THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
USE AND DISCLOSURE OF HEALTH INFORMATION
The Agency may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. The Agency has established policies to guard against unnecessary disclosure of your health information.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To Provide Treatment. The Agency may use your health information to coordinate care within the Agency and with others involved in your care, such as you attending physician and other health care professionals who have agreed to assist the Agency in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. The Agency also may disclose your health care information to individuals outside of the Agency involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.
To Obtain Payment. The Agency may include your health information in invoices to collect payment from third parties for the care you receive from the Agency. For example, the Agency may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or the Agency. The Agency also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for home care and the services that will be provided to you.
To Conduct Health Care Operations. The Agency may use and disclose health information for its own operations in order to facilitate the function of the Agency and as necessary to provide quality care to all of the Agency’s patients. Health care operations includes such activities as: • Quality assessment and improvement activities.
• Activities designed to improve health or reduce health care costs.
• Protocol development, case management and care coordination.
• Contacting health care providers and patients with information about treatment alternatives and other related
functions that do not include treatment.
• Professional review and performance evaluation.
• Training programs including those in which students, trainees or practitioners in health care learn under
supervision.
• Training on non-health care professionals.
• Accreditation, certification, licensing or credentialing activities.
• Review and auditing, including compliance reviews, medical review, legal services and compliance programs.
• Business planning and development including cost management and planning related analyses and formulary
development.
• Business management and general administrative activities of the Agency.
• Fundraising for the benefit of the Agency.
For example the Agency may use your health information to evaluate its staff performance, combine your health
information with other Agency patients in evaluating how to more effectively serve all Agency patients, disclose your
health information to Agency staff and contracted personnel for training purposes, use your health information to contact
you as a reminder regarding a visit to you, or contact you as part of general fundraising and community information
mailings (unless you tell us you do not want to be contacted). The Agency cannot sell your health information for any
reason or use your personal health information for marketing purposes without your prior authorization.
For Fundraising Activities. The Agency may use information about you including your name, address, phone number
and the dates you received care in order to contact you to raise money for the Agency. The Agency may also release this
information to a related Agency foundation. If you do not want the Agency to contact you, notify Privacy Officer and indicate that
you do not wish to be contacted.
For Appointment Reminders. The Agency may use and disclose your health information to contact you as a reminder
that you have an appointment for a home visit.
For Treatment Alternatives. The Agency may use and disclose your health information to tell you about or recommend
possible treatment options or alternatives that may be of interest to you.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR
WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED (check your State laws to ensure
consistency with State law requirements).
When Legally Required. The Agency will disclose your health information when it is required to do so by any Federal,
State or local law.
When There Are Risks to Public Health. The Agency may disclose your health information for public activities and
purposes in order to:
• Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the
conduct of public health surveillance, investigations and interventions.
• Report adverse events, product defects, to track products or enable product recalls, repairs and replacements and
to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
• Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or
spreading a disease.
• Notify and employer about an individual who is a member of the workforce as legally required.
To Report Abuse, Neglect Or Domestic Violence. The Agency is allowed to notify government authorities if the
Agency believes a patient is the victim of abuse, neglect or domestic violence. The Agency will make this disclosure only when
specifically required or authorized by law or when the patient agrees to the disclosure.
To Conduct Health Oversight Activities. The Agency may disclose your health information to a health oversight
agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action.
The Agency, however, may not disclose your health information if you are the subject of an investigation is not directly related to
your receipt of health care or public benefits.
In Connection With Judicial And Administrative Proceedings. The Agency may disclose your health information in
the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly
authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when the Agency makes
reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. As permitted or required by State law, the Agency may disclose your health
information to a law enforcement official for certain law enforcement purposes as follows:
• As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order,
warrant, subpoena or summons or similar process.
• For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
• Under certain limited circumstances, when you are the victim of a crime.
• To a law enforcement official if the Agency has a suspicion that your death was the result of criminal conduct
including criminal conduct at the Agency.
• In an emergency in order to report a crime.
To Coroners And Medical Examiners. The Agency may disclose your health information to coroners and medical
examiners for purposes of determining your cause of death or for other duties, as authorized by law.
To Funeral Directors. The Agency may disclose your health information to funeral directors consistent with applicable
law and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, the
Agency may disclose your health information prior to and in reasonable anticipation of your death.
For Organ, Eye Or Tissue Donation. The Agency may use or disclose your health information to organ procurement
organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of
facilitating the donation and transplantation.
For Research Purposes. The Agency may, under very select circumstances, use your health information for research.
Before the Agency discloses any of your health information for such research purposes, the project will be subject to an extensive
approval process. (If the Agency intends to routinely conduct research it is important to carefully review the authorization
requirements for research exceptions and revise the Notice provisions as needed.)
In the Event of A Serious Threat To Health Or Safety. The Agency may, consistent with applicable law and ethical
standards of conduct, disclose your health information if the Agency, in good faith, believes that such disclosure is necessary to
prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Government Functions. In certain circumstances, the Federal regulations authorize the Agency to use or
disclose your health information to facilitate specified government functions relating to military and veterans, national security and
intelligence activities, protective services for the President and others, medical suitability determinations and inmates and law
enforcement custody.
For Worker’s Compensation. The Agency may release your health information for worker’s compensation or similar
programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than is stated above, the Agency will not disclose your health information other than with your written
authorization. If you or your representative authorizes the Agency to use or disclose your health information, you may revoke that
authorization in writing at any time.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that the Agency maintains:
• Right to request restrictions. You may request restrictions on certain uses and disclosures of your health
information. You have the right to request a limit on the Agency’s disclosure of your health information to
someone who is involved in your care or the payment of your care. The agency must agree to restrict disclosure
of your personal health information upon your request, if:
a. the disclosure is for payment or healthcare operations purposes;
b. is not required by law; and
c. the protected health information pertains solely to a healthcare item or service for which you, or
someone on your behalf other than the health plan, has paid Agency in full.
If you wish to make a request for restrictions, please contact the Privacy Officer.
• Right to receive confidential communications. You have the right to request that the Agency communicate
with you in a certain way. For example, you may ask that the Agency only conduct communications pertaining
to your health information with you privately with no other family members present. If you wish to receive
confidential communications, please contact Privacy Officer. The Agency will not request that you provide any
reasons for your request and will attempt to honor your reasonable requests for confidential communications.
• Right to inspect and copy your health information. You have the right to inspect and copy your health
information, including billing records. A request to inspect and copy records containing your health information
may be made to the Privacy Officer. If you request a copy of your health information, the Agency may charge a
reasonable fee for copying and assembling costs associated with your request. If the Agency maintains your
personal health information electronically, the Agency must provide you with electronic access in a form and
format requested by you, if the information is readily producible in such format.
• Right to amend health care information. You or your representative have the right to request that the Agency
amend your records, if you believe that your health information is incorrect or incomplete. That request may be
made as long as the information is maintained by the Agency. A request for an amendment of records must be
made in writing to Privacy Officer. The Agency may deny the request if it is not in writing or does not include a
reason for the amendment. The request also may be denied if your health information records were not created
by the Agency, if the records you are requesting are not part of the Agency’s records, if the health information
you wish to amend is not part of the health information you or your representative are permitted to inspect and
copy, or if, in the opinion of the Agency, the records containing your health information are accurate and
complete.
• Right to an accounting. You or your representative have the right to request and accounting of disclosures of
your health information made by the Agency for certain reasons, including reasons related to public purposes
authorized by law and certain research. The request for an accounting must be made in writing to Privacy
Officer. The request should specify the time period for the accounting starting on or after April 14, 2003.
Accounting requests may not be made for periods of time in excess of six (6) years. The Agency would provide
the first accounting you request during any 12-month period without charge. Subsequent accounting requests
may be subject to a reasonable cost-based fee.
• Right to a paper copy of this notice. You or your representative have a right to a separate paper copy of this
Notice at any time even if you or your representative have received this Notice previously. To obtain a separate
paper copy, please contact Privacy Officer.
DUTIES OF THE AGENCY
The Agency is required by law to maintain the privacy of your health information and to provide to you and your
representative this Notice of its duties and privacy practices. The Agency is required to abide by the terms of this Notice of its
duties and privacy practices and to notify you following a breach of your unsecured protected health information . The Agency is
required to abide by the terms of this Notice as may be amended from time to time. The Agency reserves the right to change the
terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If the Agency
changes its Notice, the Agency will provide a copy of the revised Notice to you or your appointed representative. You or your
personal representative have the right to express complaints to the Agency and to the Secretary of DADS if you or your
representative believe that your privacy rights have been violated. Any complaints to the Agency should be made in writing to
Privacy Officer. The Agency encourages you to express any concerns you may have regarding the privacy of your information.
You will not be retaliated against in any way for filing a complaint.
CONTACT PERSON
The Agency has designated the Privacy Officer as its contact person for all issues regarding patient privacy and your
rights under the Federal privacy standards.
EFFECTIVE DATE
This Notice is effective April 14, 2003.
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