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.
This Notice describes the practices of Around the Clock Home Care (“Agency”) and Agency’s employees, staff and personnel. If you have any questions about this Notice or about your privacy, please feel free to contact the Privacy Officer at the address below.
Agency understands that medical information about you and your health is personal. Agency is committed to protecting medical information about you. Agency creates a record of the healthcare services and supplies you receive from Agency. Agency needs this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records generated and held by Agency regarding the healthcare services and supplies you receive. Your personal doctor will have different policies or notices regarding the doctor’s uses and disclosures of your medical information created in the doctor’s office or clinic. In addition, any hospital or clinic where you are treated will also have different policies or notices regarding the hospital’s or clinic’s uses and disclosures of your medical information created at the hospital or clinic.
This Notice will tell you about the ways in which Agency may use and disclose medical information about you. This Notice also describes your rights and certain obligations Agency has regarding the use and disclosure of medical information.
USES AND DISCLOSURES
The following categories describe different ways that Agency uses and discloses medical information. For each category of uses or disclosures Agency will explain what Agency means and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways Agency is permitted to use and disclose information will fall within one of the categories.
For Treatment. Agency may use medical information about you to provide you with healthcare services and supplies. Agency may disclose medical information about you to doctors, nurses, technicians and other Agency personnel who are involved in providing you with healthcare services and supplies. For example, a Pharmacist regarding your medications, a Laboratory regarding lab results, a Medical Supply company regarding equipment for your home, just to name a few. Agency also may disclose medical information about you to people outside Agency who may be involved in your medical care, such as hospitals, clinics, doctors, nurses, other home health care providers, family members involved in your care or other persons or organizations involved in your treatment.
For Payment. Agency may use and disclose medical information about you so that the healthcare services and supplies you receive from Agency may be billed to and payment may be collected from you, an insurance company or a third party. For example, Agency may need to give your health plan information about healthcare services and supplies you received from Agency so your health plan will pay Agency or reimburse you for the healthcare services and supplies. Agency may also tell your health plan about a healthcare service or supply you have been prescribed to obtain prior approval or to determine whether your plan will cover the healthcare service or supply. Agency may also disclose information about you to one of your other providers, so that they may bill for the services they have or will provide to you.
For Health Care Operations. Agency may use and disclose medical information about you for Agency’s operations. These uses and disclosures are necessary to run Agency and to make sure that all of our patients receive quality care. For example, Agency may use medical information to review our treatment and services and to evaluate the performance of our staff in responding to your needs. Agency may also combine medical information about many Agency patients to decide what additional services Agency should offer and what services are not needed. Agency may also disclose information to doctors, nurses, technicians and other Agency personnel for review and learning purposes. Agency may also combine the medical information Agency has with medical information from other healthcare providers to compare how Agency is doing and see where Agency can make improvements in the healthcare services and supplies Agency offers. Agency may remove certain information that identifies you (such as name, address (other than zip code), social security number, etc.) from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are. In that case, Agency will obtain a written agreement from the recipient of your medical information that the recipient will only use the information for healthcare operations purposes.
Emergencies and Barriers to Communications: We may make disclosures in the case of an emergency. We may also disclose your health information when there is a communication barrier if, using our professional judgment, we determine that you intend to allow the use or disclosure under the circumstances.
Appointment Reminders. Agency may use and disclose medical information to contact you as a reminder that you have an appointment with a home healthcare provider who will help you with the healthcare services and supplies you need.
Alternatives. Agency may use and disclose medical information to tell you about or recommend possible healthcare services and supplies options or alternatives that may be of interest to you.
Benefits and Services. Agency may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Family & Friends. Agency may release medical information about you to a friend or family member who is involved in your medical care. Agency may also give information to someone who helps pay for your care.
Research. Under certain circumstances, Agency may use and disclose medical information about you for research purposes. For example, clinical trials for new drugs or treatments. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before Agency uses or discloses medical information for research, the project will have been approved through this research approval process. However, Agency may disclose medical information about you to people preparing to conduct a research project, for example, diagnosis and medication information. In addition, Agency may disclose a limited amount of individually identifiable medical information about you for the purpose of research, so long as Agency receives a written assurance from the recipient that they will only use your medical information for research purposes. Agency will almost always ask for your specific permission if the researcher will have access to your name, address (other than zip code) or other information that reveals who you are, or will be involved in your care through Agency.
As Required By Law. Agency will disclose medical information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety. Agency may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
For FDA Activities. Agency may use or disclose medical information about you in relation to the quality, safety or effectiveness of a Food and Drug Administration regulated product or activity. For example, Agency may disclose your medical information to report adverse events or product recalls.
Genetic Testing Information: Under California law, if we keep genetic testing information about you, we will release that information only to the California state departments that monitor our work or if required by law to release that information. Otherwise, we will give out this information only if you give us your permission in writing.
Communicable Diseases: If you have a communicable disease, such as HIV/AIDS, we will provide that information to your health care provider, to providers engaged in organ procurement, or if required by law. For all other purposes, we will give out this information only with your permission.
Military and Veterans. If you are a member of the armed forces, Agency may release medical information about you as required by military command authorities. Agency may also release medical information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. Agency may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. Agency may disclose medical information about you for public health activities. These activities generally include the following: (i) to prevent or control disease, injury or disability; (ii) to report reactions to medications or problems with products; (iii) to notify people of recalls of products they may be using; (iv) to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or (v) to notify the appropriate government authority if Agency believe a patient has been the victim of abuse, neglect or domestic violence. Agency will only make this disclosure if you agree or when required or authorized by law.
In addition, Agency may remove certain information that identifies you (such as name, address (other than zip code), social security number, etc.) from this set of medical information so others may use it for public health purposes without learning who the specific patients are; Agency will obtain a written agreement from the recipient of your medical information that the recipient will only use the information for public health purposes.
Health Oversight Activities. Agency may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, Agency may disclose medical information about you in response to a court or administrative order. Agency may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. Agency may release medical information if asked to do so by a law enforcement official: (i) in response to a court order, subpoena, warrant, summons or similar process; (ii) to identify or locate a suspect, fugitive, material witness, or missing person; (iii) about the victim of a crime if, under certain limited circumstances, Agency is unable to obtain your agreement; (iv) about a death Agency believes may be the result of criminal conduct; (v) about criminal conduct at Agency; or (vi) in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. Agency may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities. Agency may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. Agency may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, Agency may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (i) for the institution to provide you with health care; (ii) to protect your health and safety or the health and safety of others; or (iii) for the safety and security of the correctional institution.
With Your Authorization: Other uses and disclosures of medical information not covered by this Notice or the laws that apply to Agency will be made only with your written permission. If you provide Agency permission to use or disclose medical information about you, by signing an authorization form, you may revoke that permission, in writing, at any time. If you revoke your permission, Agency will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that Agency is unable to take back any disclosures Agency has already made with your permission, and that Agency is required to retain our records of the healthcare services and supplies that Agency provided to you.
You have the following rights regarding medical information Agency maintains about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions about you, you must submit Agency’s Request for Access Form in writing at the following address: 5251 Office Park Dr.,Suite 400, Bakersfield CA 93309. This Form is available by writing to the Attention of the Privacy Officer at the address listed above or by calling 661- 395-5800. If you request a copy of the information, Agency may charge a fee for the costs of copying, mailing or other services and supplies associated with your request.
Agency may deny your request to inspect and copy your medical information in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by Agency will review your request and the denial. The person conducting the review will not be the person who denied your request. Agency will comply with the outcome of the review.
Right to Amend. If you feel that medical information Agency has about you is incorrect or incomplete, you may ask Agency to amend the information. You have the right to request an amendment for as long as the information is kept by or for Agency.
To request an amendment, you must submit Agency’s Request for Amendment Form in writing at the address below. This Form is available by writing to Attention Privacy Officer c/o Around the Clock 5251 Office Park Dr.,Suite 400 Bakersfield, CA 93309 or calling 661- 395-5800. In addition, you must provide a reason that supports your request.
Agency may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, Agency may deny your request if you ask Agency to amend information that: (i) was not created by Agency, unless the person or entity that created the information is no longer available to make the amendment; (ii) is not part of the medical information kept by or for the Agency; (iii) is not part of the information which you would be permitted to inspect and copy; or (iv) is accurate and complete.
Right to Submit Addendum. For California patients only, you have the right to submit a 250 word letter (i.e., “addendum”) to be added to your medical records indicating that you believe information in your medical record is incomplete or incorrect.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures Agency made of medical information about you. An accounting of disclosures will not include disclosures for treatment activities of Agency or other healthcare providers, disclosures for payment activities of Agency or other healthcare providers, disclosures for healthcare operation activities of Agency, disclosures made pursuant to your authorization, disclosures made prior to April 14, 2003, and certain other disclosures.
To request this list or accounting of disclosures, you must submit Agency’s Request for Accounting Form in writing at the address below. This Form is available by writing to Attention Privacy Officer c/o Around The Clock 5251 Office Park Drive #400Bakersfield, CA 93309 or calling 661-395-5800. The first accounting of disclosures list you request within a 12-month period will be free. For additional lists, Agency may charge you for the costs of providing the list. Agency will notify you of the cost involved and you may choose to withdraw or modify your request at that time before you have to pay anything.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information Agency uses or discloses about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information Agency discloses about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that Agency not use or disclose information about a healthcare service or supply you received.
Agency is not required to agree to your request. If Agency does agree, Agency will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must submit your request in writing to the address and number listed in this notice. Only the Privacy Officer of the Agency can approve a special restriction. In your request, you must tell Agency: (i) what information you want to limit; (ii) whether you want to limit Agency’s use, disclosure or both; and (iii) to whom you want the limits to apply (for example, disclosures to your spouse).
Right to Request Confidential Communications. You have the right to request that Agency communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that Agency only contact you at work or by mail.
To request confidential communications, you may submit your request in writing at the following address: Attention Privacy Officer c/o Around The Clock 5251 Office Park Drive #400Bakersfield, CA 93309 or calling 661-395-5800. Agency will not ask you the reason for your request. Agency will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. A copy of this notice will be left with you at the time of your initial visit. To obtain further copies of this Notice, you may write or call the Agency at the address and number listed in this notice.
QUESTIONS AND CONCERNS
If you have any questions about this Notice or concerns about your privacy, please feel free to contact us at the number and address below. If you believe your privacy rights have been violated, you may file a complaint with Agency or with the Secretary of the U.S. Department of Health and Human Services (DHHS). All complaints must be submitted in writing. You will not be penalized for filing a complaint. Please contact Agency at:
Around the Clock
5251 Office Park Dr.,Suite 400
Bakersfield, California 93309
Attention: Privacy Officer
To file a complaint with DHHS, write to: U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201.
CHANGES TO THIS NOTICE
Agency reserves the right to change this Notice. Agency reserves the right to make the revised or changed Notice effective for medical information Agency already has about you as well as any information Agency receives in the future. The Notice will contain on the first page, in the top right-hand corner, the effective date. You may request a copy of this Notice or an update of this Notice at any time.
Agency will seek to obtain your signed acknowledgement that you have received, read and understand this Notice. If Agency is unable to obtain your signature, Agency will make a notation in your medical records as to the reason why. It is your responsibility to fax or mail your signed acknowledgement to Agency at the address below.
Around the Clock Home Care
5251 Office Park Dr.,Suite 400
Bakersfield, California 93309
Attention: Privacy Officer