The terms set forth in this notice are effective 4/14/2003.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU GET ACCESS TO THIS INFORMATION.   PLEASE REVIEW IT CAREFULLY.  

Understanding your health record information
Each time you visit a hospital, physician, or other health care provider, the provider makes a record of your visit.   Typically, this record contains your health history, current symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment.    

This information, referred to as your medical record, serves as a:

• Basis for planning your care and treatment.
• Means of communication among the many health professionals who contribute to your care.
• Legal document describing the care you received.
• Source of information for public health officials charged with improving the health of the regions they serve.
• Tool to assess the appropriateness and quality of care to achieve better patient outcomes

Understanding what is in your medical record and how your health information is used helps you to:

• Ensure its accuracy and completeness.
• Understand who, what, where, why and how others may access your health information.
• Make informed decisions about authorizing disclosure to others.
• Better understand the health information rights detailed below.

Uses and Disclosures for Treatment, Payment, and Healthcare Operations
Under the Federal Privacy Standard, we will disclose your Protected Health Information for purposes of treatment, payment, and healthcare operations.   Protected health information is any information, oral or recorded in any form, created by us, that could identify you, relating to past, present, or future health conditions, health care, or payment for such care.

Treatment We may use or disclose your information to provide, coordinate, or manage your healthcare, including coordination with a third party, consulting with other healthcare providers, and referring you to another provider.   For example, we may provide your Private Health Information to pharmacies, or to other health care providers to whom we refer you, as well as health care providers who have referred you to us.  

Payment We may use or disclose your information to obtain or prepare to obtain reimbursement for your healthcare, including determining eligibility, coverage or coordination of benefits; billing; claims management; collection activities; justification of charges; precertification and preauthorization; and disclosure of certain information to   consumer reporting agencies.   For Example:   We may send a bill to you or to a third-party payer, such as your health insurance company.   The information on or with the bill may include information that identifies you, your diagnosis, and treatment received.   As a result, your insurance company may correspond with the policyholder, even if that is not you, and this correspondence may include information about your diagnosis and treatment.  

Health Care Operations
We may use or disclose your information for daily activities related to healthcare, including quality assessment and improvement activities, and protocol development.   In addition, we may use or disclose your information in reviewing the competence and qualifications of health care professionals, accreditation activities, licensing and certification activities, and training of students and staff.   Your health information may also be used in general administrative activities, including business planning and development, legal services, auditing functions, actions to manage compliance with federal privacy and security requirements, and resolving internal grievances.   For example, we may share your information with students of healthcare, as needed, for the purpose of training new providers.   We may disclose information to financial auditors for the purpose of meeting requirements to maintain our nonprofit status.

Other Uses and Disclosures
In addition to uses and disclosures for treatment, payment, and healthcare operations, we may disclose your Protected Health Information in the following ways:  

Required by Law
We are obligated by federal law to provide information as necessary to cooperate with the Department of Health and Human Services in investigations of complaints or compliance with federal law.   We may also disclose relevant health information to assist officials in identifying or locating those who might be victims or suspects in a crime, or for other purposes in response to a court order or a valid subpoena, or when otherwise required by law.  

Correctional Institution and other law enforcement situations
If you are in a correctional institution, we may release information about you as necessary for your own health care and safety, and for the health, safety, and security of others in the institution  

National Security
We may disclose to military authorities the health information of armed forces personnel under certain circumstances.   We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities.  

Health oversight activities
We may disclose Private Health Information to agencies responsible for oversight of the healthcare system, including government benefit programs you might be eligible for.

Abuse, Neglect, or Domestic Violence
We may disclose health Information about victims of abuse, neglect, or domestic violence to those authorized by law to receive this information, if required by statute or regulation.   We must promptly inform you that such a report has been made or will be made, unless we believe informing you would put you at risk, or unless act of informing would be to a personal representative that we believe is responsible for the abuse, neglect, or injury.  

Appointment reminder or notification
We may contact you to remind you of an appointment with us, to notify you of an appointment we have scheduled on your behalf with another provider, or to advise you of the need to schedule a follow-up appointment.

To Your Family and Friends
We may disclose your Private Health Information to a family member, friend, or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we do so.

To Persons Involved in Your Healthcare
We may use or disclose health information to notify, or assist in the notification of, including identifying or locating, a family member, your personal representative, or another person responsible for your care, of your location, your general condition, or death.   If you are present, then we will provide you with an opportunity to object to such uses or disclosures ahead of time.   In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment, disclosing only that which is directly relevant to the person’s involvement in your healthcare.   We will also use our professional judgment and experience with common practice, obtaining verbal authorizations when possible, to make reasonable inferences of your best interest in allowing a person to pick up supplies or medications for you or other forms of health information.   For example, if you agree, we may allow someone to pick up medications on your behalf.  

To Business Associates
We provide some services through contracts with business associates.   Examples include diagnostic tests, technical support and financial audits.   When we use these services, we may disclose your health information to the business associate so that they can perform the function(s) we have contracted with them to do and bill you or your third-party payer for services rendered, when applicable.   To protect your health information, however, we require the business associate to appropriately safeguard your information.   For example, technical support contractors may view your demographics and account information in providing their services to us.  

Research
We may disclose Private Health Information to researchers, provided measures are taken to protect your privacy.   Information will be shared in the least identifiable way possible.   For example, we may provide health information to third parties that we have enlisted to collect statistical information for the purpose of long-range business planning.   In addition, certain medical procedures and diagnoses will be reported to government agencies collecting statistical information, as required by law.  

Public Health
As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.   For example, sexually transmitted infections must be reported to state officials for purposes of public safety  

Workers’ compensation
We may disclose health information to the extent necessary to comply with laws relating to workers’ compensation.   For example, we may provide your employer with information regarding the specific injury being handled in a workers’ comp claim.   Unrelated medical information will not be released without your written consent.  

Fundraising
We may use your demographic information and information about your dates of service to raise funds on our own behalf.   In these cases, the information we use will be at the least identifiable level possible.   For example, service types and frequencies may be collected for use in applying to funding sources.    

Notification of Benefits Programs
We may contact you or relevant agencies regarding treatment alternatives and health-related benefits and services that may be of interest to you.   For example, we may contact you to advise you of programs available to assist you financially, medically, and socially.

With Your Authorization
In addition to our use of health information for treatment, payment, or healthcare operations, you may give us written authorization to use your health information, or to disclose it to anyone for any purpose.   If you give us authorization, you may revoke it in writing at any time.   Your revocation will not affect any use or disclosures permitted by the authorization while it was in effect.   Unless you give us a written authorization, we cannot use or disclose your health information for any reason, except those described in this notice.

Your Rights under the federal privacy standard  

Notice
You have a right to receive a notice of our information practices, unless you are an inmate.   You have a right to receive a paper copy of this notice upon request.  

Access
You have the right to obtain and inspect your health information by submitting a written request, with limited exceptions.   You may request that we provide copies in a format other than photocopies.   If possible, we will use the format you request. We may charge a reasonable fee based on our costs for providing the information.   We may deny access without opportunity to have the denial reviewed under certain circumstances.   If we deny access to you, we must give you a written denial in a timely manner.   You will have an opportunity to have the denial reviewed by a licensed healthcare professional other than the original reviewer if: •  A licensed healthcare professional has determined that the access is likely to endanger your life of safety, or that of another person •  The information references another person who is not a healthcare provider, and a licensed healthcare professional has determined that the access is likely to cause harm to that other person •  The request for access is made by your personal representative, and a licensed healthcare provider has determined that the access by the personal representative is likely to cause harm to you or someone else.  

Amendment
You may request an amendment to your medical record by submitting a written request that includes the reason to support the request.   We must act on this request in a timely manner or provide written denial. We may deny this request under certain circumstances.  

Request Restrictions on Use or Disclosure
You have the right to request that we place additional restrictions on our use or disclosure of your health information.   We are not required to agree with these additional restrictions, but if we do, we must document them, and abide by them, except in an emergency.   If disclosed for emergency treatment, we will request that the recipient not further use or disclose the information.   Requirement to release any information to Secretary of HHS supercedes these agreed-upon restrictions.    

Alternate Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.   For example, you can ask that we contact you only by mail or at work.   To request confidential communication, you must make your request in writing, specifying how or where you wish to be contacted, and providing satisfactory explanation as to how payments will be handled under the alternative means.   We will accommodate reasonable requests.  

Accounting of Disclosures
You have the right to request a list of certain disclosures we made of health information for purposes other than treatment, payment, or health care operations.   If you request this accounting more than once in a twelve-month period, we may charge you a reasonable, cost-based fee.  

File a Complaint
You have the right to file a complaint with us if you feel your privacy has been compromised, by submitting a brief, written description of the violation in question to our Privacy Officer.      You also have the right to file a complaint to secretary of the Department of Health and Human Services.   No retaliation will occur against you as a result of either complaint.

Our Responsibilities Under the Federal Privacy Standard
We are required by law to:   Maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information   Provide you with this notice as to our legal duties and privacy practices with respect to Private Health Information   Abide by the terms of the notice currently in effect   Train our staff concerning privacy and confidentiality   Lessen the harm of any known breach of confidentiality   WE RESERVE THE RIGHT TO CHANGE OUR PRACTICES AND TO MAKE THE NEW PROVISIONS EFFECTIVE FOR ALL INIVIDUALLY IDENTIFIABLE HEALTH INFORMATION WE MAINTAIN ABOUT YOU.   IF WE CHANGE OUR INFORMATION PRACTICES, WE WILL MAKE THE REVISED NOTICE AVAILABLE TO YOU AT YOUR NEXT VISIT.  

Please contact our Privacy Officer for more information about this notice at:
(207) 947-5337 or P.O. Box 918, Bangor, ME 04402.