Information for Patients

Maple City Health Care Center (MCHCC)-Notice of Privacy Practices

Uses and disclosure of Health Information
A. With your consent, we may use health information about you for treatment (such as sending your medical record information to a specialist physician as part of a referral), to obtain payment for treatment (such as sending billing information to a health insurance plan, and to honor my assignment of insurance benefits to insurance to pay directly for any series owed on your claims), for administrative purposes, and to evaluate the quality of care that you receive (such as comparing patient data to improve treatment methods).  

B. We may use and disclose your health information to contact you about appointments and other healthcare activities. These activities include, but are not limited to, appointment confirmations and reminders, general health reminders, invitations to schedule follow-up appointments, and lab results. You may be contacted by text message, pre-recorded messages, artificial voice messages, and/or automatic dialing system. Your phone plan’s standard message and data rates may apply.  

C. Subject to certain requirements, we may give out health information without your authorization for public health purposes, abuse or neglect reporting, and emergencies. We provide information when otherwise required by law, such as for law enforcement in specific circumstances. In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.  

D. We may participate in a health information exchange to facilitate continuity of care. We may disclose your health information, as permitted by law, to other health care providers or entities for treatment or health care operations purposes. 

E. How we use your personal information 
MCHCC is part of Organized Health Care Arrangements (OHCA) including participants in Indiana Lakes and the Clinically Integrated Network of Indiana (CINI). A current list of Indiana Lakes and CINI participants is available at https://goshenhealth.com/ilaco/indiana-lakes-network and www.cinindiana.com. As a business associate of MCHCC, Indiana Lakes and CINI supplies information technology and related services to MCHCC and other Indiana Lakes and CINI participants. Indiana Lakes and CINI also engage in quality assurance and improvement activities on behalf of its participants. For example, Indiana Lakes and CINI coordinate clinical review activities on behalf of participating organizations to establish best practice standards and assess clinical benefits that may be derived from the use of electronic health record systems. Indiana Lakes and CINI also help participants work collaboratively to improve the management of internal and external patient referrals. Your personal health information may be shared by MCHCC with other Indiana Lakes and CINI participants or a health information exchange only when necessary for medical treatment or for the health care operations purposes of the organized health care arrangement. Health care operations can include, among other things, geocoding your residence location to improve the clinical benefits you receive. Personal health information may include past, present, and future medical information as well as information outlined in the Privacy Rules.  

• Technology: for example, makes your patient record easier to use.
• Our services: for example, keep better track of referrals to other providers.
• Patient care: for example, finding the best way to treat a certain medical problem. 

The information, to the extent disclosed, will be disclosed consistent with the Privacy Rules or any other applicable law as amended from time to time. You have the right to change your mind and withdraw this consent; however, the information may have already been provided as allowed by you. This consent will remain in effect until revoked by you in writing. If requested, you will be provided a list of entities to which your information has been disclosed 

F. We may change our policy at any time.  Before we make a significant change in our policies, we will change our notice and post the new notice in the waiting area.  You can also request a copy of our notice at any time.  For more information about our privacy practices, contact the person listed below. 

Individual Rights  
A. In most cases, you have the right to look at or get a copy of health information about you that we use to make decisions about you.  If you request copies, there may be a charge to cover copying costs.  You also have the right to receive a list of instances when we have disclosed health information about you for reasons other than treatment, payment, or related administrative purposes.  If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information. 

B. You have the right to request that your health information be communicated to you in a confidential manner such as sending mail to an address other than your home. 

C. You may request in writing that we not use or disclose your information for treatment, payment, or administrative purposes or to persons involved in your care except when specifically authorized by you, when required by law, or in emergency situations. We will consider your request but are not legally required to accept it.  

Complaints 
If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the person listed below.  You may also send a written complaint to the U.S. Department of Health and Human Services. Under no circumstances will you be retaliated against for filing a complaint. 

Our Legal Duty 
We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices that are described in this notice. 

If you have questions or complaints, contact our HIPAA Compliance Officer: 
Jim Alvarez, HIPAA Compliance Officer 
Maple City Health Care Center, Inc. 
213 Middlebury St, Goshen IN-46528
574-534-3300