You have the following rights regarding the medical information that the Soldiers' Home maintains about you:

Right to Inspect and Copy:

You have a right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records but does not include psychotherapy notes.

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Medical Records Department. If you request a copy of the information, Holyoke may charge a fee for the costs of copying, mailing or other supplies associated with your request.

Right to Amend:

In the event, you feel that the medical information we have about you is incorrect or incomplete, you may ask Holyoke to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Soldiers' Home in Holyoke.

To request an amendment, your request must be made in writing and submitted to the HIPAA Privacy Officer. Your request must be supported by a reason for the amendment.

Holyoke may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, Holyoke may deny your request if you ask us to amend information that:

  • was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • is not part of the medical information kept by or for the hospital;
  • is not part of the information which you would be permitted to inspect and copy; or
  • is accurate and complete.

Right to an Account of Disclosures:

You have the right to request an "account of disclosures." This is a list of the disclosures we made of medical information about you.

To request this list of accounting of disclosures, you must submit your request in writing to the HIPAA Privacy Officer. Your request must state a time period, which may not be longer than six (6) years and may not include dates before April 16, 2003. Your request should indicate in what form you want the list (for example, paper, electronically). The first list you request within a twelve (12) month period will be provided free of charge. For any additional lists, we may charge you for the costs of providing the list. Holyoke will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions:

  • You have the right to request a restriction or limitation on the medical information Holyoke uses or discloses about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information Holyoke discloses about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that Holyoke not use or disclose information about a surgery or procedure you had.

    Please note that Holyoke is not required to agree with your request. If Holyoke does not agree with your request, we will comply with the request unless the information is needed to provide you emergency treatment.

    To request restrictions, you must make your request in writing to the HIPAA Privacy Officer, Michael Pasterczyk. In your request you must indicate the following:
  • what information you want to limit;
  • whether you want to limit our use, disclosure or both; and
  • to whom you want the limits to apply (for example, disclosures to your spouse or family).

Right to Request Confidential Communications:

You have the right to request that Holyoke communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that Holyoke only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the HIPAA Privacy Officer. We will not ask you the reason for your request. Holyoke will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Copy of this Notice:

You have a right to a copy of this notice. You may ask us to give you a copy of this notice at any time. Upon signing this notice, a copy will automatically be given to you.



This information is provided by the Soldiers' Home in Holyoke.