 |
 |
 |
 |
 |
 |
 |
 |
 |
|
NOTICE OF HIPPA PRIVACY PRACTICES This notice is effective April 14, 2003. I. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY. II. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION.* GTL, Incorporated d/b/a Link to Life (hereinafter "Link to Life" or "we") understands that your medical and health information is personal. Further, we are legally required to protect the confidentiality of your health information. We call this information "protected health information" (hereinafter, "PHI"). PHI includes information that can be used to identify you that we have created or received about your past, present or future health condition(s), the provision of health care or health care-related services to you, or the payment for this health care or related services. We are required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (hereinafter, "HIPPA") to provide you with this Notice of HIPPA Privacy Practices (hereinafter, this "Notice"). This Notice explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this Notice. We reserve the right to change the terms of this Notice at any time. Any changes will apply to the PHI that we already maintain. Whenever we make an important change to our policies, we will promptly update this Notice and post a new Notice that is accessible on the "Home Page" of our Internet website. You can also request a copy of this Notice from our office. III. HOW WE MAY USE AND DISCLOSE YOUR PHI. We use and disclose health information for many different reasons. For some of these uses or disclosures, we require your specific authorization. Below, we describe the different categories of uses and disclosures of your health information: A. Uses and Disclosures, Which Do Not Require Your Authorization. We may use and disclose your PHI without your authorization for the following reasons: 1. For treatment. We may disclose your PHI to Emergency Medical Services personnel, 911 operators, hospitals, physicians, nurses, and other health care personnel, in order to assist in the provision, coordination or management of your health care, or any related services, except where the PHI is related to HIV/AIDS, genetic testing, or federally funded drug or alcohol abuse treatment facilities, or where otherwise prohibited pursuant to state or federal law. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents. For example, we may disclose your PHI to a 911 operator or to Emergency Medical Services personnel for purposes of providing you with our Personal Emergency Response Services. 2. To obtain payment for treatment. We may use and disclose your PHI in order to assist in the billing and collection of payments for the services provided to you. For example, we may provide portions of your PHI to our billing staff and your health insurance provider to obtain payment for the services we provide to you. We may also disclose PHI to another provider involved in your care for the other provider's payment activities. For example we may disclose your health insurance information to Emergency Medical Services providers for payment for their services. We may also disclose your PHI to other third parties that may be responsible for such costs, such as family members. 3. For health care operations. We may disclose your PHI, as necessary, to operate this facility and provide quality services. For example, we may use your PHI in order to evaluate the quality of the services that you received. We may disclose your PHI to other health care professionals and entities to assist in their health care operations. We may also provide your PHI to our accountants, attorneys, consultants, and others in order to ensure that we are in full compliance with all state and federal laws that affect us. 4. When a disclosure is required by law. For example, we may disclose PHI when we are required by law to report such information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot or other wounds; for the purpose of identifying or locating a suspect, fugitive, material witness or missing person; or when subpoenaed or ordered in a judicial or administrative proceeding. 5. For public health activities. We may disclose your PHI to public health authorities that are authorized by law to collect certain health care related information. For example, we may disclose PHI to report information about deaths, various diseases, adverse events and product defects to government officials in charge of collecting that information; to prevent, control, or report disease, injury or disability as permitted by law; to conduct public health surveillance, investigations and interventions as permitted or required by law; or to notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law. 6. For health oversight activities. We may disclose your PHI to a health oversight agency for activities authorized by law. For example, we may disclose PHI to assist the government or other health oversight agencies with activities including investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, or criminal investigations, proceedings or actions; other activities necessary for the government to monitor government programs, compliance with civil rights law and the health care system in general; or other activities necessary for appropriate oversight as authorized by law. 7. To coroners, funeral directors, and for organ donation. We may disclose PHI to organ procurement organizations to assist them in organ, eye, or tissue donations and transplants. We may also provide coroners, medical examiners, and funeral directors necessary PHI relating to an individual's death. 8. For research purposes. In certain limited circumstances, we may provide PHI in order to conduct, or assist in the performance of research. Prior to conducting any such research, we will first obtain your written authorization to use your PHI, except when a Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following: (i) the use or disclosure involves no more than a minimal risk to your privacy based on the following: (A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI. 9. To avoid harm or serious threats to safety. We may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat. 10. For specific government functions. W e may disclose PHI of U.S. or foreign military personnel and veterans in certain situations. We may also disclose PHI for national security and intelligence activities authorized by law. 11. For worker's compensation purposes. We may provide PHI in order to comply with worker's compensation laws and similar programs. 12. Appointment reminders and health-related benefits or services. We may use PHI to provide appointment confirmations or to provide you information about other health care services or benefits we offer. Please let us know if you do not wish to have us contact you for these purposes, or if you would rather we contact you at a different telephone number or address. 13. Release of Information to family/friends. We may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you at the time of an emergency. For example, a family member or guardian may activate the Link to Life system and request a response on your behalf. In this example, the family member or guardian may obtain access to your important medical information if necessary. You may object in writing to our sharing of this information in whole or in part. 14. Release of Information related to lawsuits and similar proceedings. We 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 made an effort to inform you of the request or to obtain an order protecting the information the party has requested. 15. Law enforcement. We may release PHI if asked to do so by 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 office; in response to a warrant, summons, court order, subpoena or similar legal process; to identify/locate a suspect, material witness, fugitive or missing person; in an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator). B. All Other Uses and Disclosures Require Your Prior Written Authorization. Other than as stated above, we will not disclose your PHI without your written authorization. You can later revoke your authorization in writing except to the extent that we have taken action in reliance upon such authorization. C. Incidental Uses and Disclosures. Incidental uses and disclosures of information may occur. An incidental use or disclosure is a secondary use or disclosure that cannot reasonably be prevented, is limited in nature, and that occurs as a by-product of an otherwise permitted use or disclosure. However, such incidental uses or disclosures are permitted only to the extent that we have applied reasonable safeguards and do not disclose any more of your PHI than is necessary to accomplish the permitted use or disclosure. For example, disclosures about a subscriber within the office that might be overheard by persons not involved in your care would be permitted.
IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI. You have the following rights with respect to your PHI: 1. The right to request limits on uses and disclosures of your PHI. You have the right to request in writing that we limit how we use and/or disclose your PHI. You may not limit the uses and disclosures that we are legally required to make. We will consider your request to limit the use and/or disclosure of your PHI, but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them, except when otherwise required by law, in emergencies, or when the information is necessary to treat you. Under certain circumstances, we may unilaterally terminate our agreement to a restriction. 2. The right to choose how we send PHI to you. You have the right to request that we communicate with you about your PHI in a particular manner or at a certain location. For example, you may request that we send information to you at an alternate address (for example, sending information to your work address rather than your home address) or by alternate means (for example, via e-mail instead of regular mail). We must agree to your request so long as we can easily provide it in the manner you requested. Further, in order to request a type of confidential communication, you must make a written request ( see Section V below ) specifying the requested method of contact, or the location where you wish to be contacted. We will accommodate reasonable requests. You are not required to provide us with a reason for your request. 3. The right to inspect and obtain copies of your PHI. In most cases, you have the right to inspect or obtain copies of your PHI that we have, but you must make the request in writing. If we do not maintain your PHI, but we know who does, we will advise you how to obtain it. We will endeavor respond to you within thirty (30) days after receiving your written request. In certain situations, we may deny your request in whole or in part. If we do, we will advise you, in writing, our reasons for the denial and explain your right to have the denial reviewed by a health care professional chosen by us. If you request a copy of your PHI, we may charge you a reasonable fee for the cost of copying, mailing or other costs incurred by us in complying with your request. Instead of providing the PHI you requested, we may provide you with a summary or explanation of the PHI as long as you agree to that and to the cost in advance. 4. The right to obtain a list of disclosures we have made. You have the right to obtain a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures made for purposes of treatment, payment, or health care operations, those made pursuant to your written authorization, or those made directly to you or your family. This list also will not include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or prior to April 14, 2003. 5. The right to correct, update or amend your PHI. If you believe that your PHI is incorrect or incomplete, or that a piece of important information is missing, you have the right to request, in writing, that we correct the existing information or add the missing information. We will endeavor to respond to you within sixty (60) days of receiving your request in writing. We may deny your request if the PHI is (i) accurate and complete, (ii) not part of the PHI maintained by or for Link to Life, (iii) not allowed to be disclosed, (iv) not part of our records; unless , the individual or entity that created the information is not available to amend the information. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don't file a statement of disagreement with the denial, you have the right to have your request and our denial attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, advise you that we have completed the update, and tell others that are required to know about the change to your PHI. 6. The right to obtain this Notice by e-mail. You have the right to obtain a copy of this Notice by e-mail. Even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of this Notice. 7. The right to obtain an accounting of disclosures. Our subscribers have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment, non-payment or non-operations purposes. Use of your PHI as part of the routine subscriber care in our practice is not required to be documented. For example, a call center operator shares information with our records department; or the billing department using your information to file an insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing as specified in Section V below. 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 and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but we may charge you for additional lists within the same 12-month period. We will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs. 8. The right to provide an authorization for other uses and disclosures. We will obtain your written authorization for uses and disclosures that are not identified by this Notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI in these circumstances may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, we are required to retain records of the care and services we provide to you. V. HOW TO SUBMIT WRITTEN REQUESTS TO LINK TO LIFE. In order to make any information-related request, make a complaint, or in order to provide Link to Life with any written notice required under this Notice, you must make your request in writing to: Director of Human Resources/Privacy Officer Link to Life 297 North Street Pittsfield , MA 01201 Fax: __ 413-499-1557 _______________ Email:__ jh@lmrgroup.com ________________ VI. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES. If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with our Privacy Officer. You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue, S.W. ; Room 615F; Washington , DC 20201. We will take no retaliatory action against you if you file a complaint about our privacy practices. • PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES. VIII. EFFECTIVE DATE OF THIS NOTICE This notice is effective April 14, 2003
|
