail to a different address or call a different phone number.)
• Ask for special forms that you sign permitting us to share your health information with whomever you choose. You can take back your permission at any time, as long as the information has not already been shared.
• Get a list of those who have received your health information. This list will not include health information requested by you or your representative, information used to operate our programs, information used to receive payment for having provided your health care, information given out for law enforcement or judicial purposes, or information used directly in providing your health care.

See the Ontario County website for a copy of this notice.

For more privacy information, to make a request or to report a privacy problem / complaint, please contact the County Administrator’s Office at:
(585) 396-4400.

You may also report a complaint to: The Office for Civil Rights, Department of Health and Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312, New York, New York, 10278; (Telephone) (212) 264-3313 or (800) 368-1019; (Fax) (212) 264-3039; or (TDD) (212) 264-2355.

Note: *You will not be penalized for filing a complaint.

If we change the information in this notice, we will post a new notice on the Ontario County website. We will also provide you with a new copy if you ask us to do so.