1897 Palm Beach Lakes Blvd., Suite 213, West Palm Beach, FL 33409
Home Health Care Agency - Medicare Certified
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Our Agency is required by law to maintain the privacy of “protected health information” (as defined in the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996) and to provide you adequate notice of your rights and our legal duties and privacy practices with respect to the uses and disclosures of protected health information. We will use or disclose protected health information in a manner that is consistent with this notice.
The agency maintains a record (paper/electronic file) of the information we receive and collect about you and of the care we provide to you. This record includes both medical and financial information such as physicians’ orders, laboratory test results, medical history, assessments, medication lists, clinical treatment notes and insurance policy and billing information.
As required by law, the agency maintains policies and procedures about our work practices, including how we provide and coordinate care provided to our patients. These policies and procedures include how we create, maintain and protect medical records; access to medical records and information about our patients; how we maintain the confidentiality of all information related to our patients; security of the building and electronic files; and how we educate staff on privacy of patient information.
As our patient, information about you must be used and disclosed to other parties for purposes of treatment, payment and health care operations. The following is a summary of the circumstances under which and purposes for which your health information may be used and disclosed:
Providing, coordinating or managing health care and related services, consultation between health care providers relating to a patient or referral of a patient for health care from one provider to another. For example, we may disclose your information to set up medical equipment or laboratory services, discuss your medications with the pharmacy, report to physicians involved in your care, release information to a hospital or facility to which you are admitted. We may contact you to provide appointment reminders or information about other health care activities we provide.
Billing and collecting for services provided, determining plan eligibility and coverage, utilization review, pre-certification, medical necessity review. Release of information to your insurance company, self-funded or third party health plan, Medicare, Medicaid or any other person or entity that may be responsible for paying or processing for payment any portion of your bill for services. For example, occasionally an insurance company requests a copy of the medical record be sent to them for review prior to payment of the bill.
Health Care Operations:
General agency administrative and business functions, quality assurance/improvement activities; medical review; auditing functions; developing clinical guidelines; determining the competence or qualifications of health care professionals; evaluating agency performance; conducting training programs with students or new employees; licensing, survey, certification, accreditation and credentialing activities. For example, our agency periodically holds clinical record review meetings where a consulting professional will audit clinical records for meeting professional standards and utilization review.
We are permitted to use or disclose information about you without consent or authorization in the following circumstances:
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.
1. When Legally Required: Where we are required by law to disclose your health information;
2. To Report Abuse, Neglect or Exploitation: as healthcare providers we are mandated reporters of witnessed or suspected abuse, neglect or exploitation of children, disabled adults and the elderly;
3. When there are risks to public health: as required by law to: prevent or control disease, injury or disability; report births and deaths; report reactions to medications or defects with products; enable product recalls; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence;
4. Health care oversight activities such as audits, investigations, inspections and licensure by a government health oversight agency as authorized by law to monitor the health care system, government programs and compliance with civil rights laws;
5. Certain judicial administrative proceedings if you are involved in a lawsuit or a dispute. We may disclose medical information about you in response to a court or administrative order, a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested;
6. To Law Enforcement Officials for certain law enforcement purposes such as helping to identify or locate a suspect, fugitive, material witness or missing person, to comply with a court order or subpoena and other law enforcement purposes, in an emergency in order to report a crime, under certain circumstances when you are the victim of a crime;
7. To coroners, medical examiners and funeral directors, in certain circumstances to assist in carrying out their duties; for example, to identify a deceased person or determine the cause of death;
8. In event of a serious threat to health or safety: To prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public, UNS United Nursing Services will, in good faith, disclose your health information;
9. For specified government function: including military and veterans’ activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, and inmate and law enforcement custody;
10. For Workers’ Compensation purposes: Workers’ compensation or similar programs provide benefits for work-related injuries or illness.
Other uses and disclosures will be made only with your written authorization. That authorization may be revoked, in writing, at any time, except in limited situations.
YOUR RIGHTS – You have the right, subject to certain conditions, to:
• Request restrictions on uses and disclosures of your protected health information for treatment, payment or health care operations. However, we are not required to agree with any requested restriction. Restrictions to which we agree will be documented. Agreements for further restrictions however, may be terminated under applicable circumstances (e.g., emergency treatment).
• Confidential communication of protected health information. You or your health representative have the right to communicate with you in a certain way. For example, you may request that we only conduct communications pertaining to your personal health information with you privately, with no family members present. We do not require an explanation for the request as a condition of providing communications on a confidential basis and will attempt to honor reasonable requests for confidential communications.
• Inspect and obtain copies of your protected health information, including billing records. If you request a copy of your health information, we will charge a reasonable fee for copying.
• Request to amend protected health information if you feel the protected health information is incomplete or incorrect. A request to amend your record must be in writing and must include a reason to support the requested amendment. We will act on your request within sixty (60) days of receipt of the request. We may extend the time for such action by up to 30 days, if we provide you with a written explanation of the reasons for the delay and the date by which we will complete action on the request. We may deny the request for amendment if the information contained in the record was not created by us, unless the originator of the information is no longer available to act on the requested amendment; is not part of the designated medical record set; would not be available for inspection under applicable laws and regulations; and the record is accurate and complete. If we deny your request for amendment, you will receive a timely, written denial in plain language that explains the basis for the denial, your rights to submit a statement disagreeing with the denial and an explanation of how to submit that statement.
• Receive an accounting of disclosures of protected health information made by our Agency for up to six (6) years prior to the date on which the accounting is requested for any reason other than for treatment, payment or health operations and other applicable exceptions. The written accounting includes the date of each disclosure, the name/address (if known) of the entity or person who received the protected health information, a brief description of the information disclosed and a brief statement of the purpose of the disclosure or a copy of your written authorization or a written request. However, we may extend the time period for providing the accounting by 30 days if we provide you with a written statement of the reasons for the delay and the date by which you will receive the information. 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.
• Obtain a paper copy of this notice, from us upon request, even if you have received this notice previously, whether electronically or in paper format.
COMPLAINTS – If you believe that your privacy rights have been violated, you may complain to the Agency or to the Secretary of the U. S. Department of Health and Human Services. There will be no retaliation against you for filing a complaint. The complaint should be filed in writing, and should state the specific incidents(s) in terms of subject, date and other relevant matters. A complaint to the Secretary must be filed in writing within 180 days of when the act or omission complained of occurred, and must describe the acts or omissions believed to be in violation of applicable requirements [45 CFR & 160.306] For further information regarding filing a complaint or should you have questions about this notice, contact:
The Administrator for the location nearest to you:
West Palm Beach
800-334-5140 or 561-478-8788
800-596-6003 or 239-596-6003
EFFECTIVE DATE – This notice is effective April 14, 2003. We are required to abide by the terms of the notice currently in effect, but we reserve the right to change these terms as necessary for all protected health information that we maintain. If we change the terms of this notice (while you are receiving service), we will promptly revise and distribute a revised notice to you as soon as practical by mail, e-mail (if you have agreed to electronic notice) or hand delivery.