This Notice describes how your personal health information

 may be used and disclosed and how you can get access to this information.

 Please review it carefully.


Your right to privacy

We respect your right to privacy, and we are required by law to protect the privacy of your health information.  We will not use or disclose your health information without your written consent, except as described in this Notice or as required by law.  You may, at any time, revoke any authorization you previously gave permitting us to disclose your health information.

Information about you that we keep and use

Each time a Bristol Elder Services, Inc. (Bristol) staff person visits or contacts you or speaks with someone else on your behalf, a record of the visit or contact is made.  Typically, this record contains personal information such as name, address, date of birth, and medical information such as diagnoses, medications, and names of providers involved in your care.   We use this information to:

  • Plan your care and set up your services.
  • Communicate among the health and service providers who contribute to your care and service delivery.
  • Maintain a legal document describing the care and services you receive.

Your rights

Although your health and service record is the physical property of Bristol, the information in it belongs to you.  You have the right to:

  • Request that we limit how we use or disclose your information.
  • Inspect and copy your record (at your expense).
  • Request corrections, updates, or additions to your record.  (We do not alter the original record but add your changes.)
  • Receive an accounting of how your health information was disclosed.
  • Request that we use a specific telephone number or address to communicate with you.
  • Withdraw consent you have previously given to use or disclose health and service information except to the extent that information has already been shared.
  • Have a copy of this notice of privacy practices.

Our responsibilities

Bristol is required by law to:

  • Maintain the privacy of your health and service information.
  • Provide you with this notice of our privacy practices.
  • Abide by the terms of this notice that are currently in effect.
  • Use and disclose your health information only with your written consent, except as described in this Notice.
  • Notify you in the event of any breach of unsecured protected health information in which your health information may have been affected.

Information we share

There are limited times when we are permitted or required to share your health information without your signed permission.  We may share information or communicate:

  • With our contracted vendors, to provide services to you.

  • With the Division of Medical Assistance (MassHealth), the Executive Office of Elder Affairs, our contracted vendors, or your insurance provider to obtain payment for services.
  • With family members, legal representatives, or other persons responsible for your care, when sharing the information is related to your care.
  • With other health care providers, in the event you need emergency care.
  • With public health or federal organizations charged with preventing or controlling disease, injury, or disability.
  • To avoid a serious threat to safety.
  • To report abuse, neglect or exploitation.
  • For approved research, when personal information cannot be used to identify you.
  • With the U.S. Department of Health and Human Services to make certain that your privacy is protected.
  • For law enforcement purposes as required by law, or in response to a valid subpoena.

Information requiring your consent

There is specific information that requires your authorization prior to disclosure.  We may not share the following information without your authorization:

  • Psychotherapy Notes, except to carry out certain treatments, payments, or healthcare operations.
  • For marketing purposes.
  • To sell your protected health information.

Changes to this Notice

We reserve the right to change our privacy practices.  Anytime our privacy practices change, we will make a revised Notice available to you.  This Notice is also posted on our website at


Contacting us

We welcome your questions, comments, and suggestions.  You may contact your case manager or Karen Scott Statser, Director of Programs, at 774-627-1312.  If you believe your privacy rights have been violated please contact the Director of Programs.  You may also file a complaint with the Secretary of Health and Human Services in Washington D.C.  All complaints are investigated, and there is no retaliation for filing a complaint.


Effective Date of Notice

This Notice shall be effective September 23, 2013.