Montgomery County
Skip to main content
Go Search
Montgomery County Homepage


 Content Editor Web Part ‭[2]‬

This page has moved! If your browser doesn't automatically redirect within a few seconds, please click here to visit the new page.

Montgomery County Public Health
Notice of Privacy Practices


Montgomery County Public Health (MCPH) is committed to maintaining the confidentiality of your Protected Health Information (PHI). In providing care to you, we will create records regarding your treatment and the services we provide to you. We are required by law to maintain the confidentiality of your PHI. However there are some situations when we do not need your written authorization before using your PHI or sharing it with others. If you have any questions about this privacy notice or your PHI please contact the HIPAA Compliance Coordinator at 853-3531. This notice is effective April 14, 2003.

Ways we may use and disclose your Protected Health Information

TREATMENT – MCPH may use your PHI to provide treatment and or services to you. MCPH may also disclose information to others who may assist in your care such as physical therapists, nurses, physicians or others who are involved in your medical care or treatment.

PAYMENT – MCPH may use and disclose your PHI for billing and payment for services. Examples include contacting your health insurance provider to verify coverage and to obtain pre-authorization and/or payment.

HEALTH CARE OPERATIONS – MCPH may use and disclose your PHI in order to support the operation of MCPH. For example we may use and disclose your PHI to evaluate the quality of care you received, for employee review activities, to determine if additional services are needed, to determine if services are effective, in the process of training nursing students or to monitor our compliance with state and federal regulations.

APPOINTMENT REMINDERS – MCPH may use and disclose your PHI to contact you to remind you of visits and/or appointments. We may contact you by phone, at your home, to remind you of medical appointments/home visits or if we need to speak to you about a medical condition. Unless you instruct us otherwise we may leave a message for you on an answering machine in your home or with any person who answers the phone in your home. We may also send to your home an appointment reminder in the form of a postcard.

BUSINESS ASSOCIATES – MCPH may use and disclose PHI to a person or entity we have an agreement with or contract with to perform some functions for us and who would need access to the information to perform those functions. An example would be a billing service, an auditor or attorney.

HEALTH RELATED BENEFITS – MCPH may use and disclose PHI to recommend health related benefits or services that may be of interest to you.

COMMUNICATION BARRIERS – MCPH may use or disclose your PHI if we are unable to obtain your consent because of substantial communication barriers, and we believe you would want us to treat you if we could communicate with you.

HEALTH OVERSIGHT ACTIVITIES – MCPH may use and disclose PHI to a health oversight agency for activities authorized by law. These activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for officials to monitor the health care system and government programs.


  1. As required by Public Health Law
  2. As required by State or Federal Law
  3. As required by law to report suspected neglect or abuse
  4. As required by law enforcement purposes by a law enforcement official
  5. As required by a coroner or medical examiner
  6. As permitted by law for organ donation purposes
  7. As permitted by law and required by military authorities if you are a member of the armed forces of the United States

Other uses or disclosures of your PHI will be made only with your written authorization. You have the right to revoke this authorization at any time except to the extent that this agency or another agency, company or individual has already relied on the information.


RIGHT TO INSPECT AND COPY – You have the right to inspect and obtain copies of your PHI in your medical record. You must make your request in writing to this agency. You may obtain a form for this purpose by calling 518-853-3531. We may charge a fee for the cost of copying or postage. You will be informed of the amount prior to the copying of any records.

CONFIDENTIAL COMMUNICATIONS – You have the right to request that MCPH communicates with you about your PHI in a particular manner or at a certain location. For example, if you only want us to communicate with you at home and never at work, you may request this. You must make such a request in writing to the Privacy Officer. We will respond within 30 days of receiving your request.

RIGHT TO AMEND YOUR PHI – You have the right to ask us to amend your PHI if you feel it is incorrect or incomplete. To request an amendment, the request must be in writing and should include a reason that supports the request. MCPH may deny the request if your record is accurate and complete, if we did not create the information, if it is not part of the information kept by MCPH or is information that is not allowed to be disclosed.

RIGHT TO AN ACCOUNTING OF DISCLOSURES – MCPH has the obligation to provide a list of disclosures made of your PHI, except for disclosures to carry out treatment, payment, and health care operations; to individuals of PHI about them; pursuant to an authorization; or as otherwise permitted or required by this subpart as provided in 45 CFR164.502. To request a list or accounting of disclosures, a request, in writing, must be made to the Privacy Officer. The request must state a time period, which may not be longer than six years and may not include information prior to April 14, 2003. MCPH will respond to your request within 60 days.

RIGHT TO REQUEST RESTRICTIONS – You have the right to request a restriction on the use and disclosure of your PHI. MCPH is not required to agree with your request or we may not be able to comply with your request. You may make your request to the Privacy Officer.

RIGHT TO A COPY OF OUR NOTICE OF PRIVACY PRACTICES – You have a right to a copy of MCPH’s Notice of Privacy Practices at any time. You may contact MCPH to request this notice. This notice is also posted on our web site (

RIGHT TO NOTIFICATION OF BREACH – You have the right as an affected individual to be notified without “unreasonable delay” and no later than 60 days after discovery of a breach of unsecured protected health information. 

RIGHT TO FILE A COMPLAINT – If you believe your privacy rights have been violated, you may file a written complaint to the Privacy Officer at Montgomery County Public Health PO Box 1500 Fonda, NY 12068. You may also file your complaint with the Office for Civil Rights, US Department of Health and Human Services 26 Federal Plaza – Suite 3313 New York NY 10278.  You will not be penalized for filing a complaint.


NOTE: Links marked with an asterisk are not managed by Montgomery County. They are provided for your convenience only. We bear no responsibility for their content.