Proudly Promoting Elder Independence since 1974

Elder Services of Berkshire County, Inc.
Notice of Privacy Practices for Protected Health Information

Effective 4-14-2003 / Updated: 8-12-13 [PDF version for print/download]

This notice describes how medical information about you may be used and disclosed BY ELDER SERVICES OF BERKSHIRE COUNTY, INC. and how you can get access to this information.

Please review it carefully.

I. How Elder Services of Berkshire County, Inc. (ESBCI) Uses and Discloses Your Health Information:

ESBCI provides a variety of services that enable older people and adults with disabilities to stay at home in the community. Because we work with a variety of funding sources, including Medicaid, and get referrals from a number of health care providers, we may have personal health information about you.

Personal health information (PHI) includes things such as certain medical diagnoses, the kinds of medical or treatment services you get, or the dates you get the services.

By law, ESBCI must:

If you receive services from ESBCI, we may use your protected health information and disclose it to other health and human services programs as follows:

ESBCI cannot use or share your health information with anyone without your written permission, except as described above. You may cancel your permission at any time as long as you tell us in writing. We must get your permission to use your health information for marketing purposes or when we are paid for your health information. We cannot take back any health information we used or shared when we had your permission.

II. Your Health Information Rights:

You have the right:

III. ESBCI Duties:

By law ESBCI has a duty to:

ESBCI may change its privacy practices and make the new privacy practices effective for all protected health information we maintain. If our privacy practices change, we will mail a revised notice to the address you have supplied us. ESBCI’s Notice of Privacy Practices are posted on our website at www.esbci.org.

IV. For More Information or to Report a Problem:

[PDF version for print/download]

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Elder Services
of Berkshire County, Inc.

877 South Street, Suite 4E
Pittsfield, MA 01201

(413) 499-0524 Main
(800) 544-5242
(413) 442-6443 Fax
(413) 499-9764 TTY

Email

Office Hours
Monday-Friday, 8am-5pm EST