Our Privacy Commitment to You:
TM Counseling of Fulton County provides many different services to you. We understand that information about you and your family is personal. We are committed to protecting your privacy and sharing information only with those who need to know and are allowed to see the information to assure quality services to you. TM Counseling of Fulton County is required by law to maintain the privacy of your health information and to provide you with the notice of its legal duties and privacy practices with respect to your health information. This notice tells you how TM Counseling of Fulton County uses and discloses information about you. It describes your rights and what TM Counseling of Fulton County’s responsibilities are concerning information about you. When we use the word “you” in this notice, we also mean your personal representative. Depending on your circumstances and in accordance with state law, this may mean your guardian, your healthcare proxy, or your involved parent, spouse, or involved adult family member.
If you have any questions about any part of this Notice or if you want more information about the privacy practices at TM Counseling of Fulton County, please contact:
Clinical Director, Privacy Officer
Gloversville Clinic
11-21 Broadway, Gloversville, NY 12078
(518) 725-4310
Who will follow this notice:
All people who work for TM Counseling of Fulton County will follow this notice. This includes employees, persons TM Counseling of Fulton County Contracts with who are authorized to enter information in your record or need to review your record to provide services to you, and volunteers who TM Counseling of Fulton County allows to assist you.
What information is protected:
All information that we create or keep that relates to your health or care and treatment, including but not limited to your name, address, birth date, social security number, your medical information, your service or treatment plan, and other information (including photographs or other images) about your care in our programs, is considered protected information. In this notice, we refer to protected information as protected health information or “PHI”. We create and collect information about you and we keep a record of the care and services you receive through this agency. The information about you is kept in a record; it may be in the form of paper documents in a chart, or on a computer. We refer to the information that we create, collect, and keep as a “record” in this Notice.
Your Health Information Rights:
Unless otherwise required by law, your record is the physical property of TM Counseling of Fulton County, but the information in it belongs to you and you have the right to have your information kept confidential. You have the following rights
concerning your PHI:
• You have the right to see or inspect your PHI and obtain a copy of the information. Some exceptions apply, such as information compiled for use in court or administration proceedings. NOTE: TM Counseling of Fulton County requires you to make your request for records in writing to the Privacy Officer. You may request copies in paper format or in an electronic form such as a CD, portable decide or memory stick. In some instances, we may charge you for copies.
• If we deny your request to see your information, you have the right to request a review of that denial. The Executive Director/designee will appoint a licensed health care professional to review the record and decide if you may have access to the record.
• You have the right to ask TM Counseling of Fulton County to change or amend information that you believe is incorrect or incomplete. We may deny your request in some cases, for example, if the record was not created by TM Counseling of Fulton County or if after reviewing your request, we believe the record is accurate and complete.
• You have the right to request a list of the disclosures that TM Counseling of Fulton County has made of your PHI. The list however does not include certain disclosures, such as those made for treatment, payment, and health care operations, or disclosures made to you or made to others with your permission.
• You have the right to request a restriction on uses or disclosures of your health information related to treatment, payment, health care operations, and disclosures to involved family. TM Counseling of Fulton County however is not required to agree to your request.
• You have the right to request that TM Counseling of Fulton County communicates with you in a way that will help keep your information confidential. You may request alternate ways of communication with you or request that communications are forwarded to alternative locations.
• You will be notified if there is a breach of unsecured PHI containing your information; we are required by federal law to provide notification to you.