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.
INTRODUCTION: During the course of providing services and care to you, we gather, create, and retain certain personal information about you that identifies who you are and relates to your past, present, or future physical or mental condition, the provision of health care to you, and payment for your health care services. This personal information is characterized as your “protected health information.” This Notice of Privacy Practices describes how we maintain the confidentiality of your protected health information, and informs you about the possible uses and disclosures of such information. It also informs you about your rights with respect to your protected health information.
OUR RESPONSIBILITIES: We are required by federal and state law to maintain the privacy of your protected health information. We are also required by law to provide you with this Notice of Privacy Practices that describes our legal duties and privacy practices with respect to your protected health information. We will abide by the terms of this Notice of Privacy Practices. We reserve the right to change this or any future Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain, including protected health information already in our possession. If we change our Notice of Privacy Practices, we will personally deliver or mail a revised notice to you at your current address. In addition, the notice will be posted in a clear and prominent place in the Action Home Care office and on the company’s website (www.actionhc.com).
USE AND DISCLOSURE WITH YOUR AUTHORIZATION: We will require a written authorization from you before we use or disclose your protected health information, unless a particular use or disclosure is expressly permitted or required by law without your authorization. We have prepared an authorization form for you to use that authorizes us to use or disclose your protected health information for the purposes set forth in the form. You are not required to sign the form as a condition to obtaining treatment or having your care paid for. If you sign an authorization, you may revoke it at any time by written notice. We then will not use or disclose your protected health information, except where we have already relied on your authorization.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION
We may, at our discretion, use or disclose your protected health information without your written authorization in the following circumstances:
Action Home Care Employees: It is our policy to allow Action Home Care employees to share clients’ protected health information with one another to the extent necessary to permit them to perform their legitimate functions on our behalf. At the same time, we will work with and train our employees to ensure that there are no unnecessary or extraneous communications that will violate the rights of our clients to have the confidentiality of their protected health information maintained.
Your Care and Treatment: We may use or disclose your protected health information to provide you with or assist in your treatment, care and services. For example, we may disclose your health information to health care providers who are involved in your care to assist them in your diagnosis and treatment, as necessary. We may also disclose your protected health information to individuals who will be involved in your care if you leave your community.
Billing and Payment: Medicaid and Other Public or Private Health Insurers – We may use or disclose your protected health information to public or private health insurers (including medical insurance carriers, HMOs, and Medicaid) in order to bill and receive payment for your treatment and services that you receive from Action Home Care, Inc. The information on or accompanying a bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
Health Care Operations: We may use your protected health information for health care operations at Action Home Care. These uses and disclosures are necessary to manage Action Home Care, and to monitor our quality of services and care. For example, we may use your protected health information to review our services and to evaluate the performance of our staff caring for you.
Licensing and Accreditation: We may disclose your protected health information to any government or private agency, such as to the federal centers for Medicare and Medicaid services, responsible for licensing or accrediting Action Home Care, Inc., so that the agency can carry out its oversight activities. These oversight activities include audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight.
Individuals Involved in Making Decisions or Providing Payment for Your Care: Unless you specifically object, we may disclose to a family member, other relative, a close personal friend, or to any other person identified by you, all protected health information directly relevant to such person’s involvement with your care or directly relevant to payment related to your care. We may also disclose your protected health information to a family member, personal representative, or other person responsible for your care to assist in notifying them of your location, general condition, or death.
Disaster Relief: We may disclose your protected health information to a public or private entity authorized to assist in disaster relief efforts.
Business Associates: We may contract with certain individuals or entities to provide services on our behalf. Examples include data processing, quality assurance, legal, or accounting services. We may disclose your protected health information to a business associate, as necessary, to allow the business associate to perform its functions on our behalf. We will have a contract with our business associates that obligate the business associates to maintain the confidentiality of your protected health information.
Public Health Activities: We may disclose your protected health information to any public health authority that is authorized by law to collect it for purposes of preventing or controlling injury, or disability.
Coroner, Medical Examiner, or Funeral Director: We may disclose protected health information to a coroner, medical examiner, or funeral director to allow them to carry out their duties. Mandatory Disclosures We will disclose protected health information to outside persons or entities without your written authorization as required by law in the following circumstances: Court Order; Order of Administrative Tribunal: We will disclose protected health information in accordance with an order of a court or of an administrative tribunal of a government agency.
Subpoena: We will disclose protected health information in accordance with a valid subpoena issued by a party to adjudication before a court, an administrative tribunal, or a private arbitrator. Reasonable efforts will be made to notify you of the subpoena, or of efforts to obtain an order or agreement protecting your protected health information.
Law Enforcement Agencies: We will disclose protected health information to law enforcement agencies in accordance with a search warrant, a court order or court-ordered subpoena, or an investigative subpoena or summons.
Elder Abuse Reporting: We will disclose protected health information about a client who is suspected to be the victim of elder abuse to the extent necessary to complete any oral or written report mandated by law. Under certain circumstances, we may disclose further protected health information about the client to aid the investigating agency in performing its duties. We will promptly inform the client about any disclosure unless we believe that informing the client would place the client in danger of serious harm, or would be informing the client’s personal representative, whom we believe to be responsible for the abuse, and believe that informing such person would not be in the client’s best interest. Public Health: We will immediately disclose protected health information to the Florida Department of Health where we diagnose or suspect the existence of a disease of public health significance.
Other Disclosures Required by Law: We will disclose protected health information about a client when otherwise required by law. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION You have the following rights with respect to your protected health information. To exercise these rights, contact us at the following address: Action Home Care, Inc., 1645 Lakeland Hills Blvd., Lakeland, FL 33805, c/o Compliance Officer.
Right to Request Access: You have the right to inspect and copy your health records maintained by us. This includes the right to have electronic records made available in electronic format to you or to someone whom you designate. In certain limited circumstances, we may deny your request as permitted by law. However, you may be given an opportunity to have such denial reviewed by an independent licensed health care professional.
Right to Request Amendment: You have the right to request an amendment to your health records maintained by us. If your request for an amendment is denied, you will receive a written denial, including the reasons for such denial, and an opportunity to submit a written statement disagreeing with the denial. Right to Request Special Privacy Protections: You have the right to request restrictions on the use and disclosure of your protected health information for treatment, payment or health care operations, or providing notifications regarding your identity and status to persons inquiring about or involved in your care. We are generally not required to grant your request, but if we do, we will comply with your request, except in an emergency situation or until the restriction is terminated by you or us. You also have the right to request that we communicate protected health information to the recipient by alternative means or at alternative locations. Right to an Accounting: You have the right to receive an accounting of disclosures of your protected health information created and maintained by us over the six years prior to the date of your request or for a lesser period. We are not required to provide an accounting of certain routine disclosures or of disclosures of which you are already aware. Right to Receive a Copy of the Notice of Privacy Practices: You have the right to request and receive a copy of our Notice of Privacy Practices for Protected Health Information in written or electronic form. If you have received this Notice of Privacy Practices in electronic form, you also have a right to receive a copy in written form upon request.
NOTICE OF SECURITY BREACHES: We will provide you with written notification in the event of a security breach involving your Protected Health Information. The notification will describe what happened, the types of information involved, the steps that we are taking to deal with the situation, what you should do to protect yourself against any harmful consequences, and contacts for obtaining further information.
COMPLAINTS: If you believe that your privacy rights have been violated, you may file a complaint with us at the following address: Action Home Care, Inc., 1645 Lakeland Hills Blvd., Lakeland, FL 33805, or call (863) 680-2273 and ask for the Compliance Officer. You also have the right to submit a complaint to the Secretary of the U.S. Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street, S.W., Atlanta, GA 30303-8909, Attention OCR Regional Manager. We will not retaliate against you if you file a complaint.
FURTHER INFORMATION: If you have questions about this Notice of Privacy Practices or would like further information about your privacy rights, contact us at the following address: Action Home Care, Inc., 1645 Lakeland Hills Blvd., Lakeland, FL 33805, c/o Compliance Officer, or call (863) 680-2273.
My signature indicates that I have been given an explanation and acknowledge receipt of the HIPAA Privacy Notice. I have read and understand the Privacy Notice. I understand that I may contact the Agency at any time for questions or concerns.