HIPAA Notification  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

 

The  Agency  may  use your 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 care information to individuals outside
of the Agency involved in your care including family members, pharmacists, suppliers of medical
equipment or other health 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 include 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 patients 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 on non-health care professionals.
•       Accreditation, certification, licensing or credentialing activities.
•       Review and auditing, including compliance reviews, medical review, legal services, and compliance
programs.
•       Business planning and development including cost management and planning related analyses
and formulary development.
•       Business management and general administrative activities of the Agency.
•       Fundraising for the benefit of the Agency.

For example,e the Agency  may  use your health information  to evaluate its staff performance, combi 
e 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.

 

'.o contact  you as a reminder regarding a visit to you, or contact you as 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

Privacy Officer and indicate that you do not wish to be contacted.                                 
                           ·

For Appointment Reminders. The Agency may use and disclose 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 CIRCU MSTANCES UNDER WHICH AND PURPOSES  FOR WHICH YOUR HEALTH 
INFORMATION  MAY ALSO BE USED AND DISCLOSED (check your State laws to ensure consistency  with State law requirements).

 

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 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 and 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 patient 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 patient agrees to the disclosure.

 

To Conduct Health Oversight Activities. The Agency  may disclose your hea th 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  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 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 your health information  to coroners 
and medical examiners for purposes of determining your cause of death or for other duties, as 
authorized  by law.

 

To f uneral  Directors. The  Agency may disclose your health information  to funeral directors 
consistent  with applicable la:" and if necessary, to carry out their duties with respect to your 
funeral arrangements. If necessary  to carry out  the1r duties, the Agency may disclose your health 
 information  prior to and in reasonable anticipation of your death.

 

For Organ, Eye or Tissue Donation. The  Agency may  use or disclose your health information  to 
organ

pro urement  organizations or other entities engaged in the procurement,  banking or 
transplantation of organs, eyes or  tissue fur  the purpose of facilitat ng 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. (If the Agency intends to 
routinely conduct research it.is important to carefully  review the authorization requirements  for 
research exceptions and revise the Notice provisions as needed.)

 

believes that such disclosure is necessary  to prevent or lessen a serious and imminent  faith,
law and ethical standards of conduct, disclose your health information  if the Agency, in good 
The  Agency may, consistent with applicable In the Event of a Serious Threat to Health or Safety.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_  eterans, national security  and intelligence activities, protective 
services for the President and others, medical smtabilrty 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  mformation, you may  revoke that authorization  in writing al 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
?  your health information. You have the right to request a limit on the Agency's 
disclosure of your healt  mformat on to someone who is involved in your care or the payment of your 
care. However, the Agency rs not re uired  to agree to your request. If  you wish  to make a 
request for restrictions, please contact the Privacy Officer.

 

•      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 
co?duct communications pertaining to your health information  with you privately with no other 
family members present. If you wish to receive confidential communications, please contact Privacy  
Officer. 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 requesl to inspect and copy records containing
your health information may be made to the Privacy Officer. 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 representatives 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 '. cords must be made in writing to Privacy Officer. 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, 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 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 Privacy Officer. 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 representatives 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 Officer.

 

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 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 DADS if you or your      . representative believe that your privacy rights have been violated
. Any complaints  to the Agency sho ld be madem writing  to Privacy Officer. The Agency 
·encourages you  to express any concerns you may have regardmg the pnvacy of  your information. You 
will  not be retaliated  against in any way for filing a complaint.

 

 

CONTACT PERSON

privacy
The Agency has designated the Privacy Officer as its contact person for all issues regarding patient yourrights under the Federal privacy standards. You may contact  this person at info@rqsbreathe.com

 

EFFECTIVE DATE

This Notice is effective April 14, 2003. HCL HIPAA NotifofPrivac042005