Aging and
In-Home Services of Northeast Indiana, Inc.
Notice of
Privacy Practices
For
Protected Health Information
and disclosed and how you can get access to
this information.
Please
review it carefully.
If you have any questions or wish to receive additional information about the matters covered by this Notice of Privacy Practices, please contact Beth Krudop at (260) 745-1200.
Aging and In-Home Services of Northeast Indiana, Inc. (“Aging & In-Home Services”) is required to abide by the terms of this Notice of Privacy Practices (this “Notice”). Aging & In-Home Services reserves the right to change the terms of this Notice at any time. The revised Notice will apply to all protected health information Aging & In-Home Services received or created in the past as well as all protected health information Aging & In-Home Services receives or creates in the future. A current copy of the Notice will be posted in our central office and over our web site. The effective date of this Notice of Privacy Procedures is set forth on the first page of this Notice. If this Notice has been changed since your last appointment, Aging & In-Home Services will provide a copy of the current Notice when the case manager visits you. Additionally, you may obtain a copy of the current Notice by calling your case manager and requesting that one be sent to you in the mail or by asking for one when you are in the office.
Your “protected health
information” consists of all individually identifiable information which is
created or received by Aging & In-Home Services and which relates to your
past, present or future physical or mental health condition, the provision of
health care to you or the past, present or future physical or mental health
condition, the provision of health care to you the past present or future
payment for health care provided to you.
Your
Consent or Authorization is not Required
1.
Treatment: Aging & In-Home Services will
use and disclose your protected health information to provide, coordinate or
manage your health care and related services by Aging & In-Home Services
and other health care providers, including consulting with other health care
providers about your health care or referring you to another health care
provider for treatment. For example,
Aging & In-Home Services will disclose your protected health information to
a home health agency to ensure that the agency has the necessary information
needed to serve you.
2.
Payment: Aging & In-Home Services will
use and disclose your protected health information, as needed, to obtain
payment for the health care Aging & In-Home Services provides to you. When Aging & In-Home Services performs an
assessment of your needs for in-home services such as home health aide service,
the assessment process is considered a health care service. Aging & In-Home Services bills Medicaid
and other funding sources for health care services provided to you. In order to receive payment Aging &
In-Home Services will disclose protected health information.
3.
Health Care Operations: Aging
& In-Home Services may use or disclose your protected health information in
order to support the business activities of Aging & In-Home Services. These activities include, but are not limited
to, quality assessment and improvement activities, reviewing the competence or
qualification of health care professionals, conducting training programs in
which students provide assessment under the supervision of one of Aging &
In-Home Services’ skilled case managers, business planning and development and
business management and general administrative activities. For example, Aging & In-Home Services may
use Protected Health Information to track trends in clients’ conditions and
care. Additionally, Aging & In-Home
Services may use your protected health information to help ensure that all
in-home service providers provide the highest quality health care.
4.
Appointed Reminders: Aging
& In-Home Services may use or disclose your protected health information in
order to contact you and remind you of a scheduled appointment.
5.
Treatment Alternatives: Aging
& In-Home Services may use or disclose your protected health information to
inform you about treatment alternatives.
6.
Health Related Benefits and Services: Aging
& In-Home Services may use and disclose your protected health information
to inform you about health-related benefits and services that may be of
interest to you.
7.
Fundraising Activities: Aging
& In-Home Services may use or disclose your protected health information to
raise funds for aging & In-Home Services.
If you do not wish to be contacted for fund raising purposes, please
contact Dorothy Schuerman at (260) 745-1200.
8.
Others Involved in Your Health Care and Disaster
Relief: Unless you object, Aging & In-Home Services may
disclose to a family member, other relative, close personal friend or any other
person identified by you protected health information related to that person’s
involvement in your health care or payment related to your health care. Aging & In-Home Services may also use or
disclose to a person responsible for your care your protected health
information that relates to your location, general condition or death. If the opportunity for you to agree or object
to any such disclosure cannot be provided due to emergency circumstances, Aging
& In-Home Services will make these disclosures if they are in your best
interests. Additionally, Aging &
In-Home Services may disclose protected health information relating to your
location, general condition or death to any public entity authorized to assist
in disaster relief efforts.
9.
Public Health: Aging & In-Home Services may
disclose your protected health information to a public health authority
authorized to collect such information for the purpose of:
a.
preventing or controlling disease, injury or
disability;
b.
reporting disease or injury;
c.
reporting vital events such as births or deaths;
d.
conducting public health surveillance, public health
investigations and public health interventions; or
e.
at the direction of a public health authority, to an
official of a foreign government agency acting in collaboration with a public
health authority; or
f.
reporting child abuse or neglect.
10.
Food and Drug Administration: Aging
& In-Home Services may disclose your protected health information to a
person subject to the jurisdiction of the Food and Drug Administration (“FDA”)
for the purpose of activities related to the quality, safety or effectiveness
of FDA regulated products.
11.
Communicable Diseases: Aging
& In-Home Services may disclose your protected health information, if
authorized by law, to a person who may have been exposed to a communicable
disease or may otherwise be at risk of spreading a disease or condition.
12.
Employer: In certain circumstances Aging
& In-Homes Services may disclose your protected health information to your
employer if Aging & In-Home Services is providing health care to you at the
request of your employer.
13.
Abuse, Neglect or Domestic Violence: Aging
& In-Home Services may disclose your protected health information to a
government authority to receive reports of abuse, neglect or domestic violence
if Aging & In-Home Services reasonably believes that you are a victim of
abuse, neglect or domestic violence. Any
such disclosure will be made (1) to the extent it is required by law, (2) to
the extent that the disclosure is authorized by statute or regulation and Aging
& In-Home Services believes the disclosure is necessary to prevent serious
harm to you or other potential victims or (3) if agree to the disclosure.
14.
Health Oversight Activities: Aging
& In-Home services may disclose your protected health information to a
health oversight agency for any oversight activities authorized by law,
including audits; investigations; inspections; licensure or disciplinary
actions; civil, criminal or administrative actions or proceedings; or the other
activities necessary for the oversight of the health care system, government benefit
programs, compliance with government regulatory program standards or compliance
with applicable civil rights laws.
15.
Judicial and Administrative Proceedings: Aging
& In-Home Services may, upon certain conditions, disclose your protected
health information in the course of any judicial or administrative proceeding
in response to an order of a court or administrative tribunal, a subpoena,
discovery request, or other lawful process.
16.
Law Enforcement Purposes: Aging
& In-Home Services may disclose your protected health information for law
enforcement purposes to a law enforcement official in certain circumstances.
17.
Coroners, Medical Examiners and Funeral Directors: Aging
& In-Home Services may disclose your protected health information to a
coroner or medical examiner for the purpose of identifying you, determining a
cause of death or other duties authorized by law.
18.
Medical Research: Aging & In-Home
Services may disclose your protected health information for research purposes,
provided that an institutional review board authorized by law or a privacy
board waives the authorization requirement and provided that the researcher
makes certain representations regarding the use and protection of the
protection of the protection of the protected health information to be disclosed.
19.
Serious Threat to Health or Safety: Aging
& In-Home Services may disclose your protected health information, in a
manner which is consistent with applicable laws, if the disclosure is necessary
to prevent or lessen a serious threat to health or safety or the information is
necessary to apprehend an individual.
20.
National Security and Protection of the President and
Others: Aging & In-Home Services may disclose your protected
health information to authorized federal officials for the conduct of lawful
intelligence, counter-intelligence and other national security activities
authorized by law. Additionally, Aging
& In-Home Services may disclose your protected health information to
authorized federal officials for the provision of protective services to the
President, foreign heads of state, or other people authorized by law and to
conduct investigations authorized by law.
21.
Inmates: Aging & In-Home Services may
disclose your protected health information to a correctional institution or a
law enforcement official having lawful custody of you if the correctional
institution or law enforcement official represents that the information is
necessary under specific circumstances.
22.
Workers’ Compensation: Aging
& In-Home Services may disclose your protected health information as
authorized by, and in compliance with, laws relating to workers’ compensation
and other similar programs established by law that provide benefits for
work-related illnesses and injuries without regard to fault.
Any use or disclosure of your protected health information that is not listed above will be made only with your written authorization. You have the right to revoke your authorization at any time, except to the extent that Aging & In-Home Services has already used or disclosed your protected health information in reliance on the authorization.
Your Rights Regarding Your Protected Health Information
1. Restriction of Use and Disclosure: You have the right to request that Aging & In-Home Services restrict the protected health information Aging & In-Home Services uses and discloses in carrying out treatment, payment and health care operations. You also have the right to request a restriction of the protected health information Aging & In-Home Services discloses to a family member, other relative or any other person identified by you, which is relevant to such person’s involvement in your treatment or payment for your treatment. Aging & In-Home Services is not Obligated to Agree to any Restriction that you Request. If Aging & In-Home Services agrees to a restriction, however, Aging & In-Home Services may only disclose your protected health information in accordance with that restriction, unless the information is needed to provide emergency health care to you.
If you wish to request a restriction on the use and disclosure of your protected health information. Please send a written request to the Privacy Officer which specifically sets forth (1) whether you are restricting the use or the disclosure of your protected health information, (2) what protected health information you wish to limit, and (3) to whom you wish the limits to apply. Aging & In-Home Services will not ask why you are requesting the restriction. The Privacy Officer will review your request and notify you whether or not Aging & In-Home Services will agree to your requested restriction. Aging & In-Home Services reserves the right to terminate its agreement to a restriction by notifying you. The restriction will no longer apply to protected health information obtained after the revocation of the restriction.
2. Confidential Communications: You have the right to request that you receive communications of your protected health information from Aging & In-Home Services in alternative means or at alternative locations. Aging & In-Home Services will accommodate all reasonable requests. To request that Aging & In-Home Services make communications of your protected health information by alternative means or at alternative locations, please send a written request to the Privacy Officer setting forth the alternative means by which you wish to receive communications or the alternative location at which you wish to receive such communications. Aging & In-Home Services will not ask why you are making such a request. When appropriate, Aging & In-Home Services may condition the provision of a reasonable accommodation upon receiving information relating to how payment, if any, will be received.
3. Access to Protected Health Information: You have the right to inspect and obtain a copy of your protected health information that Aging & In-Home Services maintains in a designated record set, for so long as that protected health information is maintained in a designated record set. A “designated record set” is a group of records maintained by or for Aging & In-Home Services, which includes medical records, billing records and records used in whole or in part to make decisions about you. You do not have the right to inspect or copy psychotherapy notes, information compiled in reasonable anticipation of, or for the use in, a civil, criminal or administrative action or proceeding, or information that Aging & In-Home Services is otherwise prohibited by law from disclosing.
If you wish to inspect or obtain a copy of your protected health information, please send a written request to the Privacy Officer. If you request a copy of your protected health information, Aging & In-Home Services may charge a fee for the cost of copying and mailing the information.
Aging & In-Home Services may, for certain limited reasons, deny your request to inspect or obtain a copy of your protected health information. If Aging & In-Home Services denies your request, you may be entitled to a review of the denial. If you are entitled to review and you wish to have Aging & In-Home Service’s decision reviewed, please contact the Privacy Officer. The Privacy Officer will designate a licensed health care professional to review your request. This reviewing health care professional will not have participated in the original decision to deny your request. Aging & In-Home Services will comply with the decision of the reviewing health care professional.
4. Amending Protected Health Information: You have the right to request that Aging & In-Home Services amend your protected health information in a designated record set for so long as that information exists in a designated record set. To request that an amendment be made to your protected health information, please send a written request to the Privacy Officer. Your written request must provide a reason that supports the requested amendment.
Aging & In-Home Services may deny your request if it does not contain a reason that supports the requested amendment. Additionally, Aging & In-Home Services may deny your request to have your protected health information amended if Aging & In-Home Services determines that (1) the information was not created by Aging & In-Home Services, unless the person or entity that created the information is no longer available to make the amendment; (2) the information is not part of a designated record set; (3) the information is not available for your inspection; or (4) the information is accurate and complete.
5. Accounting of Disclosures of Your Protected Health Information: You have the right to request a listing of certain disclosures of your protected health information made by Aging & In-Home Services during the period of up to six (6) years prior to the date on which you make your request. Any accounting you request will not include (1) disclosures made to carry out treatment, payment or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to an authorization given by you; (4) disclosure’s made to other people involved in your care or made for notification purposes; (5) disclosures made for national security or intelligence purposes; (6) disclosures made to correctional institutions or law enforcement officials; or (7) disclosures made prior to April 14, 2003. The right to receive an accounting is subject to certain other exceptions, restrictions and limitations set forth in applicable statutes and regulations.
To request an accounting of the disclosures of your protected health information made by Aging & In-Home Services, please send a written request to the Privacy Officer. Your written request must set forth the format in which you want the accounting (i.e., hard copy, electronically) and the period for which you wish to receive an accounting. Aging & In-Home Services will provide one free accounting during each twelve (12) month period. If you request additional accountings during the same twelve (12) month period, you will be charged for all costs Aging & In-Home Services incurs in preparing and providing that accounting. Aging & In-Home Services will inform you of the fee for each accounting in advance and will allow you to modify or withdraw your request in order to reduce or avoid the fee.
6. Obtaining a Copy of this Notice: You have the right to request and receive a paper copy of this Notice of Privacy Practices form Aging & In-Home Services at any time.
Complaints
If you believe
that your privacy rights have been violated, you may file a complaint with
Aging & In-Home Services or with the Secretary of Health and Human
Services. To file a complaint with Aging
& In-Home Services, please contact Claire Dokmecian at (260) 745-1200. All complaints must be submitted in writing. The Practice Will Not Retaliate Against
You For Filing A Complaint.