“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.”
DATE PUBLISHED 11/28/16
EFFECTIVE DATE 11/28/16
This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPPA). This Notice describes how we, Solange Assisted Living Agency may use and disclose your protected health Information (PHI) to carry out treatment, payment of health care access and control your protected health information in some cases. Your protected health information” means any of your written and oral information, including demographic data that can be used to identify you. This is health information that is created or received by us, your home health care provider, and it relates to your past, present, or future physical or mental health and condition. To the extent that you may have any questions or concerns relating to the matters and issues addressed in this Notice, please do not hesitate to contact our Privacy Officer at Solange Assisted Living.
Uses/Disclosures related to Treatment, Payment or Health Care Operations of your Protected Health Information.
The law permits us to use and/or disclose Protected Health Information to carry out treatment, payment and other care operations.
Solange Assisted Living may use your protected health information for providing treatment, obtaining payment for treatment and conducting health care operations. Your protected health information may be used or disclosed only for these purposes unless Solange Assisted Living has obtained your authorization, or the use of disclosure is otherwise permitted by the HIPPA Privacy Regulations or the State made in writing, orally or by facsimile.
Treatment. We will use and disclose your protected health information to provide, coordinate or manage your health care and other related services. This includes the coordination or management of your health care with the third party for treatment purposes. An example of when Solange Assisted Living might use/disclose your Protect Health Information for treatment/care purposes is when your medical/health information is your medical/health condition; properly diagnosed your condition, prescribed and executes care plans, and treats you. Another example would be that we may disclose your Protected Health Information to the pharmacy to fill a prescription, to a laboratory to order a blood test, or to a home health agency that is providing care in your place of residence. We may also disclose protected information to other physicians who may be treating you or consulting with your physician with respect to your care. In some cases, we may also disclose your Protect Health Information to an outside treatment provider for the treatment activities of the other provider.
Payment. Your protected health information will be used as needed to obtain payment for the services that we provide. This may include certain communications to your health insurer to get approval for the treatment that we recommend. For example, if the hospital admission is recommended, we may need to disclose information to your health insurer to get prior approval for the hospitalization. We may need to disclose protected health information to your insurance company to determine whether you are eligible, or whether a service is covered under your protected health information to your insurance company to demonstrate the medical necessity of the services or, as required by your insurance company for utilization review. We may also disclose patient information to another provider in your care for the other provider’s payment activities.
Health Care Operations. Some examples of what constitutes Health Care Operations are when we use or disclose your Protected Health Information for quality assessment, scheduling and improving activities which would make us a better home health care provider with better services. Another example would be when we use and disclose Protected Health Information to better manage our operations such as when we share information with a Business Associate, such as therapist and skilled nursing staff to ensure proper and timely skilled nursing professional home health services. We may use and disclose your Protected Health Information, as necessary for our own health care operations to facilitate the function of the provider and to provide quality care to all patients. Health care operations include such activities as:
- Quality assessment and improvement activities.
- Employee Review Activities
- Training Programs including those in which students, trainees, or practitioners in health care learn under supervision.
- Accreditation, certification, licensing or credentialing activities.
- Review and auditing, including compliance review, medical review, legal services and maintaining compliance programs.
- Business management and general administrative activities.
- In certain situations, we may also disclose patient information to another provider or home health operations.
- Other Uses and Disclosures. As part of treatment, payment and health care operations, we may also use and/or disclose your Protected Health Information for the following purposes:
- To remind you of your appointment.
- To inform you of potential treatment alternatives or options
- To inform you of the health-related benefits or services that may be of interest to you.
To contact you or raise funds for the provider of an institutional foundation related to the provider. If you do not wish to be contacted regarding fundraiser, please contact our Privacy Officer.
Uses and Disclosures Beyond Treatment, Payment and Health Care Operations Permitted Without Authorization or the Opportunity to Object- Federal privacy rules allow us to use or disclose your Protect Health Information without your permission or authorization for several reasons, including the following:
When Legally Required. We will disclose your Protected Health Information when we are required to do so by Federal, State, or Local Law.
When there are Risks to Public Health. We may disclose your Health Information for the following public activates and purpose.
- To prevent, control, or report disease, injury or disability as permitted by law.
- To report vital events such as birth or death as permitted or required by law.
- To conduct public health surveillance, investigations and interventions as permitted or required by law.
- To collect or report adverse events and product defects, track FDA regulated products; enable products recalls, repairs or replacements to the FDA and to conduct post-marking surveillance.
- To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law.
- To report to an employer the information about an individual who is a member, or the workforce as legally permitted or required.
- To Report Abuse, Neglect or Domestic Violence. We may notify government authorities if we believe that the patient is a victim of abuse, neglect or domestic violence. We will make the disclosure only when specifically, or authorized by law or when the patient agrees to the disclosure.
- To Conduct Health Oversight Activities. We may disclose your Protected Health Information to as health oversight agency for activities including audits, civil, administrative or criminal investigations, proceeding or actions, inspections; licensure or disciplinary actions; or other actives necessary for appropriate oversight as authorized by law. We will not disclose your Protected Health Information if you are the subjects of an investigation and your Protected Health Information is not directly related to your receipt of health care or public benefits.
- In Connection with Judicial and Administrative Proceedings. We may disclose your Protected Health Information in the course of any judicial or administrate proceedings in response to an order of a court or administrate tribunal as expressly authorized by such order in response to a subpoena in some circumstances.
- For Law Enforcement Purposes. We may disclose your Protected Health Information to a Law Enforcement Official for law enforcement purpose as follows:
- As required by law for reporting certain types of wounds or other physical injuries.
- Pursuant to court order, court order warrant, subpoena, summons or similar process.
- For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
- Under certain limited circumstances, when you are a victim of a crime.
- To a law enforcement official if we, the provider, have a suspicion that your death as the result of criminal conduct.
- In an emergency in order to report a crime.
- To Coroners, Funeral Directors and for Organ Donation. We may disclose Protected Health Information to a coroner or medical examiner for identification purposes, to determine cause of death or for the corner or medical examiner to perform other duties authorized by law. We may also disclose protected health Information to a funeral director, authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected Health Information may be used and disclosed for cadaver organ, eye or tissue donation purposes.
- For Research Purpose. We may use or disclose your Protected Health Information for research when the use or disclosure for research has been approved by an institutional review board or privacy board, that has reviewed the research protocols to address the privacy board, that has reviewed the research proposal and research protocols to address the privacy of your Protected Health Information.
- In the Event of a Serious Threat to Health or Safety. We may, consistent with applicable law and ethical standards or conduct, use or disclose your Protected Health Information, if we believe, in good faith, that such use or disclose is necessary to prevent or lessen a serious and imminent threat to your health and safety or to the health safety of the public.
- For Specifies Government Functions. In certain circumstances. The Federal regulations authorize the provider to use or disclose your Protected Health Information to facilitate specified government functions relating to military and veterans activates, national security and intelligence activates, protective services for the President and others, medical suitability determinations, correctional institutions and law enforcement custodial situations.
- For Workers’ Compensation. The provider may release your Protected Health Information to comply with worker’s compensation laws or similar programs.
- Uses and Disclosures Permitted Without Authorization, but With the Opportunity to Object.
In some cases, the law permits us to use and/or disclose Protected Health Information, without requiring you to sign an Authorization. In many cases, these types of uses and/or disclosures are permitted to promote the government’s need to ensure a safe and healthy society. In other cases, the law does not require an Authorization because it would be impractical to require an Authorization.
We may disclose your Protected Health Information to your family member or a close personal friend if it is directly relevant to the person’s involvement in your care or payment related to your care. We can also disclose your Protected Health Information in connection with trying to locate or notify family members or other involved in your care concerning your location, condition or death.
You may object to these disclosures. If you do not object or we determine, in the exercise of professional judgment, that it is in your best interests for us to make a disclosure of information that is directly relevant to the person’s involvement with your care, we may disclose your Protected Health Information, as described.
Uses and Disclosures Which You Authorize
For other types of uses and/or disclosures of Protected Health Information, the law requires us to obtain what is known as an Authorization.
You may revoke an Authorization at any time, as long as we have not already reasonably relied on it to make a particular use and/or disclosure.
Other than as stated above, we will disclose your Protected Health Information other than with your written authorization. You may revoke your authorization in writing at any time expect to the extent that we have taken action in reliance upon the authorization.
Your Rights- You have the following rights regarding your health information:
YOUR Right to Inspect and Request a Copy of Your Protected Health Information. You may inspect and obtain a copy of your Protected Health Information that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that your physician and the provider use for making decisions about you.
Under Federal law, however, you may not inspect or copy the following records: psychotherapy notes, information complied in reasonable anticipation of, or for use in a civil, criminal or administrative action or proceeding; and Protected Health Information that is subject to a law that prohibits access to Protected Health Information. Depending on the circumstances, you may have the right to make decision to deny access reviewed.
We may deny your request to inspect or copy your Protected Health Information, if in our professional judgment, we determine that the access requested is likely to endanger your life of safety or that of another person, or that is likely to cause substantial harm to another person referenced within the information. You have the right to a review of this decision.
To inspect and copy your medical information, you must submit a written request to the Privacy Officer whose contact information is listed on the last [page of this Notice. If you request a copy of your information, we may charge you a fee for the charge of coping, mailing or other costs incurred by us in complying with your request.
Please contact our Privacy Officer if you have questions about access to your medical records.
YOUR Right to Request Additional Restrictions on Users/ Disclosures of your protected Health Information. You may ask us not to use or disclose certain parts of your Protected Health Information for the purpose of treatment, payment or health care operations. You may also request that we may not disclose your Protected Health Information to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restrictions concerned and to whom you want the restrictions to apply.
Solange Assisted Living is not required to agree to a restriction that you may request. We may notify you or deny you your request to a restriction. If Solange Assisted Living does agree to the requested restriction, we may not use or disclose you Protected Health Information in circumstances, we may terminate our agreement to a restriction by contacting the Privacy Officer.
Your Right to Request to Receive Confidential Communications from Us by Alternative Means or at an Alternative Location. You have the right to request that we communicate with you in certain ways. We will accommodate reasonable request. We may condition this accommodation by asking you for information as to how payment will be handled, or specifications or an alternative address, or other method of contact. We will not require you to provide an explanation for your request. Requests must be made in writing to our Privacy Officer.
YOUR Right to Amend Your Protected Health Information. You may request an amendment of your Protected Health Information in a designated record set as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for an amendment, you have a right to file a statement of disagreement with us and we may prepare a rebuttal. Requests for an amendment must be in writing to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendments.
YOUR Right to Receive an Accounting of Disclosures of your Protected Health Information.
You have the right to request an accounting of certain disclosures of your Protected Health Information made by Solange Assisted Living Agency. The right applies to disclosures for Purpose other than treatment, payment or health care operations as described in this Notice of Privacy Practices. We are also not accountable for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures for a facility directory to friends or family members involved in your care or certain other disclosures we are permitted to make without your authorization. The request for an accounting must be made in writing to our Privacy Officer. The request should specify the time period sought for the accounting. We are not required to provide an accounting for disclosures that took place prior to July 1,206. Accounting requests may not be made for periods of time more than six (6) years. We will provide the first accounting you request during any 12- months period without charge. Subsequent accounting request may be subject to a reasonable cost- based fee.
Your Right to Obtain A Paper Copy of this Notice. Upon request, we will provide a separate paper copy of this Notice even if you have already received a copy of this notice or have agreed to accept this notice electronically. Please do not hesitate to contact the Privacy Officer a Solange Assisted Living.
Your Right to Complain about How Your Protected Health Information is Handled by Solange Assisted Living. You have the right to complain to us about how we handled you Protected Health Information, including if you believe in good faith that we may have violated your privacy rights under the law. To register a complaint with us, you may write, call or request to see the Director of Patient care Services (DPCS) of Solange Assisted Living.
We do not have rigid requirements for you to file a complaint. Rather we simply ask that you provide us with the necessary information to properly follow-up on your concerns and/ or complaints in a timely fashion, so that we may be able to address it in the most proactive and effective manner.
In addition, if you believe that we may have been attentive to or have violated your privacy rights, you also have the right to contact the United States Department of Human Services (HHS) and enforcing the HIPPA Privacy rules is the HHS Office of Civil Rights (OCR).
Medical Privacy, Complaint Division Office of Civil Rights United States Department of Health and Human Services
200 Independence Avenues, S.W,
Room 509 F, HH Building Washington, D. C. 20201
Voice Hotline Number: 1-800-368-1019
We again emphasize that it is against our policies and procedures to retaliate against a patient that has been retaliated against in any way, upon your filing a complaint with us or the HHS OCR. Please immediately contact our Privacy Officer so that we may properly address that issue for you.
Our Duties a s your Home Health Care Provider– Coach is required by law to maintain the privacy of your protected heath information and to provide you with this notice of our duties and privacy practices. We are required to abide by the terms of this notice and it may be amended from time to time. We reserve the right to change the terms to this notice and to make new notice provisions effective for all protected health information that we may maintain. If Coach changes its Notice, we will provide a copy of the revised notice by sending a copy of the revised notice vis regular mail or through in- person contact.
Complaints– You have the right to express complaints to the provider and to the Secretary of Health and Human Services, if you believe that your privacy rights have been violated. You may complain to the provider by contraction the provider’s Privacy Officer verbally in writing, using the contact information below.
We encourage that you express any concerns that you may have regarding the privacy of your information. You may not be retaliated against in any way for filing a complaint.
Contact Person– The provider contact person for all issues regarding patient privacy and your rights under the Federal Privacy Standards is the Privacy Officer. Information regarding matters covered by this notice can be requested by contacting the privacy officer. Complaints against the provider can be mailed to the privacy officer by sending them to:
Attn: Privacy Officer (Director of Patient Care Services or Designee)
Solange Assisted Living
1900 E Pikes Peak Ave. Suite 6
Colorado Springs, Colorado, 80909
Phone: (719) 391-4444
Effective Date: This notice is effective July 15, 2006.