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NORTH
WOODS HOME NURSING & HOSPICE
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
NORTH
WOODS HOME NURSING AND HOSPICE 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
your 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:
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Quality assessment and improvement activities.
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Activities designed to improve health or reduce health care
costs.
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Protocol development, case management and care coordination.
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Contacting health care providers and patients with
information about treatment alternatives and other related functions
that do not include treatment.
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Professional review and performance evaluation.
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Training programs including those in which students, trainees
or practitioners in health care learn under supervision.
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Training of non-health care professionals.
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Accreditation, certification, licensing or credentialing
activities.
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Review and auditing, including compliance reviews, medical
reviews, legal services and compliance programs.
-
Business planning and development including cost management
and planning related analyses and formulary development.
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Business management and general administrative activities of
the Agency.
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.
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.
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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 an 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 and your health information is not
directly related to your receipt of health care or public benefits.
In
Connection With Judicial And Administrative Proceedings. As permitted or required by state law, 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 an
administrative tribunal as expressly authorized by such order or in
response to a subpoena/discovery request or other lawful notice.
Reasonable efforts will be made 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.
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For the purpose of identifying or locating a suspect,
fugitive, material witness or missing person.
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Under certain limited circumstances, when you are the victim
of a crime.
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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.
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:
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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. However,
the Agency is not required to agree to your request.
If you wish to make a request for restrictions, please
contact HIPPA
COMPLIANCE OFFICER.
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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 HIPPA COMPLIANCE OFFICER AT 1-800-852-3736. The Agency will not request that you provide any
reasons for your request and will attempt to honor your reasonable
requests for confidential communications.
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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 HIPPA
COMPLIANCE OFFICER AT 800-852-3736.
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.
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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 HIPPA COMPLIANCE OFFICER,
P.O. BOX 307, MANISTIQUE, MI 49854.
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.
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Right to an
accounting. You
or your representative have the right to request an 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 HIPPA COMPLIANCE OFFICER, P.O. BOX
307, MANISTIQUE, MI 49854.
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.
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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 HIPPA
COMPLIANCE OFFICER, 800-852-3736.
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
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 CMS if you or your
representative believe that your privacy rights have been violated.
Any complaints to the Agency should be made in writing to HIPPA COMPLIANCE OFFICER, P.O. BOX
307, MANISTIQUE, MI 49854.
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 HIPPA
COMPLIANCE OFFICER as its contact person for all issues
regarding patient privacy and your rights under the Federal privacy
standards. You may
contact this person at P.O.
BOX 307, MANISTIQUE, M I 49854, 800-852-3736.
EFFECTIVE
DATE
This Notice is effective April 14, 2003.
IF
YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT HIPPA
COMPLIANCE OFFICER, P.O.
BOX 307, MANISTIQUE, M I 49854,
800-852-3736. |
