PRIVACY RIGHTS

STATEMENT OF CLIENT PRIVACY RIGHTS

As a Personal Care Services client, you have the privacy rights listed below:

1. You have the right to know why we need to ask you questions.
   We are required, by law, to collect health information to make sure:
   A)You get quality healthcare, and
   B) Payment for insurance clients is correct.
2. You have the right to have your personal healthcare information kept confidentialYou may be asked to tell us information about yourself so that we will know which Personal Care services will be best for you. We keep anything we learn about you confidential. This means, only those who are legally authorized to know, or who have a medical need to know, will see your personal health information.
3. You have the right to refuse to answer questions.
   We may need your help in collecting your health information. If you choose not to answer, we will fill in the information as best we can. You do not have to answer every question to get services.
4. You have the right to look at your personal health information.
   We know how important it is that the information we collect about you is correct. If you think we made a mistake, ask us to correct it.

PRIVACY ACT STATEMENT – HEALTH CARE RECORDS

THIS STATEMENT GIVES YOU ADVICE REQUIRED BY LAW (the Privacy Act of 1974).

THIS STATEMENT IS NOT A CONSENT FORM. IT WILL NOT BE USED TO RELEASE OR TO USE YOUR HEALTH CARE INFORMATION.

We are required, by law, to maintain the privacy of individually identifiable client health information (this information is “protected health information” and is referred to, herein, as “PHI”). We are also required to provide you of a copy of this policy. We will abide by the terms of this notice and notify you if we cannot agree to a requested restriction. We will accommodate requests you may have to communicate health information by alternative means or at alternative locations.

We will only use, or disclose, your PHI as permitted, or required, by applicable state law. This Notice applies to your PHI in our possession, including the medical records generated by us.

Our Agency understands that your health information is highly personal, and we are committed to safeguarding your privacy. Please read this Notice of Privacy Practices thoroughly. It describes how we will use and disclose your PHI.

This Notice applies to the delivery of health care by our Agency. This Notice also applies to the utilization review and quality assessment activities of our Agency.

This summary describes how we use and share information about you. This summary describes how you may see and get copies of this information.

We might use or share information about you for:

Treatment. Such as when our staff discuss your care.

Payment. Such as when we bill your insurance company for services provided to you.

Operations. Such as when we work to make the quality of the care we provide better. When we give out information about the different services we provide.

Other ways. Such as when we send disease reports to county and state health officials (this is required by law). When we provide information to law enforcement agencies, funeral directors, organ donation groups, and researchers. When we share information to protect the health and safety of others or you. Or when we respond to court requests. We also may send you appointment reminders, greeting cards, and newsletters.

How you may see and get copies of this information:

You have the right to:

• Ask for restrictions on the ways we use and give out your information.
• Get and inspect a copy of your health record.
• Add information to your health record.
• Ask that your health information be sent to an alternate address or that you be called at an alternate phone number.
• Change your mind if you told us we could use or share your information for reasons other than those listed above.
• Get a list of the times we gave out your information. It will be a list of the times that the law requires us to keep a record of giving out your information.

Our Commitment to Respect Privacy

Our Agency is required to:

• Keep your information private.
• Let you know if we cannot do what you have asked us to do with your information.
• Try to reach you at another location or phone number, if you ask us to do so.
• Use and/or give out your information as listed above, and as the law permits, unless we have your permission to do more.

If there are any changes regarding what we do with your information, we will give you a new notice at the next visit, but not later than 30 days.

The Agency needs your health information in order to give you quality care. It is important that the information is correct. Incorrect information could result in payment errors. Incorrect information, also, could make it hard to be sure that the Agency is giving you quality services. If you choose not to provide information, there is no requirement for the Personal Care Services agency to refuse services to you.

NOTICE OF HIPAA & PRIVACY RIGHTS

Name of Agency: Angels Of Serenity Home Care 

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. Below is a description, including at least one (1) example of the types of uses and disclosures that the above organization is permitted to make for each of the following purposes: treatment, payment, and health care operations.
   Disclosures to other health care providers, including, for example, to clients’ attending physicians. Submission of claims and supporting documentation including, for example, to organizations responsible to pay for services provided by the organization. Disclosures to conduct the operations of the organization, including, for example, sharing information to supervisors of staff members who provide care to clients.
2. Below is a description of each of the other purposes for which the organization is permitted or required to use or disclose protected health information without an individual’s written consent or authorization.
   To clients, incident to another permitted use or disclosure, by agreement, to the Secretary of the U.S. Department of Health and Human Services, as required by law, for public health activities, information about victims of abuse, neglect or domestic violence, health oversight activities, for judicial and administrative proceedings, for law enforcement proceedings, about decedents, for cadaveric organ, eye or tissue donation, for research purposes, to avert a serious threat to health or safety, for specific government functions, to business associates of the organization, to personal representatives, de-identified information, to workforce members who are victims of crimes, to workers’ compensation programs, for involvement in the individual’s care and for notification purposes, with the individual present, for limited uses and disclosures when the individual is not present, and for disaster relief purposes.
3. Other uses and disclosures, such as disclosure of psychotherapy notes, use of protected health information for marketing activities and the sale of protected health information, will be made only with the individual’s written authorization and the individual may revoke such authorization.
4. The organization may contact the individual to schedule visits and for other coordination of care activities.
5. The individual has the right to request further restrictions on certain uses and disclosures of protected health information, but the organization is not required to agree to any requested restriction(s), except disclosures must be restricted to health plans if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law and the protected health information pertains solely to a health care item or service for which the individual
6. The individual has the right to receive confidential communications of protected health information, the right to inspect and copy protected health information, the right to amend protected health information, the right to receive an accounting of disclosures of protected health information and the right to obtain a paper copy of this Notice from the organization upon request.
7. The organization is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information and to notify affected individuals following a breach of unsecured protected health information.
8. The organization is required to abide by the terms of this Notice currently in effect.
9. The organization reserves the right to change the terms of its Notice and to make the new notice provisions effective for all protected health information that it maintains. Individuals may obtain a revised copy of this Notice upon request.
10. Individuals may complain to the organization and to the Secretary of the U.S. Department of Health and Human Services if they believe their privacy rights have been violated. Complaints should be directed to                                           (Name or title of person) at the organization at the following telephone number: _________________ Individuals will not be retaliated against for filing a complaint.
11. For further information, individuals should contact ___________________ (Name or title of person) at the organization at the following telephone number: ____________.
12. This Notice is in effect as of _____________________.

HIPAA PRIVACY RIGHTS

Clients have the right to give adequate notice concerning the use/disclosure of their PHI on the first date of service delivery, or as soon as possible after an emergency.

The Privacy Rule grants clients’ new rights over their PHI, including the following:

1. Receive a Privacy Notice at the time of the first delivery of service,
2. Restrict use and disclosure, although the covered entity is not required to agree,
3. Have PHI communicated to them by alternate means and at alternate locations to protect confidentiality,
4. Inspect, correct, and amend PHI and obtain copies, with some exceptions,
5. Request a history of non-routine disclosures for six years prior to the request, and,
6. Contact designated persons regarding any privacy concerns or breach of privacy, within the facility or at HHS.