This Notice Describes how Medical Information About You may be Used and Disclosed and How You Can Get Access to This Information.  Please Review it Carefully.

Codman Square Health Center (CSHC) and its affiliated physicians or providers make a record each time you receive health care or services. Your records have information about your symptoms, examination, test results, diagnosis, and billing for services. The law requires CSHC to keep your health information private and also to tell you about how it keeps health information private. CSHC is required to abide by the terms of the Notice of Privacy Practices (NPP) currently in effect. You can always request a copy of this Notice from our Registration area.

This notice applies to CSHC and the following individuals or organizations:

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

Health Information Exchange

Boston Medical Center, Boston Health Net, Boston Accountable Care Organization: CSHC and these organizations may access and disclose medical information electronically, for treatment, payment, and health care operations purposes as described in this Notice or when we have your signed authorization.

CSHC is part of an organized health care arrangement including participants in the OCHIN, Inc. A current list of OCHIN participants is available here. As a business associate of CSHC, OCHIN supplies information technology and related services to CSHC and other OCHIN participants. OCHIN also engages in quality assessment and improvement activities on behalf of its participants. Your health information may be shared by CSHC with other OCHIN participants when necessary for health care operations purposes of the organized health care arrangement.

Codman uses Epic Care Everywhere (electronic medical records) to facilitate the exchange of health information between health care providers for treatment purposes.


Use means sharing health information inside CSHC. Disclosure means release of health information outside CSHC. We may use and disclose health information in the following ways without getting specific permission.

Treatment, Payment, Health Care Operations

Treatment – to provide, coordinate or manage your health care and related services. Doctors, nurses, technicians, medical students and others involved in taking care of you share medical information about you. Your treatment includes working with people involved in your care before and after your CSHC services.

For example, CSHC may disclose information to

  1. an ambulance service that takes you to or from CSHC;
  2. a rehabilitation center or home health agency that will be caring for you; and
  3. other doctors who may be treating you, such as the doctor to whom a CSHC provider refers you or who is otherwise involved in your care.

Payment for Treatment – to help CSHC obtain payment for your health care services.

Payment activities include

  1. checking eligibility or referral from a health plan;
  2. reviewing need for and use of services; and
  3. sending bills to your insurance company.

Health Care Operations – to help run CSHC or to check the quality of care that you receive. For example we may combine information from multiple sources about patients to review their care. We may also use health information to review employees’ performance; train students; help meet health center licensing and accreditation rules; and market and raise funds for CSHC. We may disclose your health information to “Business Associates” that we hire to help us, such as billing and computer software companies, or accountants. All Business Associations must assure us in writing that they will safeguard your health information by signing a Business Associate Agreement.

Other Permitted Uses and Disclosures

CSHC may also use and disclose your health information for the following:

  • Appointment Reminders: sent to you about medical treatment or care.
  • Health-Related Benefits and Services and Treatment Alternatives: sending information about treatment alternatives or other health-related benefits and services that may interest you.
  • Fundraising Activities: contacting you about CSHC fundraising efforts. Any materials received will contain information on how to remove yourself from the fundraising list.


For the following uses and disclosures of health information we must provide an opportunity for you to agree or object:

Patient Directory/Register
Your name and location while at CSHC may be disclosed to persons who ask for you by name in a manner in which your confidentiality is protected. If you are unable to object or agree CSHC may include you in the directory and disclose your directory information if it is determined it is in your best interest to do so. If you become able to agree or object you will be given an opportunity to express your wishes.

If you object to being included in CSHC Directories, we will not disclose your information to anyone who asks for you, including but not limited to florists, the United States Postal Service, family, friends, clergy, and anyone else asking for you or your location.

Persons Involved in Your Care, Relatives and Close Friends
We may disclose your Personal Health Information to people involved in your care or in payment for your care such as family members, relatives, close friends or other persons you identify. When you are not present, we may use professional judgment and your best interests and decide to disclose relevant information to an individual who is directly involved in your health care. In whichever case, we would disclose only information we feel is relevant to the person’s involvement and limit the release only to the minimum necessary.

To notify your family or other person responsible for your care of your location, general condition, or death.

Disaster Relief Purposes

  • To authorized public or private entities to assist in disaster relief efforts.
  • To coordinate uses and disclosures to individuals involved in your care.


CSHC may use or disclose your protected health information in some cases without your authorization. The following list describes the ways this may happen. Not every use or disclosure in a category will be listed but we provide a brief description in certain cases.

  • As required by law.
  • For Public Health Activities: to prevent or control disease, injury, or disability; to report child abuse or neglect; or as otherwise authorized by law; to report reactions to medicine or problems with products; to notify a person exposed to a contagious disease
  • To prevent a serious threat to health or safety.
    • To your employer for evaluation of work related illness or injury, or for medical surveillance purposes.
    • For Lawsuits and Administrative Proceedings: To respond to court or administrative order; to respond to a subpoena or lawful request.
    • For law enforcement purposes: To respond to a warrant, identify suspects, or to report crime on CSHC property.
    • To report suspected abuse and neglect of the elderly, disabled, or nursing home patients to appropriate government agencies.
    • To comply with laws relating to Workers’ Compensation or other similar programs.
    • To correctional institution or law enforcement, if you are an inmate of a correctional institution or in law enforcement custody, to provide you with health care; to protect the health and safety of yourself or others; for health and safety of correctional institution.
    • To Coroners and Medical Examiners: To identify, determine cause of death or perform other duties.
    • To Funeral Directors to carry out their duties.
    • To Health Oversight Agencies for activities such as audits or inspections to oversee the health care system or government programs
  •  Research uses and disclosures permitted without authorization: Reviews of information to prepare research; research on dead person’s information; or research use or disclosure with an approved waiver of authorization. Such waivers require special review and approval.
  • Special Government Activities
    • Military Activities: To appropriate military command authorities as required, if you are U.S. armed forces personnel; and for foreign military personnel, to appropriate foreign military authorities.
    • To authorized federal officials
      • for lawful national security purposes,
      • to provide protective services for the President and others.


Other uses or disclosures of your record will be made only with your written authorization. Disclosures requiring written authorization include drug and alcohol treatment records, mental health records, and AIDS/HIV and genetic testing information.

You may withdraw an authorization at any time; however, we are not able to take back disclosures that we have already made with your authorization.

Also, you cannot withdraw an authorization that was a condition of obtaining insurance coverage. All withdrawals must be made in writing.

Contact the CSHC Privacy Officer 617-822-8285.


Regarding medical information we maintain about you, you have the right to: Request restrictions on uses and disclosures of your record for treatment, payment or health care operations. All requests must be made in writing. The law does not require us to agree to restriction requests. For emergency treatment, we may use or disclose restricted information. The right to request restrictions does not apply to uses and disclosures required by law.

Request confidential communications of protected health information in a certain way or at a certain place. All requests must be made in writing. If we accept your request, we will require you to provide information about payment handling, alternate address, and contact method.

  • Inspect and copy protected health information that may be used to make decisions about you. This does not include psychotherapy notes, clinical laboratory data or information compiled in anticipation of or for use in a civil, criminal or administrative action or proceeding. This right is suspended temporarily until study completion for information created or obtained during research. The law permits us to charge a fee for copying costs.
  • Request us to amend information that may be used to make decisions about you. We are not required to agree to your request. We may deny your request if:
    • CSHC did not create the information, unless the person or entity that created the information is no longer available to make the amendment;
    • the information is not part of the information kept by or for CSHC to make decisions about you;
    • the information is not part of the information that you are allowed to inspect or copy; or
    • the information is complete and accurate. You must request an amendment in writing and supply a reason to support your request.
  • Receive an accounting of certain disclosures of your protected health information. The accounting right does not apply to disclosures that you have authorized or to disclosures for treatment, payment, and health care operations.
  • Obtain a paper copy of this Notice upon request.


We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as for any information we receive in the future. We will post a copy of the current Notice in the health center.

If we change the NPP, you will be offered a new NPP at your next visit to Codman Square Health Center after the change takes effect.


To exercise your rights or for more information about matters in this Notice, please contact:

Codman Square Health Center
Compliance Department
637 Washington Street
Dorchester, MA 02124

Compliance Director

Privacy Officer


CSHC will in no way retaliate against you for filing a complaint. If you believe your privacy rights have been violated or to file a complaint, please call the Privacy Officer at 617-822-8285.

Call/E-mail Compliance Hotline at:
617-822-8100 or ext. 8100 or

If you remain dissatisfied with the outcome, you may also contact:

The Massachusetts Board of Registration in Medicine
200 Harvard Mill Square Suite 330 Wakefield, MA 01880

MassPRO (If you have Medicare)
245 Winter Street Waltham, MA 02451

Massachusetts Department of Public Health,
Division of Health Care Quality: Complaint Unit

99 Chauncy Street 11th Floor
Boston, MA 02111

The Joint Commission Office of Quality Monitoring
One Renaissance Boulevard
Oakbrook Terrace, IL 60181