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Health
Insurance Portability &
Accountability Act (HIPAA) Compliance Plan
Notice of Privacy Practices
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 of
Privacy Practices describes how National Home Care Health Agency (NHC)
may use or disclose your protected health information, with whom
that information may be shared, and the safeguards we have in place
to protect it. It also describes your rights to access and control
your protected health information.
A protected
health information is information about you, including demographic
information, that may identify you and that relates to your past,
present or future physical or mental health or condition and
comparable health care services.
National Home Care
Health Agency (NHC) is required to abide by the terms of this Notice
of Privacy Practices. We may change the terms of our notice, at any
time. The new notice will be effective for all protected health
information that we maintain at that time. Upon your request, we
will provide you with any revised Notice of Privacy Practices by:
accessing our website,
http://www.nationalhomecare.net
or calling the office and requesting that a revised copy be sent to
you in the mail; or asking for one at the time of your next
appointment.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE
You will be asked
to sign an acknowledgment of receipt of this notice. Our intent is
to make you aware of the possible uses and disclosures of your
protected health information and your privacy rights. The delivery
of your services will in no way depend on your signed
acknowledgment. If you decline to sign an acknowledgment, we will
continue to provide our services. We can and will also use and
disclose your protected health information for provision, payment,
and reporting of services, when necessary.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following
are examples of permitted uses and disclosures of your protected
health care information. These examples are not meant to be
exhaustive.
Required Uses
and Disclosures: By law, we must make disclosures to you
unless it has been determined by a competent medical authority that
it would be harmful to you. We must also disclose health
information when required by the Secretary of the Department of
Health and Human Services to investigate or determine our compliance
with the requirements of Section 164.500 et. seq.
Treatment:
We will use and disclose your protected health information to
provide, coordinate, or manage your health care and any related
services. This includes the coordination or management of your
health care with a third party. For example, we would disclose your
protected health information, as necessary, to an insurance company
that pays for services provided to you. We will also disclose
protected health information to other associates who may be involved
in providing your services.
Payment:
Your protected health information will be used, as needed, to
obtain payment for your health care services. This may include
certain activities that NHC might undertake for health care services
we provide for you such as: making a determination of eligibility or
coverage; reviewing services provided to you for medical necessity;
and undertaking utilization review activities. For example, your
protected health information might be disclosed to a business
associate to arrange payment for respite services.
Healthcare
Operations: We may use or disclose, as‑needed, your
protected health information to support the daily activities related
to healthcare. These activities include, but are not limited to:
quality assessment activities; investigations; communications about
a service; conducting or arranging for other healthcare related
activities; and care coordination.
We will share your
protected health information with third party business associates
that perform various activities for NHC. The business associates
will also be required to protect your health information.
We may use or
disclose your protected health information, as necessary, to provide
you with appointment reminders or other health‑related benefits and
services that may be of interest to you. For example, your name and
address may be used to send you a newsletter about our nonprofit
organization and the services we offer.
Others
Involved in Your Healthcare: We may disclose to a family
member, caregiver, a close friend or any other person you identify,
your protected health information that directly relates to that
person’s involvement in your health care. We may use or disclose
protected health information to notify or assist in notifying a
family member, personal representative or any other person who is
responsible for your care of your location, general condition or
death. Finally, we may use or disclose your protected health
information to an authorized public or private entity to assist in
disaster relief efforts and to coordinate uses and disclosures to
family or other individuals involved in your health care. If there
is a family member, other relative, or close friend to whom you do
not want us to disclose your protected health information, please
notify National Home Care.
Required By
Law: We may use or disclose your protected health
information to the extent that the use or disclosure is required by
law. The use or disclosure will be made in compliance with the law
and will be limited to the relevant requirements of the law.
Public
Health: We may disclose your protected health information to
a public health authority that is permitted by law to collect or
receive the information. The disclosure will be made for the purpose
of controlling disease, injury or disability. National Home Care
may disclose your protected health information, if authorized by
law, to a person, who may have been exposed to a communicable
disease, or may otherwise be at risk of contracting or spreading the
disease or condition. In addition, we may disclose your
protected health information, if we believe that you have been a
victim of abuse, neglect or domestic violence, to the governmental
entity or agency authorized to receive such information. In this
case, the disclosure will be made consistent with the requirements
of applicable federal and state laws.
Health
Oversight: National Home Care may disclose protected health
information to a health oversight agency for activities authorized
by law, such as audits, investigations, and inspections. Oversight
agencies, seeking this information, include government agencies that
oversee the health care system, government benefit programs, other
government regulatory programs and civil rights laws.
Legal
Proceedings: We may disclose protected health information in
the course of any judicial or administrative proceeding, in response
to an order of a court or administrative tribunal (to the extent
such disclosure is expressly authorized), and/or in certain
conditions in response to a subpoena, discovery request, or other
lawful process.
Law
Enforcement: We may disclose protected health information
for law enforcement purposes. These law enforcement purposes
include: (1) legal processes required by law; (2) information
requests for identification and location purposes; (3) issues
pertaining to victims of a crime; (4) suspicion that death has
occurred as a result of criminal conduct; and (5) in the event, that
a crime occurs on the premises of NHC.
Research:
We may disclose your protected health information to researchers
when their study has been approved by an institutional review board
that has reviewed the research proposal and established protocols to
ensure the privacy of your protected health information.
Criminal
Activity: Consistent with applicable federal and state laws,
we may disclose your protected health information, if we believe
that the use or disclosure is necessary to prevent or lessen a
serious and imminent threat to the health or safety of a person or
the public. We may also disclose protected health information if it
is necessary for law enforcement authorities to identify or
apprehend an individual.
Military
Activity and National Security: When the appropriate
conditions apply, National Home Care may use or disclose protected
health information of individuals who are Armed Forces Personnel:
(1) for activities deemed necessary by appropriate military command
authorities; (2) for the purpose of a determination by the
Department of Veterans Affairs of your eligibility for benefits; or
(3) to foreign military authority if you are a member of that
foreign military services. We may also disclose your protected
health information to authorized federal officials for conducting
national security and intelligence activities, including for the
provision of protective services to the President or others legally
authorized.
YOUR RIGHTS
REGARDING YOUR
PROTECTED HEALTH INFORMATION
Following is a
statement of your rights with respect to your protected health
information and a brief description of how you may exercise these
rights.
You have the
right to inspect and copy your protected health information.
This means you may inspect and obtain a copy of protected health
information about you that is contained in your client record for as
long as we maintain the data. A client record contains medical,
financial and service information and any other information
necessary to provide services to you.
Under certain
circumstances, such as protected health information that is subject
to law prohibiting access, you may be denied access to protected
health information. Depending on the circumstances, a decision to
deny access may be reviewed. In some circumstances, you may have a
right to have this decision reviewed. Please contact our Privacy
Contact if you have questions about access to your client record.
You have the
right to request a restriction of your protected health information.
This means you may ask National Home Care not to use or
disclose any part of your protected health information. We will
consider all requests for restrictions carefully, but are not
required to agree to any restrictions.
You must request a
restriction in writing to the NHC Privacy Contact. In your request,
you must tell us: (1) what information you want restricted; (2)
whether you want us to restrict our use, disclosure, or both; (3) to
whom you want the restriction to apply, for example, disclosure to
family members or friends who may be involved in your care; and (4)
an expiration date.
If we believe it is
in your best interest to permit use and disclosure of your protected
health information, your protected health information will not be
restricted. If NHC does agree to the requested restriction, we may
not use or disclose your protected health information in violation
of that restriction unless it is needed to provide emergency
treatment.
You may revoke a
previously agreed upon restriction, in writing, at any time.
You have the
right to request confidential communications. We will
accommodate reasonable requests. We will not request an explanation
from you as to the basis for the request. Please make this request
in writing to our Privacy Contact.
You may have
the right to have us amend your protected health information.
If you believe that the information we have about you is incorrect
or incomplete, you may request an amendment to your protected health
information as long as we maintain this information. While we will
accept requests for amendment, we are not required to agree to the
amendment.
You have the
right to receive an accounting of certain disclosures we have made,
if any, of your protected health information. This right
applies to disclosures for purposes other than treatment, payment or
healthcare operations as described in this Notice of Privacy
Practices. It excludes disclosures we may have made to you, to
family members or friends involved in your care, or for notification
purposes. You have the right to receive specific information
regarding these disclosures that occurred after April 1, 2003. You
may request a shorter timeframe. The right to receive this
information is subject to certain exceptions, restrictions and
limitations.
You have the
right to obtain a paper copy of this notice from us, upon
request, even if you have agreed to accept this information
electronically. To obtain a paper copy, send your written request to
National Home Care Administrator, or visit our website at
http://www.nationalhomecare.net
COMPLAINTS
You may complain to
National Home Care or to the Secretary of Health and Human Services
if you believe your privacy rights have been violated by us. You may
file a complaint with us by notifying our Administrator of your
complaint. We will not retaliate against you for filing a complaint.
CONTACT
INFORMATION
You may contact
National Home Care Administrator for further information about the
complaint process, or for further explanation of this document at:
National Home Care
9900 Stirling Road
Cooper City, FL 33024
Phone: (954) 450-0499
Fax: (954) 450-1430
This notice was
published and became effective on April 1, 2003.
CONSENT FOR PURPOSES OF TREATMENT,
PAYMENT AND HEALTHCARE OPERATIONS
I consent to the use or disclosure
of my protected health information by National Home Care (NHC) for
the purpose of making referrals on my behalf, carry out treatment to
me, or obtaining payment for my health care bills. I understand
that referrals or treatment of me may be conditioned upon my consent
as evidenced by my signature on this document.
I understand I have the right to
request a restriction as to how my protected health information is
used or disclosed to make referrals, carry out treatment, or
payment. NHC is not required to agree to the restrictions that I
may request. However, NHC agrees to a restriction that I request,
the restriction is binding.
I have the right to revoke this
consent, in writing, at any time, except to the extent that NHC has
taken action in reliance on this consent.
My "protected health information"
means health information, including my demographic information,
collected from me and created or received by NHC or another aging
network provider. This protected health information relates to my
past, present or future physical or mental health or condition and
identifies me, or there is a reasonable basis to believe the
information may identify me.
I understand I have a right to
review NHC’s Notice of Privacy Practices prior to signing this
document. National Home Care‘s Notice of Privacy Practices has been
provided to me. The Notice of Privacy Practices describes the types
of uses and disclosures of my protected health information that will
occur in my treatment, payment of my bills or in the performance of
health care operations of NHC. The Notice of Privacy Practices for
National Home Care is also provided National Home Care office
bulletin board and on the NHC website at
http://www.nationalhomecare.net
This Notice of Privacy Practices
also describes my rights and NHC’s duties with respect to my
protected health information.
National Home Care reserves the
right to change the privacy practices that are described in the
Notice of Privacy Practices. I may obtain a revised notice of
privacy practices by accessing NHC’s website, calling the office and
requesting a revised copy be sent in the mail or asking for one at
the time of my next appointment.
______________________________________
Signature of
Client or Personal Representative
______________________________________
Name of Client
or Personal Representative
___________________________
Date
___________________________________________________
Description of
Personal Representative’s Authority
ACKNOWLEDGMENT OF RECEIPT
NATIONAL HOME CARE
NOTICE OF
PRIVACY PRACTICES
I,
____________________________________________________________
(First name, middle
initial, last name)
[Please Print]
have received a copy of
NATIONAL HOME CARE NOTICE OF
PRIVACY PRACTICES. I acknowledge that I have read and understand
the Notice and my rights, as outlined therein. I have been given
the opportunity to ask questions which have been answered to my
satisfaction.
________________________________________ ______________
(Signature of client or authorized representative) (Date)
______________________________
(Date of Birth)
The purpose of this document is to
acknowledge your receipt of the Notice of Privacy Practices of
National Home Care
as required by Section 164.520 of
the federal Health Insurance Portability and Accountability Act
(HIPAA.) The delivery of your services is in no way dependent on
you signing this acknowledgment. If you decline to sign this
acknowledgment, we will continue to provide your services. If
you have any questions about the purpose of the Notice of Privacy
Practices or what is contained in it, please contact
National Home Care
Administrator at (954) 450-0499 or
by mail at the address below.
Please sign this Acknowledgment
of Receipt of the Notice of Privacy Practices and mail the
original to the address below. Keep a copy for your files.
National Home
Care
9900 Stirling Road
Cooper City, FL 33024
Phone: (954) 450-0499
Fax: (954) 450-1430 |
