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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
Excellent In Home Care, Inc. may use you 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 information to
individuals outside of the Agency involved in your care including family
members, pharmacists, suppliers of medical equipment or other health
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 private
duty 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:
- Quality assessment and improvement
activities.
- Activities designed to improve health or
reduce health care costs
- Protocol development, case management and
care coordination
- Contacting health care providers and clients
with information about treatment alternatives and other related functions that
do not include treatment.
- Professional review and performance
evaluation.
- Training programs including those in which
students, trainees or practitioners in health care learn under supervision.
- Training of non health care professionals
- Accreditation, certification, licensing or
credentialing activities.
- Review and auditing, including compliance
reviews, medical reviews, legal services and compliance programs.
- Business planning and development including
cost management and planning related analysis and formulary development.
- Business management and general
administrative activities of the Agency.
- Fundraising for the benefit of the Agency.
For example, the Agency may use your health
information to evaluate its staff performance, combine your health information
with other Agency patients in evaluating how to more effectively serve all
Agency patients, disclosed your health information to Agency staff and
contracted personnel for training purposes, use your health information to
contact you as a reminder regarding a visit to you, or contact you as a part of
general fundraising and community information mailings (unless you tell us you
do not want to be contacted).
For Fundraising Activities. The Agency may use information about
you including your name, address, phone number and the dates you received care
in order to contact you to raise money for the Agency. The Agency may also
release this information to a related Agency foundation. If you do not want the
Agency to contact you, notify Sharon Kean at (800) 824 2460 and indicate that
you do not wish to be contacted.
For Appointment Reminders. The Agency may use and disclosed 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 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.
- 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 client 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 client 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 administration or criminal investigations, inspections, licensure
or disciplinary action. The Agency, however, may not disclosed 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. The
Agency may disclose your health information in the course of any judicial or
administrative proceeding in response to an order of the court or administrative
tribunal as expressly authorized by such order or in response to a subpoena,
discovery request or other lawful process, but only when the Agency makes
reasonable efforts 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.
- 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 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 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.
For Organ, Eve Or Tissue Donation. The Agency may use or disclose
your health information to organ procurement organizations or other entities
engaged in the procurement, banking or transplantation of organs, eyes or tissue
for the purpose of facilitating the donation and transplantation.
For Research Purposes. The Agency may, under very select
circumstances, use your health information for research. Before the Agency
discloses any of your health information for such research purposes, the project
will be subject to an extensive approval process.
In the Event of A Serious Threat To Health Of 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:
- 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
the Privacy Official.
- 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 the
Privacy Official, Sharon Kean. The Agency will not request that
you provide any reasons for your request and will attempt to honor your
reasonable requests for confidential communications.
- 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 Privacy Official at (800)
824 2460. 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.
- 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 the Privacy Official. 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, it 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.
- 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 the Privacy Official at
6400 Laurel Canyon Blvd., Suite 450, North Hollywood, CA 91606. 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.
- 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 the Privacy
Official at (800) 824 2460. You or your representative may also obtain a
copy of the current version of the Agency's Notice of Privacy Practices at its
website, www.eihc.com.
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 DHHS if you or your
representative believe that your privacy rights have been violated. Any
complaints to the Agency should be made in writing to the Privacy Official at
6400 Laurel Canyon Blvd., Suite 450, North Hollywood, CA 91606. 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 Privacy Official as its contact person for all
issues regarding client privacy and your rights under the Federal privacy
standards. You may contact this person at (800) 824 2460.
EFFECTIVE DATE
This Notice is effective April 14, 2003.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE
PRIVACY OFFICIAL AT 6400 LAUREL CANYON BLVD., SUITE 450, NORTH HOLLYWOOD, CA
91606 OR CALL AT (800) 824 2460.
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