The Harold Leever Regional Cancer Center

Notice of Privacy Practices

This notice describes how medical health information about you may be used and disclosed and how you can get access to this information.
Please review it carefully.

What is the purpose of this Notice?
We respect the privacy of your health information and pledge to protect that information. This Notice describes your rights and our duties on the subject of your health information. It tells you about how we may use and give out (“disclose”) your personal medical information. This Notice applies to all information received or created by our employees, staff, and volunteers as well as by doctors and other health care staff who practice at The Harold Leever Regional Cancer Center (HLRCC).

Our promise to you about our duties and responsibilities:
We are required by law to protect the privacy of your information. We are also required to give you this notice about what we do with the information we collect and maintain about you. We must follow the practices described in this notice. The Notice will be posted in public areas in our building. We agree to consider any reasonable privacy requests and to notify you if we are unable to meet those requests. We will not use or give out you information without your permission, except as described in this notice.

Who will follow this Notice?
The Harold Leever Regional Cancer Center provides care to our patients together with physicians and other health professionals. This Notice will be followed by:
All employees of The Harold Leever Regional Cancer Center;
Any health professional who treats you at The Harold Leever Regional Cancer Center
Any health profession from St. Mary’s Hospital, Waterbury Hospital, or Waterbury Radiation Oncology Associates, P.C.

What are your rights as a patient?

You have the following rights regarding your health information at The Harold Leever Regional Cancer Center:

  • You have the right to ask us to limit how your personal medical information is used and given out for your care, for billing, and for our business reasons. If you give us a written request to limit this information, we will consider your request. Please understand that under the law, we do not have to accept it. You may also ask us to limit your medical information that we use and give out to a family member, friend or other person who is involved in your care or the payment for your care.
  • You have the right to see and get a copy of your medical or billing records or other written information that we may use to make decisions about your care, with some limited exceptions. In most cases, we may charge a reasonable fee for our costs in copying and mailing the information you have asked for. There are certain circumstances where we cannot agree to your request. In these cases, you will have the right to review the reasons why we did agree with your request. A licensed health care professional named by HLRCC will perform the review.
  • You have the right to request that we add to (“amend”) your health record if you believe that the information is incorrect or if you believe that important information is missing. Your request must be made in writing and must state the reason for your requests. If we disagree with your request, you may ask us to include your written statement requesting the change as part of your record. We will provide you a written statement that lists the reasons why we disagreed with your request.
  • You have the right to get a listing or “accounting” of those people or organizations that received your medical information from us. This listing includes disclosures made by HLRCC or by others on our behalf. It does not include disclosures for treatment, payment and our business operations or certain other exceptions. To request an accounting of disclosures, you must send us a request in writing. The first list provided within a 12-month period will be free. After that, we may charge you our costs.
  • You have the right to receive a paper copy of this Notice at any time upon request.
  • You have the right to request that we communicate with you about your health matters in a different way or at a different place. For example, you can ask that we contact you only at a certain phone number or address that may be different form your home address. We will agree to reasonable requests.

Who do I contact for more information or to report a problem?
If you believe that your privacy rights have been violated, you may file a complaint in writing with HLRCC by contacting the person below:

Deborah Parkinson,
Operations Manager and Privacy Officer
The Harold Leever Regional Cancer Center
1075 Chase Parkway
Waterbury, CT 06708
Telephone: 203-575-5564
Email: dparkinson@leevercancercenter.org

You may also file a complaint with the Office of Civil Rights in the U.S. Department of Health and Human Services at the following address:

Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201

There are no penalties if you file a complaint.

What happens if HLRCC changes this Notice?
We reserve the right to change this notice. We will post a copy of the current notice in HLRCC. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at HLRCC for treatment or health care services, you may ask for a copy of the current notice in effect. If we change this notice, you will be notified the next time you come to HLRCC and you may receive a new copy.

When and how will HLRCC use and/or give out your personal medical information?
We may use and disclose your health information for purposes of treatment, payment and health care operations (our business operations). There are times when we must use your personal medical information. The Harold Leever Regional Cancer Center must use and give out your personal medical information to provide information:

  • To you or someone who has the legal right to act for you (your personal representative).
  • To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected.
  • Where required by law, and
  • In certain emergency circumstances.

What are treatment, payment, and health care operations and what are some examples?
Treatment: Treatment is when we provide care to you. It includes many pieces including when physicians and others consult on your case or when referrals are needed. We will use and disclose your health information when we provide you with treatment and services, and to coordinate your care. Your health information may be used by doctors and nurses, as well as by lab technicians, dieticians, physical therapists, physicists, dosimetrists, radiologists or other personnel involved in your care. For example, a dosimetrist at HLRCC will need certain information to prepare a treatment plan ordered by your doctor. We may also disclose health information to individuals or facilities that will be involved in your care after you leave HLRCC.

Payment: Payment involves when we bill for services we provided. It also involves receiving payment from individuals or insurance companies. We will disclose your health information so that we can bill and receive payment for the treatment and services you receive. For billing and payment purposes, we may disclose your health information to your representative, insurance or managed care company, Medicare, Medicaid, or another payer. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed treatment or service. Payment information may include things that identify you, your diagnosis, procedures performed on you, and supplies we used.

Health Care Operations: Health care operations involves a variety of things that HLRCC must do to operate its business or administrative side. We may use and disclose your health information as necessary for HLRCC operations or business purposes. These may include management purposes and to monitor our quality of care. For example, health information of many patients may be combined and studied for purposes such as evaluating our employees and reviewing the qualifications and practices of doctors and other licensed health care staff at HLRCC. We also may use and disclose health information for education and training purposes.

In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician or health care provider. We may also call you by name in the reception area or waiting area when your physician or therapist is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

How else does The Harold Leever Regional Cancer Center use and disclose medical information?
We may also use and disclose health information about you for specific purposes. Below is a list of the various ways in which we may use or disclose your health information.

  • HLRCC Directory – Unless you object, we will include certain limited information about you in our scheduling system while you are a patient. We may give this information, including your religious affiliation, to any member of visiting clergy.
  • Patient Information Display – Unless you object, we will include your name, physician, and other necessary information on a patient services board located in the appropriate treatment planning or in private office areas. The patient services board is not in public areas.
  • Individuals Involved in Your Care or Payment for Your Care – Unless you object, we may disclose health information about you to a family member, close personal friend or other person you identify, including clergy, who is involved in your care. These disclosures are limited to information necessary for that person to help with your care or in arranging payment for your care.
  • Disaster Relief – We may disclose health information about you to an organization assisting in a disaster relief effort.
  • Emergencies – We may use or disclose your health information as necessary in emergency treatment situations. We will attempt to obtain permission from you or your representative as soon as possible.
  • Communication Barriers – We may use and disclose your protected health information if your physician or another physician in the practice tries to get permission from you but can’t because of language barriers. In this case, the physician will use reasonable judgment that you intend to give permission to use or disclosure information under the circumstances.
  • As Required By Law – We may disclose your health information when required to do so.
  • Public Health Activities – We may disclose your health information for public health activities. These activities may include, for example:
    • reporting to a public health or other government authority for the purpose of preventing or controlling disease, injury, or disability,
    • reporting child abuse or neglect, reporting births and deaths;
    • reporting to the federal Food and Drug Administration (FDA) issues concerning problems with products and product recalls, etc., or
    • to notify a person who may have been exposed to or is at risk of spreading a communicable disease, if authorized by law.
  • Reporting Victims of Abuse, Neglect or Domestic Violence – If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your health information to notify a government authority. This will happen if we are authorized or required by law or if you agree to the report. For child/elder abuse or neglect, we will disclose your health information to government authorities.
  • Health Oversight Activities – We may disclose your health information to a health oversight agency authorized by law. These may include, for example, Medicare audits, investigations, State Health Department inspections and licensure actions or other legal proceedings.
  • Legal Proceedings – We may disclose your health information response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process; efforts must be made to contact you about the request or to obtain an order or agreement protecting the information.
  • Law Enforcement – We may disclose your health information for certain law enforcement purposes. These include, for example, complying with reporting requirement or reporting emergencies or suspicious deaths; to comply with a court order warrant, or similar legal process; to identify or locate a suspect or missing person; or to answer certain requests for information concerning crimes
  • Research – Your health information may be used for research purposes, but only if the privacy aspects of the research have been reviewed and approved by the Institutional Review Boards, at either or both St. Mary’s Hospital or Waterbury Hospital, that have reviewed the research proposal and set standards to ensure the privacy of your protected health information.
  • Coroners, Medical Examiners, Funeral Directors, and for Organ Donation – We may release your health information to a coroner, medical examiner or funeral director. If you are an organ donor, we may disclose your information to an organization involved in the donation of organs or tissue.
  • To Avoid a Serious Threat to Health or Safety – Should it be necessary to prevent a serious threat to your health or safety or the health or safety of others, we may use or disclose health information. This type of disclosure will be limited to someone able to help lessen or prevent the threatened harm.
  • Military Activity and National Security – When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities believed necessary by appropriate military command authorities: (2) for the purpose of a determination by the Department of Veterans affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
  • Workers’ Compensation – We may use or disclose your health information to comply with laws relating to workers’ compensation or similar programs.
  • Inmates/Law Enforcement Custody – If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the institution or official for certain purposes including the health and safety of you and others.
  • Fundraising Activities – We may use your contact information such as your name, address and phone number and the dates you received treatment or services, to contact you in an effort to raise money for HLRCC. We also may disclose contact information for fundraising purposes to a foundation related to HLRCC.
  • Appointment Reminders – We may use or disclose health information to remind you about appointments.
  • Treatment Alternative and Health-Related Benefits and Services – We may use or disclose your health information to inform you about treatment alternatives and health-related benefits and services that may be of interest to you. For example, your name and address may be used to send you a newsletter about products or services that we believe may be beneficial to you.

Your authorization or permission is required for other uses of your medical information.

Except as described in this Notice, we will use and disclose your health information only with your written authorization. When you sign our Patient Agreement, you allow us to use and disclose you health information for treatment, payment and health care operations. A written authorization must specify other particular uses or disclosures that you may allow. You may revoke an authorization to use or disclose health information, in writing, at any time. If you revoke an authorization, except where we have already relied on the authorization.