Page 232 - CHHA Binder 2.3.20

4/11/2019

Notice of Privacy Practices

Informs patient of VNSNY compliance with
Health Insurance Portability and Accountability
Act (HIPAA) regulations.
Informs patient that their health care
information is protected and safe with VNSNY.
Advises patient that information is only
shared with medical personnel that are
involved in their case and the insurance
company on file with VNSNY.
Informs patient they have a right to inspect
and copy their medical record with written
requests. A fee is charged for copy requests.
Informs patient how to contact VNSNY to
obtain a medical record.
Informs patient how to contact VNSNY
Compliance Officer if they feel their privacy
has been violated.

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Advanced Care Planning/ Self Determination

Advance Care Planning is a
process that helps you plan for
future medical care in case you
are unable to make decisions on
your own. This form provides
information regarding the
process, choosing a health care
agent, advance directive
documents, including health care
proxy, living wills, DNR, and DNI.

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