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Notice
of Privacy Practices for Protected Health Information
"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."
Putnam
County HomeCare & Hospice is required by law to maintain the
privacy of protected health information and to provide you adequate
notice of your rights and our legal duties and privacy practices with
respect to the uses and disclosures of protected health information.
[45 CFR § 165.520] We will use or disclose protected
health information in a manner that is consistent with this notice.
The
agency maintains a record (paper/electronic file) of the information
we receive and collect about you and of the care we provide to you.
This record includes physicians' orders, assessments, medication
lists, clinical progress notes and billing information.
As
required by law, the agency maintains policies and procedures about
our work practices, including how we provide and coordinate care
provided to our patients. These policies and procedures include how
we create, maintain and protect medical records; access to medical
records and information about our patients; how we maintain the
confidentiality of all information related to our patients; security
of the building and electronic files; and how we educate staff on
privacy of patient information.
As
our patient, information about you must be used and disclosed to
other parties for purposes of treatment, payment and health care
operations. Examples of information that must be disclosed:
Treatment:
Providing, coordinating or managing health care and related
services, consultation between health care providers relating to a
patient or referral of a patient for health care from one provider
to another. For example, we meet on a regular basis to discuss how
to coordinate care to patients and schedule visits.
Payment:
Billing and collecting for services provided, determining plan
ligibility and coverage, utilization review (UR), precertification,
and medical necessity review. For example, occasionally the
insurance company requests a copy of the medical record sent to them
for review prior to paying the bill.
Health
Care Operations: General agency administrative and business
functions, quality assurance/improvement activities; medical review;
auditing functions; developing clinical guidelines; determining the
competence or qualifications of health care professionals;
evaluating agency performance; conducting training programs with
students or new employees; licensing, survey, certification,
accreditation and credentialing activities; internal auditing and
certain fundraising and marketing activities. For example, our
agency periodically holds clinical record review meetings where the
consulting professional of our record review committee will audit
clinical records for meeting professional standards and utilization
review.
The
following uses and disclosures do not require your consent,
and include, but are not limited to, a release of information
contained in financial records and/or medical records, including
information concerning communicable diseases such as Human Immune
Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome
(AIDS), drug/alcohol abuse, psychiatric diagnosis and treatment
records and/or laboratory test results, medical history, treatment
progress and/or any other related information to:
Your
insurance company, self-funded or third-party health plan,
Medicare, Medicaid or any other person or entity that may be
responsible for paying or processing for payment any portion of
your bill for services;
Any
person or entity affiliated with or representing Putnam County
HomeCare & Hospice for purposes of administration, billing and
quality and risk management;
Any
hospital, nursing home or other health care facility to which you
may be admitted;
Any
assisted living or personal care facility of which you are a
resident;
Any
physician providing you care;
Licensing
and accrediting bodies, including the information contained in the
OASIS Data Set to the state agency acting as a representative of
the Medicare/Medicaid program;
Contact
you to provide appointment reminders or information about other
health activities we provide;
Contact
you to raise funds for the Agency;
Other
health care providers to initiate treatment.
We
are permitted to use or disclose information about you without
consent or authorization in the following circumstances:
In
emergency treatment situations, if we attempt to obtain
consent as soon as practicable after treatment;
Where
substantial barriers to communicating with you exist and we
determine that the consent is clearly inferred from the
circumstances;
Where
we are required by law to provide treatment and we are unable
to obtain consent;
Where
the use or disclosure of medical information about you is
required by federal, state or local law;
To
provide information to state or federal public health
authorities, as required by law to: prevent or control disease,
injury or disability; report births and deaths; report child abuse
or neglect; report reactions to medications or problems with
products; notify persons of recalls of products they may be using;
notify a person who may have been exposed to a disease or may be at
risk for contracting or spreading a disease or condition; and notify
the appropriate government authority if we believe a patient has
been the victim of abuse, neglect or domestic violence (if you agree
or when required or authorized by law);
Health
care oversight activities such as audits, investigations,
inspections and licensure by a government health oversight agency as
authorized by law to monitor the health care system, government
programs and compliance with civil rights laws;
Certain
judicial administrative proceedings if you are involved in a
lawsuit or a dispute. We may disclose medical information about you
in response to a court or administrative order, a subpoena,
discovery request or other lawful process by someone else involved
in the dispute, but only if efforts have been made to tell you about
the request or to obtain an order protecting the information
requested;
Certain
law enforcement purposes such as helping to identify or locate a
suspect, fugitive, material witness or missing person, or to comply
with a court order or subpoena and other law enforcement purposes;
To
coroners, medical examiners and funeral directors, in certain
circumstances, for example, to identify a deceased person, determine
the cause of death or to assist in carrying out their duties;
For cadaveric organ, eye or tissue donation purposes to
communicate to organizations involved in procuring, banking or
transplanting organs and tissues (if you are an organ donor);
For certain research purposes under very select
circumstances. We may use your health information for research.
Before we disclose any of your health information for such research
purposes, the project will be subject to an extensive approval
process. We will usually request your written authorization before
granting access to your individually identifiable health information;
To
avert a serious threat to health and safety: To prevent or
lessen a serious and imminent threat to the health or safety of a
particular person or the general public, such as when a person
admits to participation in a violent crime or serious harm to a
victim or is an escaped convict. Any disclosure, however, would only
be to someone able to help prevent the threat;
For
specialized government functions, including military and
veterans' activities, national security and intelligence activities,
protective services for the President and others, medical
suitability determinations, correctional institution and custodial
situations;
We
are permitted to use or disclose information about you without
consent or authorization provided you are informed in advance and
given the opportunity to agree to or prohibit or restrict the
disclosure in the following circumstances:
To
a family member, relative, friend, or other identified person, the
information relevant to such person's involvement in your care or
payment for care; to notify family member, relative, friend, or
other identified person of the individual's location, general
condition or death.
Other
uses and disclosures will be made only with your written
authorization. That authorization may be revoked, in writing, at any
time, except in limited situations.
YOUR
RIGHTS - You have the right, subject to certain conditions, to:
Request
restrictions on uses and disclosures of your protected health
information for treatment, payment or health care operations.
However, we are not required to agree to any requested restriction.
Restrictions to which we agree will be documented. Agreements for
further restrictions may, however, be terminated under applicable
circumstances (e.g., emergency treatment).
Confidential
communication of protected health information. We will arrange
for you to receive protected health information by reasonable
alternative means or at alternative locations. Your request must be
in writing. We do not require an explanation for the request as a
condition of providing communications on a confidential basis and
will attempt to honor reasonable requests for confidential
communications.
Inspect
and obtain copies of protected health information which is
maintained in a designated record set, except for psychotherapy
notes, information compiled in reasonable anticipation of, or for
use in, a civil, criminal or administrative action or proceeding, or
protected health information that is subject to the Clinical
Laboratory Improvements Amendments of 1988 [42 USC § 263a and
45 CFR 493 § (a)(2)]. If you request a copy of your health
information, we will charge a reasonable fee for copying. If we
deny access to protected health information, you will receive a
timely, written denial in plain language that explains the basis for
the denial, your review rights and an explanation of how to exercise
those rights. If we do not maintain the medical record, we will tell
you where to request the protected health information.
Request
to amend protected health information for as long as the
protected health information is maintained in the designated record
set. A request to amend your record must be in writing and must
include a reason to support the requested amendment. We will act on
your request within sixty-days (60) of receipt of the request. We
may extend the time for such action by up to 30 days, if we provide
you with a written explanation of the reasons for the delay and the
date by which we will complete action on the request.
We
may deny the request for amendment if the information contained in
the record was not created by us, unless the originator of the
information is no longer available to act on the requested amendment;
is not part of the designated medical record set; would not be
available for inspection under applicable laws and regulations; and
the record is accurate and complete. If we deny your request for
amendment, you will receive a timely, written denial in plain
language that explains the basis for the denial, your rights to
submit a statement disagreeing with the denial and an
explanation of how to submit that statement.
Receive
an accounting of disclosures of protected health information
made by our Agency for up to six (6) years prior to the date on
which the accounting is requested for any reason other than for
treatment, payment or health operations and other applicable
exceptions. The written accounting includes the date of each
disclosure, the name/address (if known) of the entity or person who
received the protected health information, a brief description of
the information disclosed and a brief statement of the purpose of
the disclosure or a copy of your written authorization or a written
request for disclosure. We will provide the accountings within 60
days of receipt of a written request. However, we may extend the
time period for providing the accounting by 30 days if we provide
you with a written statement of the reasons for the delay and the
date by which you will receive the information. We will 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.
To
obtain a paper copy of this notice, even if you had agreed to
receive this notice electronically, from us upon request. The
patient or patient's representative may also obtain a copy of the
current version of the Agency's Notice of Privacy Practices at its
website, www.pchh.net
COMPLAINTS
- If you believe that your privacy rights have been violated, you
may complain to the Agency or to the Secretary of the U.S. Department
of Health and Human Services. There will be no retaliation against
you for filing a complaint. The complaint should be filed in
writing, and should state the specific incident(s) in terms of
subject, date and other relevant matters. A complaint to the
Secretary must be filed in writing within 180 days of when the act or
omission complained of occurred, and must describe the acts or
omissions believed to be in violation of applicable requirements. [45
CFR § 160.306]
CONTACT
PERSON
The
Agency has designated the Privacy Official as its contact person for
all issues regarding patient privacy and your rights under the
Federal privacy standards. You may contact this person at 139 Court
Street, P. O. Box 312, Ottawa, Ohio 45875. Our phone number is
419-523-4449.
EFFECTIVE DATE
This
Notice is effective April 14, 2003.
IF
YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT the
Privacy Official at 419-523-4449.
The Only Home Care Agency Located In Putnam County,
Serving Our Community Since 1966.
139 Court Street · P.O. Box 312
Ottawa, OH 45875 · 419-523-4449
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