OPTIMAL IN HOME CARE INC.
PATIENT NOTICE OF HOME CARE PRIVACY RULES
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully.
Uses and Disclosures of Health Information:
The Agency may use your health information, information that constitutes Protected Health Information (PHI) as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. For any other reason the Agency must obtain your consent. The Agency has established policies to guard against unnecessary uses and disclosure of your health information.
• 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 use or disclose your health information to individuals outside of the Agency involved in your care including family members, pharmacists, suppliers or medical equipment or other care 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 home 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.
• Training programs including those in which students, trainers or practitioners in health care learn under supervision.
• Training of non-health care professionals.
• Accreditation, certification, licensing or credentialing activities.
• Business management and general administrative activities of the Agency
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, disclose 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 (unless you tell us you do not want to be contacted).
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED WITHOUT FIRST RECEIVING YOUR WRITTEN CONSENT:
• When Legally Required: The Agency will disclose your health information when it is required to do so by any Federal, State or local law.
• When There Are Risksto 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, replacements and to conduct post-marketing surveillance and compliance with requirements of the FDA.
• 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 employee about an individual who is a member of the workplace as legally required.
• To Report Abuse, Neglect, Exploitation, Or Domestic Violence: The Agency is allowed to notify government authorities if the Agency believes a patient is the victim of abuse, neglect, exploitation, or domestic violence. The Agency will make this disclosureonly
when specifically required or authorized by law or when the patient 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 administrative or criminal investigations, inspections, licensure or disciplinary action. The Agency, however, may 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.
• 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 a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or lawful purposes, 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.
• To Coroners and Medical Examiners: The Agency may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
• In the Event of Serious Threat to Health or 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 andimminent 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 authorized 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.
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 yourcare. However, the Agency is not required to agree to your request. If you wish to make a request for restrictions, please contact the Agency administrator.
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 noother family members present. If you wish to receive confidential communications, please contact the Agency administrator. 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 the Agency administrator. 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 has 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 Agency administrator. The Agency may deny the request if 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 notcreated by the Agency, ·if the records you are requesting are not part of the Agency's records, if 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 a Paper Copy of this Notice: You or your representative has a right to a separate paper copy of this Notice at any time even if you or your representative has received this Notice previously. To obtain a separate paper copy, please contact the Agency administrator.
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 and may be amended from time to time. The Agencyreserves the right to change the terms of this 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 and your appointed representative. You or your personal representative have the right to express complaints to the Agency and to the Secretary of the Department of Health and Human Services if your or your representative believe that your privacy rights have been violated. 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.
State law also imposes restrictions on how we use your PHI. The following Texas laws govern the Agency's use of PHI:
• Texas Insurance Code Article 28A.01 - 28A.04
• Texas Insurance Code Article 288.01 - 28B.12
• Title 28 Texas Administrative Code, Chapter 22, Sections 22.51 - 22.67
These laws will be enforced until the effective date of this Notice (4/14/03). As of that date, these laws will be superseded by HIPAA privacy regulations, as related in this Notice.
Duties of the Agency: You or your personal representative have the right to express complaints to the Agency and to the Secretary of the Department of Health and Human Services if you or your representative believe that your privacy rights have been violated. 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.
A complaint with the regional office of civil rights (OCR) may be filed.
Such complaints may be in writing, on paper or electronically, by mail fax or email.
The complaint must include identification of the Agency, employee or business associate involved and must describe the violation. Complaints must be filed within 180 days of learning of the alleged violation or should have been aware of the alleged violation. The 180-day period may be extended by OCR if "good cause" can be shown.
Complaints may be filed with OCR Regional office with mailing address:
US Department of Health and Human Services, Region VI, OCR,
1301 Young St., Suite 1169,
Dallas, Texas 75202 Or:
Telephone: (800) 368-1019
Fax: (214) 767-0432
TDD: (800) 537 - 7697
Individuals may contact the Agency's HIPAA Compliance Officer for further information about the Agency's privacy policies at:
2656 South Loop W. Suite 645 Houston, TX 77054
Phone: (713) 669 - 0299 Fax: (713) 669 - 0244- Effective April 14, 2003