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INDEPENDENT
HOME HEALTH CARE NOTICE OF PRIVACY PRACTICES Effective: April
14, 2003 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.
This notice will tell you how we may use and disclose protected
health information about you. Protected health information
means any health information about you that identifies you
or for which there is a reasonable basis to believe the information
can be used to identify you. In this notice, we call all of
that protected health information, "medical information."
This notice also will tell you about your rights and our duties
with respect to medical information about you. It will tell
you how to complain to us if you believe we have violated
your privacy rights. How We May Use and Disclose Medical Information
About You.
We use and disclose medical information about you for a number
of different purposes. Each of those purposes is described
below.
• For Treatment.
We may use medical information about you to provide, coordinate
or manage your health care and related services by both us
and other health care providers. We may disclose medical information
about you to doctors, nurses, hospitals and other health facilities
or organizations who become involve in your care. We may consult
with other health care providers concerning you and as part
of the consultation share your medical information with them.
Similarly, we may refer you to another health care provider
and as part of the referral share medical information about
you with that provider. For example, your physician may have
ordered therapy for your condition. When we refer you to the
therapist, we also provide medical information about you to
the therapist so they can evaluate your needs and develop
a Plan of Care that best suits you.
• For Payment.
We may use and disclose medical information about you so we
can be paid for the services we provide to you. This can include
billing you, your insurance company, or a third party payor.
For example, we may need to give your insurance company information
about the health care services we provide to you so your insurance
company will pay us for those services. We also may need to
provide your insurance company or a government program, such
as Medicare or Medicaid, with information about your medical
condition and the health care you need to determine if you
are covered by that insurance or program.
• For Health Care Operations.
We may use and disclose medical information about you for
our own health care operations. These are necessary for us
to operate Independent Home Health Care and to maintain quality
health care for our patients. For example, we may use medical
information about you to review the services we provide and
the performance of our employees in caring for you. We may
disclose medical information about you to train our staff.
We also may use the information to study ways to more efficiently
manage our organization.
• How We Will Contact You.
Unless you tell us otherwise in writing, we may contact you
or your caregiver by either telephone or by mail. We may leave
messages for you on the answering machine or voice mail. If
you want to request that we communicate to you in a certain
way or at a certain location, see "Right to Receive Confidential
Communications" on page 6 of this Notice.
• Appointment Reminders.
We may use and disclose medical information about you to contact
your residence about our upcoming home visit to provide services
to you.
• Treatment Alternatives.
We may use and disclose medical information about you to contact
you about treatment alternatives that may be of interest to
you.
• Health Related Benefits and Services.
We may use and disclose medical information about you to contact
you about health-related benefits and services that may be
of interest to you.
• Marketing Communications.
We may use and disclose medical information about you to communicate
with you about a product or service to encourage you to purchase
the product or service.
This may be:
-- To describe a health-related product or service that is
provided by us;
-- For your treatment;
-- For case management or care coordination for you;
--To direct or recommend alternative treatments, therapies,
health care providers, or settings of care. We may communicate
to you about products and services in a face-to-face communication
by us to you or by phone. All other use and disclosure of
medical information about you by us to make a communication
about a product or service to encourage the purchase or use
of a product or service will be done only with your written
authorization.
• Individuals Involved in Your Care.
We may disclose to a family member, other relative, a close
personal friend, or any other person identified by you, medical
information about you that is directly relevant to that personÕs
involvement with your care or payment related to your care.
We also may use or disclose medical information about you
to notify, or assist in notifying, those persons of your location,
general condition, or death. If there is a family member,
other relative, or close personal friend that you do not want
us to disclose medical information about you to, please notify
the Branch Manager in Coeburn by calling 276-395-5770 or 1-800-413-3756
or tell our staff member who is providing care to you.
• Disaster Relief.
We may use or disclose medical information about you to a
public or private entity authorized by law or by its charter
to assist in disaster relief efforts. This will be done to
coordinate with those entities in notifying a family member,
other relative, close personal friend, or other person identified
by you of your location, general condition or death.
• Required by Law.
We may use or disclose medical information about you when
we are required to do so by law, such as information requested
by Medicare, Medicaid or other insurance.
• Public Health Activities.
We may disclose medical information about you for public health
activities and purposes. This includes reporting medical information
to a public health authority that is authorized by law to
collect or receive the information for purposes of preventing
or controlling disease. Or, one that is authorized to receive
reports of child/elder abuse and neglect. It also includes
reporting for purposes of activities related to the quality,
safety or effectiveness of a United States Food and Drug administration
regulated product or activity.
• Victims of Abuse, Neglect or Domestic Violence.
We may disclose medical information about you to a government
authority authorized by law to receive reports of abuse, neglect,
or domestic violence, if we believe you are a victim of abuse,
neglect, or domestic violence. This will occur to the extent
the disclosure is:
(a) required by law;
(b) agreed to by you; or,
(c) authorized by law and we believe the disclosure is necessary
to prevent serious harm to you or to other potential victims,
or, if you are incapacitated and certain other conditions
are met, a law enforcement or other public official represents
that immediate enforcement activity depends on the disclosure.
• Health Oversight Activities.
We may disclose medical information about you to a health
oversight agency for activities authorized by law, including
audits, surveys by accrediting agencies, investigations, inspections,
licensure or disciplinaryactions. These and similar types
of activities are necessary for appropriate oversight of the
health care system, government benefit programs, and entities
subject to various government regulations.
• Judicial and Administrative Proceedings.
We may disclose medical information about you in the course
of any judicial or administrative proceeding in response to
an order of the court or administrative tribunal. We also
may disclose medical information about you in response to
a subpoena, discovery request, or other legal process but
only if efforts have been made to tell you about the request
or to obtain an order protecting the information to be disclosed.
• Disclosures for Law Enforcement Purposes.
We may disclose medical information about you to a law enforcement
official for law enforcement purposes:
a. As required by law.
b. In response to a court, grand jury or administrative order,
warrant or subpoena.
c. To identify or locate a suspect, fugitive, material witness
or missing person.
d. About an actual or suspected victim of a crime and that
person agrees to the disclo sure. If we are unable to obtain
that personÕs agreement, in limited circumstances, the information
may still be disclosed.
e. To alert law enforcement officials to a death if we suspect
the death may have resulted from criminal conduct.
f. About crimes that occur at our facility.
g. To report a crime in emergency circumstances.
• Coroners and Medical Examiners.
We may disclose medical information about you to a coroner
or medical examiner for purposes such as identifying a deceased
person and determining cause of death.
• Funeral Directors.
We may disclose medical information about you to funeral directors
as necessary for them to carry out their duties.
• Organ, Eye or Tissue Donation.
To facilitate organ, eye or tissue donation and transplantation,
we may disclose medical information about you to organ procurement
organizations or other entities engaged in the procurement,
banking or transplantation of organs, eyes or tissue.
• Research.
Under certain circumstances, we may use or disclose medical
information about you for research. Before we disclose medical
information for research, the research will have been approved
through an approval process that evaluates the needs of the
research project with your needs for privacy of your medical
information. We may, however, disclose medical information
about you to a person who is preparing to conduct research
to permit them to prepare for the project, but no medical
information will leave Independent Home Health Care during
that personÕs review of the information.
• To Avert Serious Threat to Health or Safety.
We may use or disclose protected health information about
you if we believe the use or disclosure is necessary to prevent
or lessen a serious or imminent threat to the health or safety
of a person or the public. We also may release information
about you if we believe the disclosure is necessary for law
enforcement authorities to identify or apprehend an individual
who admitted participation in a violent crime or who is an
escapee from a correctional institution or from lawful custody.
• Military.
If you are a member of the Armed Forces, we may use and disclose
medical information about you for activities deemed necessary
by the appropriate military command authorities to assure
the proper execution of the military mission. We may also
release information about foreign military personnel to the
appropriate foreign military authority for the same purposes.
• National Security and Intelligence.
We may disclose medical information about you to authorized
federal officials for the conduct of intelligence, counter-intelligence,
and other national security activities authorized by law.
• Protective Services for the President.
We may disclose medical information about you to authorized
federal officials so they can provide protection to the President
of the United States, certain other federal officials, or
foreign heads of state.
• Security Clearances.
We may use medical information about you to make medical suitability
determinations and may disclose the results to officials in
the United States Department of State for purposes of a required
security clearance or service abroad.
• Inmates; Persons in Custody.
We may disclose medical information about you to a correctional
institution or law enforcement official having custody of
you. The disclosure will be made if necessary:
(a) to provide health care to you;
(b) for the health and safety of others; or,
(c) the safety, security and good order of the correctional
institution.
• Workers Compensation.
We may disclose medical information about you to the extent
necessary to comply with workersÕ compensation and similar
laws that provide benefits for work-related injuries or illness
without regard to fault.
• Other Uses and Disclosures.
Other uses and disclosures will be made only with your written
authorization. You may revoke such an authorization at any
time by notifying Privacy Officer, Independent Home Health
Care, P.O. Box 1970, Coeburn, VA 24230, in writing of your
desire to revoke it. However, if you revoke such an authorization,
it will not have any affect on actions taken by us in reliance
on it.
Your Rights With Respect to Medical Information About You.
You have the following rights with respect to medical information
that we maintain about you.
• Right to Request Restrictions.
You have the right to request that we restrict the uses or
disclosures of medical information about you to carry out
treatment, payment, or health care operations. You also have
the right to request that we restrict the uses or disclosures
we make to:
(a) a family member, other relative, a close personal friend
or any other person identified by you; or,
(b) public or private entities for disaster relief efforts.
For example, you could ask that we not disclose medical information
about you to your brother or sister. To request a restriction,
you may do so at any time. If you request a restriction, we
request that you submit that request in writing to Privacy
Officer, Independent Home Health Care, P.O. Box 1970, Coeburn,
VA 24230.
You need to tell us:
(a) what information you want to limit;
(b) whether you want to limit use or disclosure or both; and,
(c) to whom you want the limits to apply (for example, disclosures
to your spouse).
We are not required to agree to any requested restriction.
However, if we do agree, we will follow that restriction unless
the information is needed to provide emergency treatment.
Even if we agree to a restriction, either you or we can later
terminate the restriction.
• Right to Receive Confidential Communications.
You have the right to request that we communicate medical
information about you to you in a certain way or at a certain
location. For example, you can ask that we only contact you
by mail. We will not require you to tell us why you are asking
for the confidential communication. If you want to request
confidential communication, you must do so in writing to Privacy
Officer, Independent Home Health Care, P.O. Box 1970, Coeburn,
VA 24230.
Your request must state how or where you can be contacted.
We will accommodate your request. However, we may, when appropriate,
require information from you concerning how payment will be
handled. We also may require an alternate address or other
method to contact you.
• Right to Inspect and Copy.
With a few very limited exceptions, such as psychotherapy
notes, you have the right to inspect and obtain a copy of
medical information about you. To inspect or copy medical
information about you, you must submit your request in writing
to Privacy Officer, Independent Home Health Care, P.O. Box
1970, Coeburn, VA 24230.
Your request should state specifically what medical information
you want to inspect or copy. If you request a copy of the
information, we may charge a fee for the costs of copying
and, if you ask that it be mailed to you, the cost of mailing.
We will act on your request within thirty (30) calendar days
after we receive your request. If we grant your request, in
whole or in part, we will inform you of our acceptance of
your request and provide access and copies.
We may deny your request to inspect and copy medical information
if the medical information involved is:
a. Psychotherapy notes;
b. Information compiled in anticipation of, or use in, a civil,
criminal or administrative action or proceeding;
If we deny your request, we will inform you of the basis for
the denial, how you may have our denial reviewed, and how
you may complain. If you request a review of our denial, it
will conducted by a licensed health care professional designated
by us who was not directly involved in the denial. We will
comply with the outcome of that review.
• Right to Amend.
You have the right to ask us to amend medical information
about you. You have this right for so long as the medical
information is maintained by us. To request an amendment,
you must submit your request in writing to Privacy Officer,
Independent Home Health Care, P.O. Box 1970, Coeburn, VA 24230.
Your request must state the amendment desired and provide
a reason in support of that amendment. We will act on your
request within sixty (60) calendar days after we receive your
request. If we grant your request, in whole or in part, we
will inform you of our acceptance of your request and provide
access and copying. If we grant the request, in whole or in
part, we will seek your identification of and agreement to
share the amendment with relevant other persons. We also will
make the appropriate amendment to the medical information
by appending or otherwise providing a link to the amendment.
We may deny your request to amend medical information about
you.
We may deny your request if it is not in writing and does
not provide a reason in support of the amendment. In addition,
we may deny your request to amend medical information if we
determine that the information:
a. Was not created by us, unless the person or entity that
created the information is no longer available to act on the
requested amendment;
b. Is not part of the medical information maintained by us;
c. Would not be available for you to inspect or copy; or,
d. Is accurate and complete.
If we deny your request, we will inform you of the basis for
the denial. You will have the right to submit a statement
of disagreeing with our denial. Your statement may not exceed
two pages. We may prepare a rebuttal to that statement. Your
request for amendment, our denial of the request, your statement
of disagreement, if any, and our rebuttal, if any, will then
be appended to the medical information involved or otherwise
linked to it. All of that will then be included with any subsequent
disclosure of the information, or, at our election, we may
include a summary of any of that information. If you do not
submit a statement of disagreement, you may ask that we include
your request for amendment and our denial with any future
disclosures of the information. We will include your request
for amendment and our denial (or a summary of that information)
with any subsequent disclosure of the medical information
involved. ou also will have the right to complain about our
denial of your request. ¥ Right to an Accounting of Disclosures.
You have the right to receive an accounting of disclosures
of medical information about you. The accounting may be for
up to six (6) years prior to the date on which you request
the accounting but not before April 14, 2003.
Certain types of disclosures are not included in such an accounting:
a. Disclosures to carry out treatment, payment and health
care operations;
b. Disclosures of your medical information made to you;
c. Disclosures that are incident to another use or disclosure;
d. Disclosures that you have authorized;
e. Disclosures for our facility directory or to persons involved
in your care;
f. Disclosures for disaster relief purposes;
g. Disclosures for national security or intelligence purposes;
h. Disclosures to correctional institutions or law enforcement
officials having custody of you;
i. Disclosures that are part of a limited data set for purposes
of research, public health, or healthcare operations (a limited
data set is where things that would directly identify you
have been removed.
j. Disclosures made prior to April 14, 2003. Under certain
circumstances your right to an accounting of disclosures to
a law enforcement official or a health oversight agency may
be suspended. Should you request an accounting during the
period of time you right is suspended, the accounting would
not include the disclosure or disclosures to a law enforcement
official or to a health oversight agency. To request an accounting
of disclosures, you must submit your request in writing to
Privacy Officer, Independent Home Health Care, P.O. Box 1970,
Coeburn, VA 24230.
Your request must state a time period for the disclosures.
It may not be longer than six (6) years from the date we receive
your request and may not include dates before April 14, 2003.
Usually, we will act on your request within sixty (60) calendar
days after we receive your request. Within that time, we will
either provide the accounting of disclosures to you or give
you a written statement of when we will provide the accounting
and why the delay is necessary. There is no charge for the
first accounting we provide to you in any twelve (12) month
period. For additional accountings, we may charge you for
the cost of providing the list. If there will be a charge,
we will notify you of the cost involved and give you an opportunity
to withdraw or modify your request to avoid or reduce the
fee. ¥ Right to Copy of this Notice. You have the right to
obtain a paper copy of our Notice of Privacy Practices. You
may obtain a paper copy even though you agreed to receive
the notice electronically. You may request a copy of our Notice
of Privacy Practices at any time. You may obtain a copy of
our Notice of Privacy Practices over the Internet at our web
site, www.indhomehealth.com. To obtain a paper copy of this
notice, contact the Branch Manager at the location that serves
you or the nurse that provides your care.
Our Duties
• Generally.
We are required by law to maintain the privacy of medical
information about you and to provide individuals with notice
of our legal duties and privacy practices with respect to
medical information. We are required to abide by the terms
of our Notice of Privacy Practices in effect at the time.
• Our Right to Change Notice of Privacy Practices.
We reserve the right to change this Notice of Privacy Practices.
We reserve the right to make the new noticeÕs provisions effective
for all medical information that we maintain, including that
created or received by us prior to the effective date of the
new notice.
• Availability of Notice of Privacy Practices.
A copy of our current Notice of Privacy Practices will be
posted at all locations. A copy of the current notice also
will be posted on our web site, www.indhomehealth.com. At
any time, you may obtain a copy of the current Notice of Privacy
Practices by contacting the Branch Manager at the location
that serves you.
• Effective Date of Notice.
The effective date of the notice will be stated on the first
page of the notice.
• Complaints.
You may complain to us and to the United States Secretary
of Health and Human Services if you believe your privacy rights
have been violated by us. To file a complaint with us, contact
Privacy Officer, Independent Home Health Care, P.O. Box 1970,
Coeburn, VA 24230. All complaints should be submitted in writing.
To file a complaint with the United States Secretary of Health
and Human Services, send your complaint to him or her in care
of: Office for Civil Rights, U.S. Department of Health and
Human Services, 200 Independence Avenue SW, Washington, D.C.
20201. You will not be retaliated against for filing a complaint.
¥ Questions and Information. If you have any questions or
want more information concerning this Notice of Privacy Practices,
please contact the Branch Manager at the office that serves
you or contact the Privacy Officer at the Coeburn office by
calling
1-800-413-3756.
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