Privacy Contact Phone Numbers:

We at Central Maine Medical Family are committed to protecting the confidentiality of your medical information, and are required by law to do so. The Notice of Privacy Practices describes how we may use your medical information and how we may disclose it to others. The notice also describes the rights you have concerning your own medical information. Please review it carefully and let us know if you have questions. We will ask you to sign an acknowledgement that you received our Notice of Privacy Practices.

We regard the safeguarding of your personal identifiable information as an important duty. This information includes your name, address, and telephone number or medical services provided to you and anything else that could be used to identify you. The elements of this notice, the consents or authorizations you sign are required by state and federal law for your protection and to ensure your informed consent to the use and disclosure of information necessary to support your relationship with us. We have in place safeguards to protect the privacy of your information. Our staff is regularly trained on the obligation to protect the privacy of our patients. We hold medical records in a secure area within the facility. Only staff members that have a “need to know” are permitted access to your medical records or other information. Our staff understands the legal and ethical obligation to protect your information. A violation of this Notice of Privacy Practices will result in disciplinary action.


How will we use your medical information and share it with others?

Treatment: We may use your medical information to provide you with medical services and supplies. We may also share your medical information with others who need to treat you. This includes; doctors, physician assistants, nurses, medical and nursing students, technicians, therapists, emergency service and medical transportation providers, medical equipment providers, medical imaging technologists, and others involved in your care. For example, we will allow your physician to have access to your medical record to assist in your treatment and for follow-up care.

We may contact you to remind you of an upcoming appointment, to inform you about possible treatment options, or to tell you about health-related services available to you.

We will use and share your medical records in an emergency to ensure you receive the necessary medical services.

If there is a substantial communication barrier and we try but cannot obtain your consent, and your doctor, using his or her professional judgment, concludes that you consent to the use or disclosure of your medical record, the necessary information will be shared.

Patient Directory: To help family members and visitors locate you while you are in the Hospital, the Hospital has a patient directory. This directory includes your name, where you are in the Hospital and religion (if any). You have the option, at registration, to limit who has access to this information.

Family Members and Others Involved in Your Care: We may share your medical information with a family member or friend who is involved in your medical care, or to someone who helps pay for your care. We also may share your medical information with disaster relief organizations to help locate a family member or friend in a disaster. If you do not want us to share your medical information with family members or others, please let us know.

Payment: We may use and share your medical information to get paid for the medical services and supplies we provide to you. For example, your health plan or health insurance company may ask to see parts of your medical record (chart) before they will pay us for your treatment.

Health Care Operations: We may use and share your medical information if it is necessary to improve the quality of care we provide to patients or to run the facility. We may use your medical information to look for ways to improve your care. For example, we may look at your medical record (chart) to evaluate whether staff, your doctors, or other health care professionals did a good job.

Research: We may use or share your medical information for research projects, such as studying how well a type of treatment worked. These research projects must go through a special process that protects the confidentiality (privacy) of your medical information.

Required by Law: Federal, state, or local laws sometimes require us to share patients’ medical information. For instance, we are required to report child abuse or neglect and must provide certain information to law enforcement officials in domestic violence cases. We also are required to give information to the State Workers’ Compensation Program for work-related injuries.

Public Health: We may report certain medical information for public health purposes. We may need to report patient problems with medications or medical products to the Food and Drug Administration (FDA). Notify patients of recalls of products they are using.

Public Safety: We may share medical information for public safety purposes in limited circumstances. We may share medical information to law enforcement officials in response to a search warrant or a grand jury subpoena. We may share medical information to assist law enforcement officials in identifying or locating a person. To prosecute a crime of violence, to report deaths that may have resulted from criminal conduct, and to report criminal conduct at the facility. We may share your medical information to law enforcement officials and others to prevent a serious threat to health or safety.

Health Oversight Activities: We may share medical information with a government agency that oversees the Facility or its staff, such as the State Department of Health & Human Services, the federal agencies that oversee Medicare, the Board of Medical Examiners or the Board of Nursing. These agencies need medical information to watch how well we follow state and federal laws.

Coroners, Medical Examiners and Funeral Directors: We may share medical information concerning patients who have died to coroners, medical examiners and funeral directors. We may share medical information to groups that handle organ, eye or tissue donation or transplantation.

Military, Veterans, National Security and Other Government Purposes: If you are a member of the armed forces, we may release your medical information as required by military command authorities or to the Department of Veterans Affairs. We may share medical information to federal officials for intelligence and national security purposes, or for presidential Protective Services.

Judicial Proceedings: We may share medical information if a court orders us to or if we receive a subpoena or a search warrant.

Information with Additional Protection: Certain types of medical information have additional protection under state or federal law. For instance, medical information about HIV/AIDS, mental health, and alcohol and drug abuse treatment has more protection in Maine. We are required in many circumstances to get your permission before sharing this information.

Other Uses and Disclosures: If we wish to use or share your medical information for a reason that is not discussed in this Notice, we will seek your permission. If you give your permission, you may change your mind at any time, unless we have already relied on your permission to use or share the information. If you want to change your mind about sharing your medical information, please notify the Privacy Office in writing.

What are your rights?

Right to Request Your Medical Information: You have the right to look at your own medical information and to get a copy. (The law requires us to keep the original record.) This includes your medical record, your billing record, and other medical records we use to make decisions about your care. To request a copy of your medical information, write to the Medical Records Department. We will respond to your request as soon as possible, but no later than 30 days from the date of your request. When you request a copy of your information, we will tell you then how much the copy will cost. You can look at your record at no cost.

However, you do not have the right to psychotherapy notes or information gathered in reasonable anticipation of a civil, criminal, or administrative proceeding. Your right of access may be limited if providing this information could endanger the health or safety of yourself or others.

Right to Request Changes to your Medical Information: If you look at your medical information and believe that some of the information is wrong or incomplete, you may submit a request to have it fixed. To request a change, write to the Medical Records Department. We will respond as soon as possible, but no later than 60 days from the date of your request. If we deny your request, you have the right to submit a written statement of reasonable length disagreeing with the denial. We then have the right to send a rebuttal statement.

Right to Get a List of Certain Disclosures of Your Medical Information: You have the right to request a list of many of the disclosures we make of your medical information. This list does not include information used for treatment, payment, health care operations or any information released with your consent. If you would like to get a copy of the list, write to the Medical Records Department. We will respond as soon as possible, but no later than 60 days from the date of request. We will provide the first list to you free, but we may charge you for any additional lists you request during the same year. We will tell you in advance what this list will cost.

Right to Request Restrictions on How We Will Use or Share Your Medical Information for Treatment, Payment, or Health Care Operations: You have the right to request us not to share your medical information for your treatment, payment for care, or to operate the facility. We are not required to agree to your request, but if we do agree, we will comply with that agreement. If you want to request that we not share your information, in a particular case, you must make this request in writing to the Medical Records Department and describe your request in detail.

Right to Request Private Communications: You have the right to ask us to communicate with you in a way that you feel is more private. For example, you can ask us not to call your home, but to contact you only by mail. To do this, write to the Privacy Contact.

Right to a Paper Copy: If you have received this notice electronically, you have the right to a paper copy at any time. You may download a paper copy of the notice from our Web site, at www.cmmc.org or you may obtain a paper copy of the notice at any CMMF Office.

Changes to this notice.

From time to time, we may change our practices concerning how we use or share patient medical information, or how we will protect patient rights concerning their information. We reserve the right to change this Notice and to make the provisions in our new Notice effective for all medical information we maintain. If we change these practices, we will publish a revised Notice of Privacy Practices. You can get a copy of our current notice of Privacy Practices at any time by stopping in any of CMMF locations or from the website.

Which health care providers are covered by this notice?

This Notice of Privacy Practices applies to our personnel, volunteers, students, and trainees. The Notice also applies to other health care providers that come to our facility to care for patients, such as physicians, physician assistants, therapists, and other health care providers who are not employed by us, unless these other health care providers give you their own Notice that describes how they will protect your medical information. We may share your medical information with these providers for treatment purposes, payment and health care operations. This arrangement is solely for sharing information and not for any other purpose.

Do you have concerns or complaints?

Please tell us about any problems or concerns you have with your privacy rights or how we use or share your medical information. If you have a concern, please contact the Privacy Contact at your facility as listed on page 1.

If for some reason we cannot resolve your concern, you may also file a complaint with the federal government at Region 1, Department of Human Services, Government Center, J.F. Kennedy Federal Building - Room 1875, Boston, Massachusetts 02202. We will not penalize you or retaliate against you in any way for filing a complaint with the federal government.

Do you have questions?

We are required by law to give you this Notice and to follow the terms of the Notice that is currently in effect. If you have any questions about this Notice, or have further questions about how we may use and share your medical information, please contact the Privacy Contact at the number listed on page 1.

Effective date: April 14, 2003