NOTICE OF PRIVACY PRACTICES
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.
The Health Insurance Portability and Accountability Act (HIPAA) is a Federal law. It requires that your health information be kept private and protected. This law also requires that we provide you with this notice. This notice will explain our legal duties and privacy practices regarding protected health information (PHI). This notice became effective April 14, 2003.
I. Our Duty to Safeguard Your Protected Health Information
We are committed to preserving the privacy and confidentiality of your health information whether created by us or maintained on our premises. We are required by certain state and federal regulations to implement policies and procedures to safeguard the privacy of your health information. We are required by state and federal regulations to abide by the privacy practices described in this notice including any future revisions that we may make to the notice as may become necessary or as authorized by law.
Individually identifiable information about your past, present, or future health or condition, the provisions of health care to you, our payment for the health care treatment or service you receive is considered protected health information (PHI). As such, we are required to provide you with this Privacy Notice that contains information regarding our privacy practices that explains how, when, and why we may use or disclose your PHI and your rights and our obligations regarding any such uses or disclosures. Except in specific circumstances, we must use or disclose only the minimum necessary PHI to accomplish the intended purpose of the use or disclosure of such information.
We reserve the right to change this notice at any time and to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future about you. Should we revise/change this Privacy Notice, we will post a copy of the new/revised Privacy Notice from Tania Adams.
Should you have any questions concerning our privacy notice, please feel free to contact Communicare, Inc. at 1-866-802-9191.
II. How we May Use and Disclose Your Protected Health Information
We use and disclose PHI for a variety of reasons. We have limited right to use and/or disclose your health information for purposes of treatment, payment, or for the operations of our facility. For other uses, you must give us your written authorization to release your PHI unless the law permits or requires us to make the use or disclosure without your authorization.
Should it become necessary to release your PHI to an outside party, we will require the party to have a signed agreement with us that the party will extend the same degree of privacy protection to your information as we do.
The privacy law permits us to make some uses or disclosures of your PHI without your consent or authorization. The following describes each of the different ways that we may use or disclose you PHI. Where appropriate, we have included examples of the different types of uses or disclosures. These Include:
1. Use and Disclosures Related to Treatment:
We may disclose your PHI to those who are involved in providing medical and nursing care services and treatments to you. For example, we may release health information about you to our treatment team, nurses, therapists, pharmacists, consultants, physicians, practicum students, etc. We may also disclose your PHI to outside entities performing other services relating to your treatment; such as diagnostic laboratories, external case managers, waiver support coordinators, home health agencies, family members etc.
2. Use and Disclosures Related to Payment:
We any use or disclose your PHI to bill and collect payment for services or treatments we provided to you. For example, we may contact your insurance facility, health plan, or another third party to obtain payment for services we provide to you.
3. Use and Disclosures Related to Health Care Operations:
We may use or disclose your PHI to perform certain functions within our facility should these uses or disclosures become necessary to operate our facility and to ensure that you and others we provide care and services to continue to receive quality care and services. For example, we will take your photograph for identification purposes for your own safety while on community inclusive activities. We may disclose your PHI to our staff and staff from state agencies for auditing, care planning, treatment, licensure and learning purposes. We may also combine your health information with information from other providers to study how our facility is performing in comparison to like facilities or what we can do to improve the care and services we provide you. When information is combined, we remove all information that would identify you so that others may use the information in developing research on the delivery of health care services.
4. Use and Disclosures Related to Treatment Alternatives, Health-Related Benefits and Services:
We may use or disclose your PHI for purposes of contacting you to inform you of treatment alternatives or health-related benefits and services that may be of interest to you. For example, a newly released medication or alternative treatment that has a direct relationship to the treatment or medical condition.
III. Uses and Disclosures requiring Your Written Authorization
For uses and disclosures of your PHI beyond treatment, payment and operation purposes, we are required to have your written authorization, except as permitted by law. You have the right to revoke an authorization at any time to stop future uses or disclosures of your information except to the extent that we have already undertaken an action in reliance upon your authorization. Your revocation request must be provided to us in writing. The name, address, telephone number of the person to contact is located on the last page of this document. You may use our Authorization for use or Disclosure of Protected Health Information for and/or Revocation of an Authorization form to submit your request to us. Copies of these forms are available from Tania Adams.
Examples of uses or disclosures that would require your written authorization include, but are not limited to the following:
1. A request to provide your PHI to an attorney for use in a civil litigation claim.
2. A request to provide certain information to an insurance facility for the purposes of providing you with information relative to insurance benefits.
3. A request to provide certain information to another individual or facility.
IV. Uses or Disclosures of Information Based Upon Your Verbal Agreement
In the following situations, we may disclose a limited amount of your PHI if we provide you with an advance oral or written notice and you do not object to such a release or such release is not otherwise prohibited by law. However, if there is an emergency situation and you are unable to object (because you were not present or you were incapacitated, etc.), disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interest. When a disclosure is made based on these emergency situations, we will only disclose health information relevant to the person’s involvement in your care. For example, if you are sent to the emergency room, we may only inform the person that you suffered an apparent seizure, have pain in a certain location, etc., and/or we may provide information on your prognosis or progress. You will be informed and given an opportunity to object to further disclosures of such information as soon as you are able to do so.
1. Information Used or Disclosed in the Facility Director:
We may use or disclose your name and/or room number in our facility directory. Information concerning your general condition or room location may be provided to callers or visitors or callers when they ask for you by name. You may object to the release of this information. You may use our Request to Restrict the Use of Disclosure of Protected Health Information form to notify us of your objection or you objection may be made orally. The name, address, telephone number of the person to contact is located on the last page of the document. (See also Section VI, paragraph 1).
2. Information Disclosed to Family members, Friends or Others Involved in Your Care:
We may disclose your PHI to your family members and friends who are involved in your care or who help pay for your care. We may also disclose your PHI to a disaster relief organization for the purposes of notifying your family and/or friends about your general condition, location, and/or status. You may object to the release of this information. You may use our Request to Restrict the Use of Disclosure of Protected Health Information form to notify us of your objection or you objection may be made orally. The name, address, telephone number of the person to contact is located on the last page of this document. (See also Section VI, paragraph 1).
V. Uses and Disclosure of Information That Do Not Require Your Consent or Authorization
State and federal laws and regulations either require or permit us to use or disclose your PHI without your consent or authorization. The uses or disclosures that we make without your consent or authorization include the following:
1. When Required by Law:
We may disclose your PHI when a federal, state or local law required that we report information about suspected abuse, neglect, domestic violence or relating to suspected criminal activity, reporting adverse incidents/significant events, reactions to medications or injury from a health care product, or in response to a court order or subpoena. We must also share PHI with authorities that monitor our compliance with privacy requirements.
Law Enforcement: We may disclose your PHI if asked to do so by a law enforcement official:
In response to court order, subpoena, warrant, summons, or similar process;
To identify or locate a suspect, fugitive, material witness, or missing person;
About the victim of a crime if, under certain circumstances, we are unable to obtain the person’s agreement;
About criminal conduct at the facility;
In emergency circumstances to report a crime, the location of the crime or victims; or the identity, description or location of the person that committed the crime.
1. Lawsuits and Disputes:
We may disclose your PHI if you are involved in a lawsuit or dispute related to response to a court order or administrative order. We may disclose your PHI about you in response to a subpoena, discovery request (which may include written notice to you) or to obtain an order protecting the information requested.
2. For Public Health Activities:
We may disclose your PHI when we are required to collect information about disease or injury, or to report to a public health authority.
3. For Health Oversight Activities:
We may disclose your PHI to a health oversight agency such as protection and advocacy agency, the state agency (ies) responsible for inspecting our facility or to other agencies responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents or to ensure that we are in compliance with applicable state and federal laws and regulation.
4. Relating to Decedents:
We may disclose your PHI relating to an individual’s death for purposes of identifying with coroners, medical examiners, or funeral directors, and to organ procurement organizations relating to organ, eye, or tissue donations transplants.
5. For Research Purposes:
In certain circumstances, we may disclose your PHI in order to assist medical, psychiatric, or behavioral research. Researchers will be required to sign a Confidentiality and Non-Disclosure Agreement form before permitted access to health information for research purposes.
6. To Prevent Threats to Health or Safety:
We may disclose your PHI to avoid serious treat to your health or safety of others. When such disclosure is necessary, information will only be released to those law enforcement agencies or individuals who have the ability or authority to prevent or lessen the threat of harm.
7. For Specific Government Functions:
We may disclose your PHI of military personnel and veterans, when requested by military command authorities, or to correctional institutions.
VI. Your Right Regarding Your Protected Health Information
You have the following rights concerning the use or disclosure of your PHI that we create or that we maintain on our premises:
1. To Request Restrictions on Uses and Disclosures of Your Protected Health Information:
You have the right to request that we limit how we use or disclose your PHI for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or services. For example, you could request that we not disclose to family members or friends information about treatment you received.
Should you wish a restriction be placed on the use and disclosure of your PHI, you must submit such request in writing. (Note: You may submit such request using our Request to Restrict the Use and Disclosure of Protected Health Information form).
We are not required to agree to your restriction request. However, should we agree, we will comply with your request not to release such information unless the information is needed to provide emergency care or treatment to you.
2. The Right to Inspect and Copy Your Medical and Billing Records:
You have the right to inspect and copy your health information, such as your medical billing records that we use to make decisions about your care and services. In order to inspect and/or copy your health information, you must submit a written request to us. If you request a copy of your medical information, we may charge you a reasonable fee for the paper, labor, mailing, and/or retrieval costs involved in filing your request. We will provide you with information concerning the cost of copying your health information prior to performing such service. You may submit your request on our Request for Inspection/Copy of Protected Health Information form.
We will respond within thirty (30) days of receipt of such requests. Should we deny your request to inspect and/or copy your health information, we will provide you with written notice of our reasons of the denial and your rights for requesting a review of our denial. If such review is granted or is required by law, we will select a licensed health care professional not involved in the original denial process to review your request and our reasons of denial. We will abide by the reviewer’s decision concerning your inspection/copy requests. You may submit your denial review requests on our Denial of Inspection/Copy of Protected Health Information form.
3. The Right to Amend or Correct Your Health Information:
You have the right to request that your health information be amended or corrected if you have reason to believe that certain information is incomplete or incorrect. You have the right to make such requests of us for as long as we maintain/retain your health information. Your requests must be submitted to us in writing. We will respond within sixty (60) days of receiving the written request. If we approve your request, we will make such amendments/corrections and notify those with a need to know of such amendments/corrections.
We may deny your request if:
a. Your request is not submitted in writing;
b. Your written request does not contain a reason to support your request;
c. The information was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
d. It is not part of the health information kept by or for our facility;
e. It is not part of the information which you would be permitted to inspect/copy; and/or
f. The information is already accurate and complete.
If your request is denied, we will provide you with a written notification of the reason (s) of such denial and your rights to have the request, the denial, and any written response you may have relative to the information and denial process appended to your health information. You may submit your amendment/correction requests on our Requests for Amendment/Correction of Protected Health Information form.
4. The Right to Request Confidential Communications:
You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you may request that we not send any health information about you to a family member’s address. We will agree to your request as long as it is reasonably easy fro us to do so. You are not required to reveal nor will we ask the reason for your request. To request confidential communication you must:
a. Notify us in writing;
b. Indicate what information your wish to limit;
c. Indicate whether or not you wish to limit or restrict our use or disclosure of such information; and
d. Identify to whom the restrictions apply (e.g., which family member (s), agency, etc.)
You may submit your requests on our Request for Restriction of Confidential Communication form.
5. The Right to Request an Accounting of Disclosures of Protected Health Information:
You have the right to request that we provide you with a listing of when, to whom, for what purpose, and what content of your PHI we have released over a specified period of time. This accounting will not include any information we have made for the purposes of treatment, payment, or health care operations or information released to you, your family, or the facility directory, or disclosures made for national security purposes, or any release pursuant to your authorization.
Your request must be submitted in writing and must indicate the time period for which you wish the information (e.g., May 1, 2003 through August 31, 2005). Your request may not include releases for more than seven (7) years prior to the date of your request any may not include releases prior to April 14, 2003. Your request must indicate in what form (e.g., printed copy or electronic mail) you wish to receive this information. We will respond within sixty (60) days of receiving the written request. The first accounting you request during a twelve (12) month period will be free. For additional accountings, a fee may be charged for providing the list. We will notify you of the fee before any costs are incurred. You may submit your requests on our request for an Accounting of disclosures of Protected Health Information form.
6. The Right to a Paper Copy of this Notice:
You have the right to a paper copy of this Notice and you may request a copy at any time from any member of our staff.
VII. How To File a Complaint About Our Private Practices
If you have reason to believe that we have violated your privacy rights, violated our privacy polices and procedures, or you disagree with a decision we made concerning access to your protected health information, etc., you have the right to file a complaint with us or the Secretary of the Department of Health and Human Services. Complaints may be filed without fear of retaliation in any form. You may submit your complaint on our Privacy Practices Complaint Form.