Notice of Privacy Practices

Click HERE to download a copy of our Notice of Privacy Practices.


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Madison County
Notice of Privacy Practices

This notice describes the privacy practices of Madison County and the privacy rights of the people we serve.  It will describe how information about you may be used and disclosed and how you can get access to this information.

The Health Insurance Portability and Accountability Act (HIPAA) Privacy rule DOES NOT CHANGE the way you get services from Madison County, or the privacy rights you have always had under federal and state laws.  The Privacy rule adds some details about how you can exercise your rights.


Effective Date:

This Notice of Privacy Practices is effective as of January 1, 2021.

Our Privacy Commitment to You:

We at Madison County provides many different services to you.  We understand that information about you and your family is personal.  We are committed to protecting your privacy and sharing information only with those who need to know and are allowed to see the information to assure quality services for you.  We are required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information.  This notice tells you how Madison County uses and discloses information about you.  It describes your rights and what our responsibilities are concerning information about you.  When we use the word “you” in this Notice, we also mean your personal representative.  Depending on your circumstances and in accordance with state law, this may mean your guardian, your health care proxy, or your involved parent, spouse, or involved adult family member.

If you have questions about any part of this notice or if you want more information about the privacy practices at Madison County, please contact:

Privacy Officer

Madison County

138 N Court Street

Wampsville, New York 13163

Phone: (315) 366-2203

Who will follow this Notice?

All people who work for Madison County will follow this notice.  This includes employees, persons Madison County contracts with who are authorized to enter information in your record or need to review your record to provide services to you, and volunteers who Madison County allows to assist you.

What information is protected:

All information that we create or keep that relates to your health or care and treatment, including but not limited to your name, address, birth date, social security number, your medical information, your service or treatment plan, and other information (including photographs or other images) about your care in our programs, is considered protected information.  In this Notice, we refer to protected information as protected health information or “PHI”.  We create and collect information about you and we keep a record of the care and services you receive though this agency.  The information about you is kept in a record; it may be in the form of paper documents in a chart or on a computer.  We refer to the information that we create, collect, and keep as a “record” in this Notice. 

Your Health Information Rights:

Unless otherwise required by law, your record is the physical property of Madison County, but the information in it belongs to you and you have the right to have your information kept confidential.  You have the following rights concerning your PHI:  

Get an electronic or paper copy of your medical record 

  • You have a right to see or inspect your PHI and obtain a copy (electronic or paper) of the information.  Some exceptions apply, such information compiled for use in court or administration proceedings.  NOTEMadison County requires you to make your request for records in writing to the appropriate department’s HIPAA Privacy Officer. You may request copies in paper format or in an electronic form such as a CD, portable device, or memory stick.       In some instances, we may charge you for copies.  
  • We will provide a copy or a summary of your health information, within 10 days of your request. If we need additional time to respond to your request for copies, we will notify you in writing explaining the reason for the delay and expected completion date.
  • If we deny your request to see your information, you have the right to request a review of that denial.  The Department Head/designee will appoint a licensed health care professional to review the record and decide if you may have access to the record. 

Ask us to correct your medical record

  • You have the right to ask us to change or amend information that you believe is incorrect or incomplete.  We may deny your request in some cases, for example, if the record was not created by Madison County or if after reviewing your request, we believe the record is accurate and complete. 

Get a list of those with whom we’ve shared information

  • You have the right to request a list (accounting) of the disclosures that Madison County has made of your PHI.  The list, however, does not include certain disclosures, such as those made for treatment, payment, and health care operations, or disclosures made to you or made to others with your permission. 

Ask us to limit what we use or share

  • You have the right to request a restriction on uses or disclosures of your health information related to treatment, payment, health care operations, and disclosures to involved family.  Madison County, however, is not required to agree to your request. 

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. Disclosure of protected health information to a personal representative may be limited in cases of domestic or child abuse.
  • We will make sure the person has this authority and can act for you before we take any action.

Request confidential communications

  • You have the right to request that Madison County communicates with you in a way that will help keep your information confidential.  You may request alternate ways of communication with you or request that communications are forwarded to alternative locations. 

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.

Notified of a Breach

  • You will be notified if there is a breach of unsecured PHI containing your information; we are required by federal law to provide notification to you.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information listed on page 1 of this Notice.
  • 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 visiting
  • We will not retaliate against you for filing a complaint.

Get a copy of this privacy notice

  • You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the notice electronically. A copy of our current notice will always be posted on our website ( and in our reception areas. 

NOTE: Other regulations may restrict access to HIV/AIDS information, federally protected education records, and federally protected drug and alcohol information.  See any special authorizations or consent forms that will specify what information may be released and when, or contact the County Privacy Officer.

 Our Responsibilities to You

We are required by law to maintain the privacy of your protected health information, to notify you of our legal duties and your legal rights, and to abide by the privacy policies described in this Notice. We are required to: 

  • Maintain the privacy of your information in accordance with federal and state laws.
  • Give you this Notice that tells you how we will keep your information private.  
  • Tell you if we are unable to agree to a limit on the use or disclosure that you request. 
  • Carry out reasonable requests to communicate information to you by special means or at other locations.
  • Get your written permission to use or disclose your information except for the reasons explained in this notice.  

We have the right to change our practices regarding the information we keep.  If practices are changed, we will tell you by giving you a new notice.  Notices will be posted on our website:

How We Use and Disclose Your Health Information:

We may use and disclose information without your permission for the purposes described below.  For each of the categories of uses and disclosures, we explain what we mean and offer an example.  Not every use or disclosure is described, but all of the ways we will use or disclose information will fall within these categories.

Treatment: We will use your information to provide you with treatment and services.  We may disclose information to doctors, nurses, psychologists, social workers, and other Madison County personnel, volunteers, or interns who are involved in providing your care.  

For example, involved staff may discuss your information to develop and carry out your treatment or service plan and other Madison County staff may share your information to coordinate different services you need, such as medical tests, respite care, transportation, etc.  We may also need to disclose your information to other providers outside of Madison County who are responsible for providing you with services.

Payment: We will use your information so that we can bill and collect payment from you, a third party, an insurance company, Medicare or Medicaid, or other government agencies. 

For example, we may need to provide your health care insurer with information about the services you received in our agency or through one of our programs so they will pay us for the services.  In addition, we may disclose your information to receive prior approval for payment for services you may need.  

Health Care OperationsWe will use clinical information for administrative operations.  These uses and disclosures are necessary to operate Madison County programs and to make sure all individuals receive appropriate, quality care.  

For example, we may use information for quality improvement to review our treatment and services and to evaluate the performance of our staff in serving you.

We may also disclose information to clinicians and other personnel for on-the-job training.  We will share your health information with other Madison County staff for the purposes of obtaining legal services from our attorneys, conducting fiscal audits, and for fraud and abuse detection and compliance through our Compliance Program.  We may also disclose information to our business partners who need access to the information to perform administrative or professional services on our behalf.

Other Uses and Disclosures that Do Not Require your Permission:

In addition to treatment, payment, and health care operations, we will use your information without your permission for the following reasons: 

Help with public health reasons 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

Comply with the law

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

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

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.

Do research

We can use or share your information for health research.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Inmates and Correctional Institutions

We may disclose your health information to correctional institutions or law enforcement officials if you are an inmate or under custody of a law enforcement official. Disclosure for these purposes would be necessary: 

  • For the institution to provide health care services to you, 
  • For the safety and security of the institution,
  • And/or to protect your health and safety or the health and safety of other individuals.

Uses and Disclosures that Require Your Agreement:

We may disclose information to the following persons if we tell you we are going to use or disclose it and you agree or do not object:

  • To family members and personal representatives who are involved in your care if the information is relevant to their involvement and to notify them of your condition and location.
  • To disaster relief organizations that need to notify your family about your condition and location, should a disaster occur.
  • For fundraising purposes, we may disclose information to a charitable program that assists us in fundraising with your permission.  You have the right to refuse or opt out if you previously agreed to communications regarding fundraising.
  • For marketing of health- related services, we will not use your health information for marketing communications without your permission.
  • To disclose psychotherapy notes.

Authorization Required For All Other Uses and Disclosures:

For all other types of uses and disclosures not described in this Notice, we will use or disclose information only with a written authorization signed by you that states who may receive the information, what information is to be shared, the purpose of the use or disclosure and an expiration for the authorization.  Written authorizations are always required for the sale of PHI and use and disclosure for marketing purposes, such as agency newsletters and press releases.


You may revoke your authorization at any time.  If you revoke your authorization in writing we will no longer use or disclose your information for the reasons stated in your authorization.  We cannot, however, take back disclosures we made before you revoked and we must retain information that indicates the services we have provided to you.

Changes to this Notice:

Madison County reserves the right to change this Notice. We reserve the right to makes changes to the terms described in this Notice and make the new notice terms effective to all information that Madison County maintains.  The new notice will be will be provided to you at the next encounter after the change and acknowledgement of receipt will be obtained. Additionally, copies of this Notice will be available upon request, in our office, and on our website.

How to Exercise Your Legal Rights

Questions about our privacy policies and procedures and requests to exercise individual rights should be directed to the County’s Privacy Officer at (315) 366-2203. All complaints must be submitted in writing.

If you believe your privacy rights have been violated, you may file a complaint with the County’s Privacy Officer, or with the Secretary of the U.S. Department of Health and Human Services (“DHSS’). Should you choose to file a complaint with the County’s Privacy Officer, you will be given a complaint form and an overview of the complaint process. 

If you want to file a complaint with DHHS, the contact information is as follows:

Office for Civil Rights, DHHS

26 Federal Plaza - Suite 3312

New York, NY 10278

(212) 264-3313; (212) 264-2355 (TDD)

(212) 264-3039 FAX 

Online Complaint Portal