NOTICE OF PRIVACY PRACTICES
For Home Care of the Carolinas
Effective: April 14, 2003
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.
If you have any questions about this notice, please contact the
Privacy Liaison at (704) 982-2273.
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OUR PLEDGE REGARDING HEALTH INFORMATION:
We understand information about you and your health is personal,
and we are committed to protecting your medical information.
This Notice of Privacy Practices will explain to you about
the ways in which we may use and disclose your health information.
It also describes your rights and certain obligations we have
regarding the use and disclosure of health information.
We are required by law to make sure health information which identifies
you is kept private, to give you this notice of our legal duties
and privacy practices with respect to your health information,
and to follow the terms of the notice that is currently in effect.
WHO WILL FOLLOW THIS NOTICE.
Each location will follow HCC’s Privacy Policies and Procedures.
This notice describes the practices of our particular facility
and that of:
- Any health care professional authorized to enter information
into your medical record.
- All departments and locations of HCC.
- All employees, staff,
volunteers, and other HCC personnel.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION.
The following categories describe different ways we use and disclose
health information. For each category of uses or disclosures we
will explain what we mean and give some examples. Not every use
or disclosure in a category will be listed. However, all of the
ways we are permitted to use and disclose information will fall
within one of the categories.
For Treatment. We may use your health information to provide you
with medical treatment or services. We may disclose your health
information to doctors, nurses, technicians, medical students,
or other personnel who are involved in your care. For example,
a doctor treating you for a broken leg may need to know if you
have diabetes because diabetes may slow the healing process. Additionally,
the doctor may need to tell the dietitian if you have diabetes
so that we can arrange for appropriate meals. Different departments
or entities may share your health information in order to coordinate
the different services you need, such as prescriptions, lab work,
or x-rays. We also may disclose your health information to people
outside our home healthcare facility to provide services that are
part of your medical care.
If you receive treatment, including counseling, for certain conditions,
the treatment information or test results may receive additional
protection. These situations include: drug and/or alcohol use;
mental health problems; testing or treatment for HIV/AIDS; and
if you
are an un-emancipated minor, pregnancy, venereal disease
or emotional disturbances. We will not release any treatment information
or test results unless you authorize us to do so or we are required
by law or by a court order to do so.
For Payment. We may use and disclose your health information as
needed to obtain payment for your health care services from an
insurance company or a third party. For example, we may need to
give your health plan information about your treatment you received
so your health plan will make payment. We may also need to tell
your health plan about a treatment you are going to receive to
obtain prior approval or to determine whether your plan will cover
the treatment. We may also disclose medical information to other
health care providers for their payment purposes.
For Health Care Operations. We may use and disclose health information
about you as needed to support our healthcare operations. These
uses and disclosures are necessary to run our home health agency
and provide quality care to our patients. For example, we may use
health information to review our treatment and services and to
evaluate the performance of our staff. We may combine health information
about many patients to decide what additional services we should
offer, what services are not needed, and whether certain new treatments
are effective. Other activities for which we may disclose your
medical information include but are not limited to conducting training
programs, auditing, management and planning, customer service initiatives,
and administrative functions.
We may use and disclose health information to remind you of appointments
for treatment or medical care. We may contact you with information
about treatment alternatives or other health related benefits or
services that may be of interest to you. We may use your health
information to contact you about marketing and fundraising activities.
We may disclose your health information to other health care providers
for their health care operations as allowed by law.
Others Involved in Your Care or Payment for Your Care. Unless
you object, we may release your health information to a family
member, a relative, a close friend, or any other person you identify
who is involved in your care or payment for your care.
Facility Directory
We do not maintain a facility directory.
SPECIAL SITUATIONS
Required By Law. We
will disclose your health information when required to do so by
federal, state or local law.
To Avert a Serious Threat to Health
or Safety. We may use and
disclose your health information when necessary to prevent a serious
threat to your health and safety or the health and safety of the
public or another person. Any disclosure, however, would only be
to someone able to help prevent the threat.
Disaster Relief. We may disclose medical information about you
to an entity assisting in a disaster relief effort so that your
family can be notified about your condition, status, and location.
Research. Under
certain circumstances, we may disclose your health information
for research purposes. In most circumstances we will
ask for your specific permission if the researcher will have
access to information that reveals who you are. Business
Associate. We may disclose medical information
to a business associate for use on its behalf pursuant to a
written contract.
A business associate performs a function on behalf of HCC. For
example, HCC contracts with an audit firm to perform an annual
audit of our financial statements or an agency to provide accreditation.
Organ and Tissue Donation. If you are an organ donor, we may release
health information to organizations that handle organ procurement
or organ, eye or tissue transplantation or to an organ donation
bank, as necessary to facilitate organ or tissue donation and transplantation.
Workers' Compensation. We may disclose your health information
to comply with workers' compensation laws and other similar programs
established by law.
Public Health Risks. We may disclose your health information for
public health activities, such as to a public health authority
or other government authority allowed to receive this information.
Examples of these activities include reporting vital statistics,
communicable diseases, abuse or neglect, or information about product
recalls.
Health Oversight Activities. We
may disclose health information to a health oversight agency for
activities authorized by law.
These oversight activities include, for example, audits, investigations,
inspections, and licensure. These activities are necessary for
the government to monitor the health care system, government programs,
and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute,
we may disclose your health information in response to a court
or administrative order. We may also disclose your health information
in response to 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.
Law Enforcement. We may disclose health information under certain
conditions to law enforcement officials in response to a court
order or other legal process; to identify or locate a suspect,
fugitive, material witness, or missing person; concerning crime
victims; about a death we believe may be the result of criminal
conduct; about criminal conduct at HCC; and to report a crime in
a medical emergency.
Coroners, Medical Examiners and Funeral Directors. We may release
health information to a coroner or medical examiner. This may be
necessary, for example, to identify a deceased person or determine
the cause of death. We may also release health information to funeral
directors needed to carry out their duties.
Military, National Security and Intelligence Activities. If you
are a member of the armed forces, we may release your health information
as required by military command authorities. We may also release
health information about foreign military personnel to the appropriate
foreign military authority. We may release your health information
to authorized federal officials for intelligence, counterintelligence,
and other national security activities authorized by law. We may
disclose your health information to authorized federal officials
so they may provide protection to the President, other authorized
persons or foreign heads of state or conduct special investigations.
Inmates. We may disclose health information about an inmate to
a correctional institution or law enforcement official as authorized
by law.
Blood Testing. While you are receiving care, a healthcare worker
may accidentally be exposed to blood or other bodily fluids. If
this occurs, your blood will be tested for the presence of certain
diseases (for example, HIV, Hepatitis B and C). These tests are
necessary to help protect the healthcare worker. The results of
these tests will be a part of your medical record and will not
be released except with your prior consent or as required or permitted
by law.
Other Uses and Disclosures of Health
Information. Other uses and
disclosures of health information not covered by this notice or
the laws that apply to us will be made only with your written permission.
If you provide us permission to use or disclose your health information,
you may revoke that permission, in writing, at any time. If you
revoke your permission, we will no longer use or disclose your
health information for the reasons covered by your written authorization.
You understand we are unable to take back any disclosures we have
already made with your permission, and we are required to retain
our records of the care we provided to you.
North Carolina Law. In the event that North Carolina Law requires
us to give more protection to your health information than stated
in this notice or required by Federal Law, we will give that additional
protection to your health information.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION. You have certain
rights regarding health information we maintain about you which
are briefly explained below. If you have questions or need additional
information, please contact the Privacy Liaison
(see address and phone number listed below).
Right to Inspect and Copy. You
have the right to inspect and copy health information that may
be used to make decisions about your
care. Usually, this includes medical and billing records, but does
not include psychotherapy or substance abuse notes, certain information
compiled for or in anticipation of civil, criminal or administrative
proceedings, and information subject to a law that prohibits your
access to it. Submit your written request to the Privacy Liaison.
In certain limited cases, your request may be denied. If your request
is denied, you may request that the denial be reviewed. The person
who conducts the review will not be the person who denied the request
and we will comply with the outcome of the review.
Right to Amend. If you feel that health information we have about
you is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as we keep
the information.
- A request for an amendment must provide a reason that supports
your request. The request to amend your record may be denied,
in which case you have the right to enter a statement into
your medical
record saying that you disagree with the decision. Submit your
written request to the Privacy Liaison.
Right to an Accounting of Disclosures. You
have the right to request an "accounting of disclosures." This
is a list of the disclosures we made of your health information,
but does not include
disclosures made for treatment, payment, or for healthcare operations,
or for purposes or disclosures specifically authorized by you.
Your request must state a time period which may not be longer than
six years and may not include dates before April 14, 2003. The
first list you request within a 12 month period will be provided
free. For additional lists, we may charge you for the costs of
providing the list. We will notify you of the cost involved, and
you may choose to withdraw or modify your request at that time
before any costs are incurred. Submit your written request to the
Privacy Liaison.
Right to Request Restrictions. You
have the right to request a restriction on the health information
we use or disclose about
you for treatment, payment or health care operations. You also
have the right to request a limit on the health information we
disclose about you to someone who is involved in your care or the
payment for your care, like a family member or friend. For example,
you could ask that
we not use or disclose information about your home health service
you had. To request restrictions, you must make your request in
writing. In your request, you must tell us 1) what information
you want to limit; 2) whether you want to limit our use, disclosure
or both;
and 3) to whom you want the limits to apply, for example, disclosures
to your spouse.
We are not required to agree to your request. If we do agree,
we will comply with your request unless the information is needed
to provide you emergency treatment. You may not limit uses and
disclosures that we are legally required or allowed to make. Submit
your written request to the Privacy Liaison.
Right to Request Confidential Communications. You have the right
to request we communicate with you about medical matters in a certain
way or at a certain location. For example, you can ask that we
only contact you at work or at home.
We will not ask you the reason for your request. We will accommodate
all reasonable requests. Your request must specify how or where
you wish to be contacted. Submit your written request to the Privacy
Liaison.
Right to a Paper Copy of This Notice. You have the right to a
paper copy of this notice. You may ask us to give you a copy of
this notice at any time from our web site, www.hccservices.com
or from the HCC organization where you obtained treatment. Submit
your written request to the Privacy Liaison.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right
to make the revised or changed notice effective for health information
we already have about you as well as any information we receive
in the future. The notice will contain the effective date on the
first page. You can review the current notice at our web site www.
hccservices.com. We will also post a copy of the current Notice
of Privacy Practices at each agency location.
COMPLAINTS
If you believe your privacy rights have been violated, you may
file a complaint with HCC or with the Secretary of the Department
of Health and Human Services. To register a complaint about our
privacy practices, or if you would like to know how to file a complaint
with the Secretary of the Department of Health and Human Services,
please contact the Privacy Liaison.
You will not be penalized for filing a complaint.
PRIVACY LIAISON
If you have question, would like additional information or copies
of forms for requesting actions under your individual rights, or
wish to register a complaint, please contact the Privacy Liaison
as follows:
Privacy Liaison
P O Box 837, Albemarle, North Carolina 28002
Phone: 704-982-2273 or 800-222-6819
Effective Date: 4/14/2003
HIPAA Form V.A.01
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