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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. USE AND DISCLOSURE OF HEALTH INFORMATION Family Home Health Services may use your health information for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. In certain circumstances, your health information may be used or disclosed only after the agency has obtained your authorization. The agency has established a policy to guard against unnecessary use and disclosure of your health information. THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES
UNDER To provide treatment: Family Home Health Services may use your health information to coordinate care within the agency and with others involved in your care, such as your attending physician, members of the care team and other health care professionals have agreed to assist the agency in coordinating your care. For example, doctors 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, clergy whom you have designated, pharmacists, suppliers of medical equipment or other health care professionals that the agency uses to coordinate your care. To obtain payment: Family Home Health Services may include your health information in invoices to collect payment from third parties for the care you may receive from the agency. For example, the agency may be required by your health insurer to provide information regarding your health 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: Family Home Health
Services may use and disclose health care 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 patients. Health care operations
include such activities as: For example, Family Home Health Services 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 patients, disclose your health information to staff and contract personnel for training purposes, and use your health information to contact you as a reminder regarding a visit to you or to inform you about treatment alternatives or other health-related services and benefits that may be of interest to you. In addition, Three Rivers Family Hospice may use your health information to contact you for its own fundraising activities. FEDERAL PRIVACY RULES ALLOW THE AGENCY TO USE
OR To notify and/or communicate with your family: Unless you advise Family Home Health Services that you object, it may use or disclose your health information in order to notify your family or assist in notifying your family, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are unable or unavailable to agree or object, health professionals of Family Home Health Services will use their best judgment in any communications with your family and others. When legally required: Family Home Health Services 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: Family Home Health Services may disclose your health information for public health activities and purposes: * To prevent or control disease, injury or disability,
report disease, injury, vital events such as birth and death and the conduct
of public health surveillance, investigations or intervention. To report abuse, neglect or domestic violence: Family Home Health Services 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: Family Home Health Services may disclose your health information to a health oversight agency for activities including audits, civil, administrative or criminal investigations, proceedings or actions; inspections; licensure or disciplinary actions. The agency, however, may not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits. In connection with judicial and administrative proceedings: Family Home Health Services 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 an order; or in response to a subpoena, discovery request or other lawful process, but only when the agency makes reasonable effort to either notify you about the request or to obtain an order protecting your health information. For law enforcement purposes: Family Home Health Services may disclose your health information to a law enforcement official of law enforcement purposes as follows: * As required by law for reporting o f certain types of
wounds or other physical injustices. To coroners and medical examiners: Family Home Health
Services 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. For organ, eye or tissue donation: Family Home Health Services 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: Family Home Health Services may, under very select circumstances, use your health information for research. To avert a serious threat to health or safety: Family Home Health Services 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 specialized government functions: In certain circumstances, Family Home Health Services may 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 workers’ compensation: Family Home Health Services may release your health information for workers’ compensation or similar programs. Change of ownership: In the event that our entity is sold or merged with another organization, your health information/record will become the property of the new owner. AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION Other than as stated above, Family Home Health Services will not use or disclose your health information other than with your written authorization. If you authorize the agency to use or disclose your health information, you may revoke that authorization in writing any time, except to the extent that Family Home Health has taken action in reliance on that authorization. YOUR RIGHTS WITH RESPECT TO 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 disclosure of your health information. You have the right to request a limit on the agency disclosure of your health information to someone who is involved in your care or the payment of your care. However, Family Home Health Services is not required to agree to your request. If you wish to make a request for restrictions, please contact Family Home Health Services’ Privacy Officer. * Right to receive confidential communication: You have the right to request that the agency communicate with you through confidential means through a reasonable alternative means or at an alternative location. For example, you may ask that the agency personnel 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 the Privacy Officer. Family Home Health Services 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 must be made in writing 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. * Right to amend health care information: If you believe that your health information records are incorrect or incomplete, you may request that the agency amend the records. A request for an amendment of records must be made in writing to the Privacy Officer and must contain a statement of the reason for your request. Family Home Health Services is not required to change your health records and will provide you with information about a denial and how you can disagree with the denial. * Right to an accounting: You have the right to receive an accounting of disclosures of your health information made by the agency, except that the agency does not have to account for disclosures: authorized by you; made for treatment, payment or health operations; provided to you; provided in response to your authorization; made in order to notify and communicate with family; and/or for certain government functions, to name a few. The request for an accounting must be made in writing to the Billing Supervisor. The request should specify the time period for the accounting, but Family Home Health Services is not required to account for disclosures made before April 14, 2003 or made more than six years before the date of your request. * Right to a paper copy of this notice: You have a right to a separate paper copy of this notice at any time, even if you have received this notice previously. To obtain a separate paper copy, please contact the agency’s Privacy Officer. DUTIES OF FAMILY HOME HEALTH SERVICES Family Home Health Services is required by law to maintain the privacy of your protected health information and to provide you or your representative with notice of its duties and privacy practices with respect to protected health information. The agency is required to abide by terms of this notice as it may be amended from time to time. The agency reserves the right to change the terms of this notice and to make the new notice provisions effective for all protected health information that it maintains. If the agency changes its notice, the agency will provide a copy of the reviewed notice to you or your appointed representative. You have the right to express complaints to Family Home
Health Services and to the Secretary of the Department of Health and Human
Services if you believe that your privacy rights have been violated. Any
complaints to the agency should be made in writing to the 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. Family Home Health Services’ contact person for all issues regarding this notice or any of your privacy rights is: Aleta Dick, RN EFFECTIVE DATE This notice is effective April 14, 2003. |
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