Please ask us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

This notice describes how medical information about you may be used and disclosed and how you may access your medical information.  Please review it carefully.

Your Rights

Get a copy of your medical record

  • You can request in writing for an electronic or paper copy of your medical record. We will provide you with a copy of your record usually within in 30 days of your request.  We may charge you a reasonable fee as allowed by state law.

Ask us to correct your medical record

  • You can ask us to correct health information about you in your medical record that you believe is incorrect or incomplete.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You may ask us to contact you in a specific way, for example, home or office phone or to send mail or email to a different address. We will say “yes” to all reasonable requests.

Get a list or accounting of disclosures

  • You ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all disclosures except for those about treatment, payment, and healthcare operations.
  • We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of the privacy notice

  • You can ask us for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

 Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

 You can file a complaint

  • If you feel we have violated your rights, please contact our Privacy Officer at: Compliance Department, 637 Washington Street, Dorchester MA 02124 or call the Compliance Hotline at 617-822-8100.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.   In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • In the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

We will never share your information unless you give us written permission in the following situations:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

Our Uses and Disclosures

We participate in health information exchanges (HIEs), including the Massachusetts Health Information Highway (Mass HIway).  We use HIEs as a method to share, request, and receive electronic health information with other health care organizations. For questions, or if you want to opt out of sharing information using the Mass HIway, contact our Compliance Office at (617) 822-8172.

We typically use or share your health information in the following ways:

  • Treat you: We can use your health information and share it with other professionals who are treating you.
  • Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary.
  • Bill for your services: We can use and share your health information to bill and get payment from health plans or other entities.

 We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:

Help with public health and safety issues. We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety.

 We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if the department wants to see that we’re complying with federal privacy law.

Work with a medical examiner or funeral director.  We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Respond to lawsuits and legal actions such as workers’ compensation, law enforcement, and other government requests and with:

  • Health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services
  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

There is some health information that we can release only with your permission or a judge’s order:

  • HIV Status/Testing Results (You must authorize each in writing)
  • Social Worker Communications
  • Consent for Abortion
  • Domestic Violence Victims’ Counseling
  • Sexually Transmitted Diseases
  • Sexual Assault Victims’ Counseling
  • Genetic Test Results
  • Alcohol & Drug Abuse Records
  • Communications with Mental Health Providers (psychologist, psychiatrist, nurse mental health specialist, licensed mental health counselor, marriage, family, rehabilitation and educational psychologist and family therapist).

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see:
  • We maintain medical records for at least 20 years after your discharge or after your final treatment; other records are maintained in accordance with state and federal regulations.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our facility, and on our web site.

The effective date of this notice is January 1, 2020.

This Notice of Privacy Practices applies to Codman Square Health Center, and the following individuals and organizations:

  • Any health care professional authorized to enter information into your medical chart
  • Any health care provider who is a member of the Codman Square Health Center Medical and Dental Staff
  • All Codman Square Health Center workforce members, including employees, staff, volunteers and other health center personnel

Organized Health Care Arrangement

Codman Square Health Center is part of an organized health care arrangement including participants in OCHIN. A current list of OCHIN participants is available at as a business associate of Codman Square Health Center OCHIN supplies information technology and related services to Codman Square Health Center and other OCHIN participants. OCHIN also engages in quality assessment and improvement activities on behalf of its participants. For example, OCHIN coordinates 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. OCHIN also helps participants work collaboratively to improve the management of internal and external patient referrals.

Your personal health information may be shared by Codman Square Health Center with other OCHIN 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 operation can include, among other things, geocoding your residence location to improve the clinical benefits you receive.

The personal health information may include past, present and future medical information as well as information outlined in the Privacy Rules. 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.