Skip Ribbon Commands
Skip to main content

Prostate Cancer Treatment Program

Protects Your Health Information

 

Prostate Cancer Treatment Program (PCTP) protects your personal health information.  As required by the federal regulations known as the Health Insurance Portability and Accountability Act (HIPAA), we are providing our clients with control over access to their health information.

 

Know Your Rights

To find out what your rights are, you may review the Prostate Cancer Treatment Program Notice of Privacy Practices.  NOTICE OF PRIVACY PRACTICES (Also available in Spanish | Korean | Vietnamese | Mandarin | Russian)

The Prostate Cancer Treatment Program must keep your health information private.  We receive information about you when you apply for services, and when doctors, clinics, and others bill us for your care.  We also get medical information on your treatment when we approve your care.

 

IMPORTANT NOTICE

THE PROSTATE CANCER TREATMENT PROGRAM DOES NOT HAVE COMPLETE COPIES OF YOUR MEDICAL RECORDS.  IF YOU WANT TO LOOK AT, GET A COPY OF, OR CHANGE YOUR MEDICAL RECORDS, PLEASE CONTACT YOUR DOCTOR, CLINIC, OR HEALTH CARE PLAN. THANK YOU.

 

Helpful Forms

You can use the forms below to:

  • Ask PCTP questions about your health information, or
  • Request PCTP to take some action regarding your health information.

 

Request for Access to Protected Health Information

See and get a copy of the information Prostate Cancer Treatment Program has about you.  The Prostate Cancer Treatment Program has information about your eligibility, your health care bills, and some medical information that we use to approve services for you or manage your health care.  You may need to pay a fee for the costs of copying and mailing records.  We may keep you from seeing all or parts of your records when the law allows.  If we do, we will give you information on how to appeal our decision.

Request for Access to Protected Health Information by Parent, Guardian, or Personal Representative

Allow someone else to see and get a copy of the information the Prostate Cancer Treatment Program has about you.

Request for Release of Protected Health Information

Request that a copy of the information that the Prostate Cancer Treatment Program has about you be released to someone you designate.  The Prostate Cancer Treatment Program has information about your eligibility, your health care bills, and some medical information that we use to approve services for you or manage your health care.  You may need to pay a fee for the costs of copying and mailing records.  We may not release all or parts of your records when the law allows.  If we do, we will give you information on how to appeal our decision.

Request to Restrict Use and Disclosure of Protected Health Information

Ask us not to use or share your personal health care information.

Request to Restrict Use and Disclosure of Protected Health Information by Parent, Guardian, or Personal Representative

Allow someone else to ask us not to use or share your personal health care information.

Confidential Communication Request

Ask us to contact you only in writing or at a different address, post office box, or telephone number.  We will accept reasonable requests when necessary to protect your safety.

Request for an Accounting of Disclosures of Protected Health Information

Request a list of the times when we have shared your health information after April 14, 2003.  The list will tell you what information we shared, with whom, when, and for what reasons.  The list will not say when we gave information to you, or when we gave out information with your permission, or when we shared information for treatment, payment, or health care operations.

Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian, or Personal Representative

Allow someone else to request a list of the times when we have shared your health information after April 14, 2003.

Request to Amend Protected Health Information

Ask the Prostate Cancer Treatment Program to change your records if you believe some information we have about you is wrong.

Request to Amend Protected Health Information by Parent, Guardian, or Personal Representative

Allow someone else to ask to change the records if you believe some information we have about you is wrong.

 

Back to the Prostate Cancer Treatment Program Home Page

 

Last modified on: 8/2/2012 8:47 AM