NOTICE OF PRIVACY
PRACTICES
For
AT YOUR HOME
FAMILYCARE
(referred to in this document as “the provider”)
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 of Privacy Practices is being provided to you
as a requirement of the Health Insurance Portability and Accountability Act
(HIPAA). This Notice describes how we may use and disclose your protected
health information to carry out treatment, payment or health care operations
and for other purposes that are permitted or required by law. It also describes
your rights to access and control your protected health information in some
cases. Your “protected health information” means any of your written and oral
health information, including demographic data that can be used to identify
you. This is health information that is created or received by your health care
provider, and that relates to your past, present or future physical or mental
health or condition.
I. Uses and Disclosures of Protected Health Information
The provider may use your protected health information for purposes of
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 the Provider has obtained your authorization or
the use or disclosure is otherwise permitted by the HIPAA Privacy Regulations
or State law. Disclosures of your protected health information for the purposes
described in this Notice may be made in writing, orally, or by facsimile.
A. Treatment.
We will use and
disclose your protected health information to provide, coordinate, or manage
your health care and any related services. This includes the coordination or
management of your health care with a third party for treatment purposes. For
example, we may disclose your protected health information to a pharmacy to
fulfill a prescription, to a laboratory to order a blood test, or to a home health
agency that is providing care in your home. We may also disclose protected
health 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 protected health information to an outside treatment provider for
purposes of the treatment activities of the other provider.
B. 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 a hospital
admission is recommended, we may need to disclose information to your health
insurer to get prior approval for the hospitalization.
We may also disclose protected health information to your insurance
company to determine whether you are eligible for benefits or whether a
particular service is covered under your health plan. In order to get payment
for your services, we may also need to disclose 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 involved in your
care for the other provider’s payment activities.
C. Operations.
We may use or
disclose your protected health information, as necessary, for our own health
care operations in order 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
reviews, medical reviews, 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 health plan for their health care operations.
D. Other Uses and Disclosures. As part of treatment, payment and healthcare
operations, we may also use or disclose your protected health information for
the following purposes:
• To remind you of an appointment.
• To inform you of potential treatment
alternatives or options.
• To inform you of health-related benefits or
services that may be of interest to you.
• To contact you to raise funds for the
provider or an institutional
• foundation related
to the provider. If you do not wish to be contacted regarding fundraising,
please contact our Privacy Officer.
II. Uses and Disclosures Beyond Treatment, Payment, and Health Care Operations
Permitted Without Authorization or Opportunity to Object
Federal privacy rules allow us to use or disclose your protected health
information without your permission or authorization for a number of reasons
including the following:
A. When
Legally Required. We will disclose your protected
health information when we are required to do so by any Federal, State or local
law.
B. When There Are Risks to Public
Health. We may disclose your protected
health information for the following public activities and purposes:
• 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
product recalls, repairs or replacements to the FDA and to conduct post
marketing 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 information about
an individual who is a member of the workforce as legally permitted or
required.
C. To Report Abuse, Neglect Or Domestic
Violence. We may
notify government authorities if we believe that a patient is the victim of
abuse, neglect or domestic violence. We will make this disclosure only when
specifically required or authorized by law or when the patient agrees to the
disclosure.
D. To Conduct Health Oversight
Activities. We
may disclose your protected health information to a health oversight agency for
activities including audits; civil, administrative, or criminal investigations,
proceedings, or actions; inspections; licensure or disciplinary actions; or
other activities necessary for appropriate oversight as authorized by law. We
will 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.
E. In Connection With Judicial And Administrative Proceedings. We may disclose your protected 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 order or
in response to a subpoena in some circumstances.
F. For Law
Enforcement Purposes. We may disclose your protected health information to a law enforcement
official for law enforcement purposes as follows:
• As required by law for reporting of certain
types of wounds or other physical injuries.
• Pursuant to court order, court-ordered
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 the victim of a crime.
• To a law enforcement official if the provider has a
suspicion that your death was the result of criminal conduct.
• In an emergency in order to report a crime.
G. 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
coroner or medical examiner to perform other duties authorized by law. We may
also disclose protected health information to a funeral director, as 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 cadaveric
organ, eye or tissue donation purposes.
H. For
Research Purposes. 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 proposal and
research protocols to address the privacy of your protected health information.
I. In the Event of A
Serious Threat To Health Or Safety. We may, consistent with applicable law and ethical standards
of conduct, use or disclose your protected health information if we believe, in
good faith, that such use or 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.
J. For Specified 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 activities, national security and
intelligence activities, protective services for the President and others,
medical suitability determinations, correctional institutions, and law
enforcement custodial situations.
K. For Worker’s Compensation. The provider,
may release your health information to comply with worker’s compensation laws
or similar programs.
III. Uses
and Disclosures Permitted Without Authorization But
With Opportunity to Object
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 information in
connection with trying to locate or notify family members or others involved in
your care concerning your location, condition or death.
You may object to
these disclosures. If you do not object to these disclosures or we can infer
from the circumstances that you do not object or we determine, in the exercise
of our professional judgment, that it is in your best interests for us to make
disclosure of information that is directly relevant to the person’s involvement
with your care, we may disclose your protected health information as described.
IV. Uses and
Disclosures Which You Authorize
Other than as
stated above, we will not disclose your health information other than with your
written authorization. You may revoke your authorization in writing at any time
except to the extent that we have taken action in reliance upon the
authorization.
V. Your
Rights
You have the
following rights regarding your health information:
A. The right to inspect and copy 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 uses for making decisions about you.
Under Federal
law, however, you may not inspect or copy the following records:
psychotherapy
notes; information compiled 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 have a
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 or safety or that of another person,
or that it is likely to cause substantial harm to another person referenced
within the information. You have the right to request 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
pages of this Notice. If you request a copy of your information, we may charge
you a fee for the costs of copying, 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 record.
B. The right to request a restriction on
uses and disclosures of your protected health information. You may ask us not to use or
disclose certain parts of your protected health information for the purposes of
treatment, payment or health care operations. You may also request that we not
disclose your 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 restriction
requested and to whom you want the restriction to apply.
The provider is not required to agree to a restriction that you may
request. We will notify you if we deny your request to a restriction. If the
provider does agree to the requested restriction, we may not use or disclose
your protected health information in violation of that restriction unless it is
needed• to provide emergency treatment. Under certain circumstances, we may
terminate our agreement to a restriction. You may request a restriction by
contacting the Privacy Officer.
C. The 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 requests. We may condition this
accommodation by asking you for information as to how payment will be handled
or specification of 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.
D. The right to have your physician amend your protected health information. You may request an amendment of
protected health information about you in a designated record set for as long
as we maintain this information. In certain cases, we may deny your request for
an amendment. If we deny your request for amendment, you have the right to file
a statement of disagreement with us and we may prepare a rebuttal to your
statement and will provide you with a copy of any such rebuttal. Requests for
amendment must be in writing and must be directed to our Privacy Officer. In
this written request, you must also provide a reason to support the requested
amendments.
E. The right to receive an accounting.
You have the right to request an accounting of certain disclosures of your
protected health information made by the provider. This right applies to
disclosures for purposes other than treatment, payment or health care
operations as described in this Notice of Privacy Practices. We are also not
required to account 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 take place prior to April 14,
2003. Accounting requests may not be made for periods of time in excess of six
years. 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.
F. The 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 the notice or have agreed to accept this notice
electronically.
VI. Our
Duties
The provider is required by law to maintain the privacy of your health
information and to provide you with this Notice of our duties and privacy
practices. We are required to abide by terms of this Notice as may be amended
from time to time. We reserve the right to change the terms of this Notice and
to make the new Notice provisions effective for all protected health
information that we maintain. If the provider changes its Notice, we will
provide a copy of the revised Notice by sending a copy of the Revised Notice
via regular mail or through in-person contact.
VII. 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
contacting the provider’s Privacy Officer verbally or in writing, using the
contact information below. We encourage 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.’
VIII. Contact Person
The provider’s 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 it to:
At Your Home Familycare
6540 Lusk Boulevard
Ste. #C-266
San Diego, CA 92121
ATTN: Privacy
Officer
The Privacy Officer can be contacted by telephone at 1-888-FAMCARE
IX. Effective
Date
This Notice is effective April 14, 2003.