NOTICE OF HIPAA PRIVACY PRACTICES FOR PHI
[45 CFR 164.520] OCR HIPAA Privacy December, 2002
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION IS PROTECTED & MAY BE USED AND DISCLOSED
We are required by law to maintain the privacy of your health information; to provide you this detailed Notice of our legal duties and privacy practices, and to abide by the terms of the Notice that are currently in effect.
You have the right to:
Advise our Agency to limit what information is utilized or shared:
- Ask our Agency not to use or share certain health information for treatment, payment, or operations. Our Agency is not required to agree to your request, and may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. Our Agency will say “yes” unless a law requires us to share that information.
Choose someone to act on your behalf:
- If you have designated an individual medical power of attorney or have a legal guardian, that individual may exercise your rights and make choices about your health information.
- Our Agency will ensure the person has this authority and can act for you before we take any action.
Obtain a list of those with whom we’ve shared information:
- You can ask for a list (accounting) of the times the Agency has shared your health information for six (6) years prior to the date you ask, who the Agency shared it with, and for what purpose.
- Our Agency will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). Our Agency will provide one accounting a year at no charge, but will charge a reasonable fee if you ask for another within 12 months.
Request confidential communications:
- You can ask our Agency to contact you in a specific way (i.e.. at home/work phone) or send mail to a specific address. Our Agency will comply with all reasonable requests.
Get an electronic or paper copy of your medical record:
- You can ask to see or receive an electronic or paper copy of your medical record and other health information the Agency has about you. Ask our Agency how to do this.
- The Agency will provide a free copy of your clinical record upon request, at the next home visit or within 4 business days, whichever comes first.
Ask us to correct your medical record:
- You can ask our Agency to correct health information about you that you think is incorrect or incomplete. Ask our Agency how to do this.
- Our Agency may say “no” to your request, but we will explain why in writing within 60 days.
Get a copy of this privacy notice:
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. Our Agency will provide you with a paper copy promptly.
For certain health information, you can tell us your choices about what we share:
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care.
- Share information in a disaster relief situation.
- Include your information in a hospital directory.
If you are not able to tell us your preference, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
USES AND DISCLOSURES:
For Treatment. Our Agency will use and disclose your health information in providing you with treatment/services and coordinating your care and may disclose information to other providers involved in your care. Your health information may be used by doctors involved in your care and by nurses and health aides as well as by therapists, pharmacists, suppliers of medical equipment, or other persons involved in your care.
For Payment/Billing for Services. Our Agency may use and disclose your health information for billing and payment purposes. We may disclose your health information to your representative, or to an insurance or another third-party payer. We may contact your health plan to confirm your coverage or to request prior approval for services that will be provided to you.
For Health Care Operations. Our Agency may use and disclose your health information as necessary for operating our Agency, such as management, personnel evaluation, education and training, and to monitor our quality of care. We may disclose your health information to another entity with which you have or had a relationship if that entity requests your information for certain of its health care operations or health care fraud and abuse detection or compliance activities.
To Do Research: Our Agency can use or share your information for health research. To Comply with the law: Our Agency will share information about you if state or federal laws require it, including with the US Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
To Respond to organ and tissue donation requests: Our Agency can share health information about you with organ procurement organizations.
To Work with a medical examiner or funeral director: Our Agency can share health information with a coroner, medical examiner, or funeral director when an individual dies.
To Address workers’ compensation, law enforcement, and other government requests:
Our Agency can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, etc.
To Respond to lawsuits and legal actions: Our Agency can share health information about you in response to a court or administrative order, or in response to a subpoena.
We will never share your information for the following purposes unless you give written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
- We may contact you for fundraising efforts, but you can tell us not to contact you again
We are allowed to use or share your health information in other ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
To help with public health and safety issues:
We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
SPECIFIC USES/DISCLOSURES OF YOUR HEALTH INFORMATION
Individuals Involved in Your Care or Payment for Your Care: Unless you object, our Agency may disclose health information about you to a family member, close personal friend, or other person you identify, including clergy, who is involved in your care.
Emergencies: Our Agency may use or disclose your health information as necessary in emergency treatment situations.
As Required By Law: We may use or disclose your health information when required by law to do so.
Business Associates: Our Agency may disclose your protected health information to a contractor or business associate that needs the information to perform services for our Agency. Our business associates are committed to preserving the confidentiality of this information.
RESPONSIBILITIES OF OUR AGENCY:
Our Agency is required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
You have the right to express concerns/complaints, without fear of retaliation, to our Agency or the US Department of Health & Human Services, regarding any act that you consider a violation of these privacy rights.
Our agency will never retaliate against you for filing a complaint.
Or, you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 877-696-6775, or www.hhs.gov/ocr/privacy/hipaa/complaints/.
For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Our Agency can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request and be posted in our office.
Health Care Connectors LLC complies with applicable Federal civil rights laws and does not discriminate in hiring or admissions, on the basis of race, color, national origin, age, disability, or sex. Our Agency does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Health Care Connectors LLC:
Provides free aids and services to patients with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters.
- Written information in other formats (large print, audio, accessible electronic formats, other formats).
Provides free language services to patients whose primary language is not English (LEP) such as:
- Qualified interpreters.
- Information written in other languages.
If you need these services, contact us at our office at 203-489-0919.
If you believe that Health Care Connectors LLC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Agency Administrator at 203-489-0919, Fax # 203-580-8334 or at email@example.com. You can file a grievance in person or by mail or fax. If you need help filing a grievance our Agency Administrator is available to help you.
You can file a grievance in person or by mail or fax. If you need help filing a grievance, Agency Administrator, Heather Flaherty RN, BSN, OCN is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F
HHH Building, Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD)
agency grievance policy/process
We strive to provide the highest quality health care services for our patients. To ensure that our services meet your needs, we encourage you to make us aware of any complaints or concerns. Complaints should be addressed to the Administrator who will promptly review the problem. If at any time you feel that a situation was not resolved to your satisfaction by this process, you may contact the office at (203) 489-0919.
We appreciate your candid comments as this helps us in the process of continually working to improve our services to our many and valued patients. If you have information about unethical behavior, criminal activities, or other concerns regarding your services, please call the Administrator at your office. Your confidentiality will be protected. The following are examples of issues that should be brought to our attention immediately. Potential criminal violations:
- Health and safety issues
- Bribes and kickbacks
- Antitrust laws
- On-the-job substance abuse
- Harassment or discrimination
- Theft and fraud
- Conflicts of interest
- Breach of confidentiality of company information or patient records
- Billing and documentation/insurance fraud
- Privacy of employee and patient records
- Violation of patient’s rights
- Insider Trading
Our Agency is committed to providing excellence in patient care. We will give full consideration to your issues and make an effort to resolve any issues to your satisfaction. We will provide you every opportunity to voice grievances without discrimination, fear of reprisal, or any discrimination from our Agency or its employees. If you have any concerns at all, please tell us. Express written or verbal concerns with an Administrator, Supervisor of Clinical Services, or any other employee that you are comfortable with. They will ensure the concern is presented to the Administrator. If you call after business hours, the Administrator will be in contact with you the next business day.
The Administrator will contact you within 10 days and will help to resolve the complaint/concern to your satisfaction. They will look at all aspects surrounding the grievance, investigation, and resolution. You will be notified of the Administrator’s decision within thirty (30) days.
If you are dissatisfied with the outcome of the complaint investigation, you may request that the Administrator submit an appeal with the Agency’s Governing Body.
You may also file a complaint with CT Home Health Hotline at: 800-828-9769 or via email: dph.flisevents.ct.gov
You may file a grievance/concern with our Agency at any time 24/7 without fear of reprisal. Please contact us at:
AGENCY NAME: Health Care Connectors LLC
AGENCY ADDRESS: One Sound Shore Drive, Suite 201, Greenwich, CT 06830
AGENCY ADMINISTRATOR NAME: Heather Flaherty RN, BSN, OCN
AGENCY TELEPHONE: (203) 489-0919