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.
A. PRIVACY POLICIES
The regulations under the Health insurance Portability and Accountability Act of 1996 (HIPAA) require that certain measures be followed in maintaining the privacy of your Protected Health Information (PHI). PHI includes individually identifiable health information such as your name, age, address, telephone number, and other information which can be used to identify you, that relates to your past, present, or future physical or mental health or condition and related health care services. The records of the treatment and services you receive at this facility will contain your PHI. We are required by applicable law to maintain the privacy of your PHI, provide you with this Notice of Privacy Practices (this “Notice”) outlining our legal duties and privacy practices at our facility concerning your PHI, follow the terms of this Notice that is currently in effect, and inform you of any changes that we make to this Notice.
The terms of this Notice apply to all records containing your PHI that are created or retained by our facility, whether made by facility staff, your doctor, or other physicians in the facility. Other providers, such as your outside doctor(s) or hospitals may have different policies regarding their use and disclosure of your PHI. This Notice does not govern what they do with your PHI. We reserve the right to revise or amend this Notice by posting a copy of our current Notice in our facility in a visible location at all times and on our website located at www.job-haines.org. Any revision or amendment to this Notice will be effective for all of your records that our facility has created or maintained in the past and for any of your records that we may create or maintain in the future unless and until this Notice is further revised. You may request a hard copy of our most current Notice at any time by contacting our Privacy Officer.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT: The Privacy Officer, Job Haines Home, 250 Bloomfield Avenue, Bloomfield, New Jersey 07003, (973) 743-0792.
B. ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE
You will be asked to provide a signed acknowledgement of receipt of this Notice. Our intent is to inform you about the possible uses and disclosures of your PHI and your privacy rights relating to your PHI. We will not condition our delivery of health care services to you upon your signing of the acknowledgement. Even if you decline to sign the acknowledgement, we will continue to treat you and will use and disclose your PHI relating to your treatment, payment for health care treatment and other services rendered to you, and health care operations relating to our facility.
C. HOW WE MAY USE AND DISCLOSE PHI
The following categories describe several of the different ways in which we may use and disclose your PHI. Neither the categories nor the examples described therein are exhaustive. We may also use and disclose your PHI as otherwise required or authorized by applicable law.
1. Treatment. Our facility may use your PHI to provide, coordinate, or manage your health care and related services within our facility and with third parties. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your PHI in order to arrange for prescriptions for you, or we might disclose your PHI to a pharmacy when a prescription is ordered for you. Many of the people who work at our facility, such as doctors and nurses, may use or disclose your PHI in order to treat you or to assist others in your treatment. We may also use and disclose your PHI to inform you of potential treatment options or alternatives.
2. Payment. Our facility may use and disclose your PHI in order to bill and collect payment for health care treatment and services that you receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We may also use and disclose your PHI to bill you directly or obtain payment from third parties, such as family members, who may be responsible for your health care costs.
3. Health Care Operations. Our facility may use and disclose your PHI to conduct our business activities with respect to the provision of health care and related services. As examples of the ways in which we may use and disclose your information for our operations, our facility may use your PHI to evaluate the quality of care you receive from us, or to conduct cost-management and business planning activities for our facility. We may also disclose your PHI to third party “business associates” who perform or assist in the performance of various activities on our behalf. These business associates will also be required to protect your PHI. We may also use your PHI to plan what services we need to provide, expand, or reduce.
4. Appointment Reminders. Our facility may use and disclose your PHI to contact you to remind you of an appointment.
5. Health-Related Benefits and Services. Our facility may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
6. Release of Information to Family/Friends. Unless you provide us a prior written objection, our facility may release your PHI to family members, friends, or any other person you identify who is involved in and/or pays for your health care or who assists in taking care of you. We may also use or disclose your PHI to notify or assist in notifying family members, personal representatives, or any other person who is responsible for your health care, of your location, general condition, or death. In addition, we may use or disclose your PHI to an authorized governmental or private entity to assist in disaster relief efforts and coordinate uses and disclosures to family or other individuals who are involved in and/or pay for your care.
7. Disclosures Required By Law. Our facility will use and disclose your PHI when we are required to do so by applicable law.
8. Facility Directories: Unless you object, we will use and disclose in our facility directory your name, residence address, and your religious affiliation. All of this information, except religious affiliation, may be disclosed to people that ask for you by name. Members of the clergy may be told your religious affiliation.
9. Emergencies: We may use or disclose your PHI in an emergency treatment situation. If this happens, we shall try to obtain your acknowledgement as soon as reasonably practicable after the delivery of treatment. If we have attempted to obtain your acknowledgement but are unable to do so, we will document that inability and may still use or disclose your PHI to provide treatment.
10. Health Information Exchanges. We may participate in one or more health information exchanges (HIEs) and may electronically share your PHI with other participants in the HIEs for treatment and other lawful purposes. If you do not opt-out of this exchange of information, we may provide your PHI to the HIEs in which we participate.
10. Marketing. We may use your PHI to communicate with you about a drug or biologic that is currently being prescribed. Any other marketing communication involving payment requires us to obtain an authorization from you prior to releasing such communication. If you decide that you do not want to receive other marketing communications, you may contact our Privacy Officer.
11. Fundraising. We may use your information to contact you to raise funds for our facility. If you do not want us to send you such information, please contact the Privacy Officer at the address set forth herein. Fundraising materials will also explain how you can tell us that you do not want to be contacted in the future.
D. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or disclose your protected health information:
1. Public Health Risks. Our facility may disclose your PHI to public health authorities that are authorized by applicable law to collect information for purposes such as:
Maintaining vital records, such as deaths;
Reporting abuse or neglect;
Preventing or controlling disease, injury or disability;
Notifying a person regarding a potential exposure to a communicable disease;
Notifying a person regarding a potential risk for spreading or contracting a disease or condition;
Reporting reactions to drugs or problems with products or devices;
Notifying individuals if a product or device they may be using has been recalled; and
Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by applicable law to disclose this information.
2. Health Oversight Activities. Our facility may disclose your PHI to a health oversight agency for activities authorized by applicable law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings. Our facility may use and disclose your PHI in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have received satisfactory assurances, in accordance with HIPAA, that reasonable efforts have been made to inform you of the request or to obtain a court or administrative order protecting the information the party has requested.
4. Law Enforcement. We may release PHI to a law enforcement official:
Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement;
Concerning a death we believe has resulted from criminal conduct;
Regarding criminal conduct at our offices;
In response to a warrant, summons, court order, subpoena or similar legal process;
To identify/locate a suspect, material witness, fugitive or missing person; and
In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the person who might have committed the crime).
5. Deceased Patients. Our facility may release PHI to a medical examiner or coroner to identify a deceased individual, to identify the cause of death, or to perform other activities authorized by applicable law. We also may release PHI to funeral directors as authorized by applicable law.
6. Organ and Tissue Donation. Our facility may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
7. Research. Our facility may use and disclose your PHI for research purposes in certain limited circumstances when authorized by applicable law. For example, we may disclose your PHI to researchers, if their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI. We will obtain your written authorization to use your PHI for research purposes whenever we are legally required to do so.
8. Serious Threats to Health or Safety. Our facility may use and disclose your PHI when we believe necessary to reduce or prevent a serious threat to the health and safety of you, another individual or the public. Under these circumstances, we will only make legally authorized disclosures to a person or organization able to help prevent or reduce the threat.
9. Military. If you are a member of U.S. or foreign military forces (including veterans), our facility may disclose your PHI as required by the appropriate authorities. For example, we may disclose your PHI for determination by the United States Department of Veterans Affairs of your eligibility for benefits.
10. National Security. Our facility may disclose your PHI to federal officials for intelligence and national security activities authorized by applicable law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations of matters of national security.
11. Inmates. Our facility may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of law enforcement officials. Disclosure for these purposes would be necessary: (a) for the Institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the hearth and safety of other individuals.
E. YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding the PHI that we maintain about you;
1. Confidential Communications. You have the right to request that our facility communicate with you about your health and related issues in a particular manner or at a certain location. In order to request a type of confidential communication, you must make a written request to the Privacy Officer at the address set forth herein, specifying the requested method of contact, or the location where you wish to be contacted. Our facility will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions: You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not Required to agree to your request except to restrict your health information from going to a health plan for purposes of carrying out payment or health plan operations if you have first paid for the health care service or item out of pocket in full; however, if we do agree, we are bound by our agreement except when otherwise required by applicable law, in emergencies, or when the PHI is necessary to treat you. You or we may revoke a previously agreed upon restriction, at any time, in writing. However, our termination of such an agreement will only apply to PHI created or received after we have informed you of the termination. In order to request a restriction in our use or disclosure of your PHI, contact the Privacy Officer at the address set forth herein. A request form will be provided to you. Your request must be in writing.
3. Inspection and Copies. You have the right to inspect and obtain a paper or electronic copy of your PHI, which includes patient medical records and billing records, but excludes psychotherapy notes, information compiled in anticipation of or for use in a lawsuit or PHI that we are prohibited from granting you access to pursuant to applicable law. In order to inspect and/or obtain a copy of your PHI, contact the Privacy Officer at the address set forth herein. A request form will be mailed or delivered to you for your completion and return to the Privacy Officer; your request must be in writing. If you request a copy of your patient medical record, billing record, or any part thereof, we will charge you a fee for each page for the costs of copying, labor and supplies associated with your request. Our facility may deny your request in certain circumstances; however, if we do, we will give you the reason in writing and, you may request an appeal of our denial. Another licensed health care professional chosen by us will conduct appeals.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our facility. To request an amendment, contact the Privacy Officer at the address set forth herein. A request form will be provided to you. Your request must be in writing. You must provide us with a reason that supports your request for amendment. Although we may accept your request for amendment, we are not required to agree to the requested amendment. For example, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the facility; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our facility, unless the individual or entity that created the information is not available to amend the information.
5. Accounting of Disclosures. All of our patients have the right to request an “accounting of disclosures,” which is a list of disclosures our facility has made of your PHI. In order to obtain an accounting of disclosures, contact the Privacy Officer at the address set forth herein. A request form will be mailed or delivered to you for your completion and return to the Privacy Officer; your request must be in writing. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure for paper records and three (3) years for electronic records and, in each instance, may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our facility may charge you for additional lists within the same 12-month period. Our facility will notify you of any costs involved with additional requests, and you may withdraw your request before you incur any costs.
6. Right to Obtain an Authorization for Other Uses and Disclosures. Our facility will obtain your written authorization for uses and disclosures that are not identified by this notice or otherwise permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the purposes described in the authorization. Please note, we are required by law to retain our records of the health care treatment and services that we have provided to you. You may not revoke an authorization to the extent that we have already taken action in reliance on the authorization.
7. Right to Paper Copy of this Notice. You are entitled to receive a paper copy of our Notice, even if you agree to obtain an electronic copy of this Notice. You may request a paper copy of this Notice at any time. To obtain a paper copy of our Notice, contact the Privacy Officer at the address set forth herein.
8. Confidential Communications. You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or for specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.
9. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a written complaint with our facility or with the Secretary of the Department of Health and Human Services. To file a complaint with our facility, contact the Privacy Officer at the address set forth herein. You will not be retaliated against for filing a complaint.
F. CONTACT INFORMATION
Again, if you have any questions regarding this Notice or our health information privacy policies, please contact the Privacy Officer at: Privacy Officer, Job Haines Home, 250 Bloomfield Avenue, Bloomfield, New Jersey 07003, (973) 743-0792.