NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
OUR LEGAL DUTY
We are required by applicable Federal and State law to maintain the privacy of your health information. We are also
required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect April 14, 2003, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. If we make significant changes in our privacy practices, we will notify our consumers of those changes.
You may request a copy of our Notice at any time. For more information about our privacy practices or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and healthcare operations.
Treatment:
We may use or disclose your health information to a physician or other healthcare provider providing treatment to you. For example, we may need to disclose health information, such as your medical history to another provider we are referring you to. This could be for the purpose of coordinating your care or scheduling necessary services.
Payment:
We may use and disclose your health information to obtain payment for services we provide to you. For example, we may provide certain portions of your health information to Medicaid in order to get paid for your treatment and/or services.
Healthcare Operations:
We may use and disclose your health information in connection with our healthcare operations. We may need to use your health information to evaluate the quality of the service you have received from our staff. Healthcare operations include quality assurance and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
We may use or disclose your protected health information in the following situations without your authorization.
Required by Law:
We may use or disclose your health information when we are required to do so by law. When a disclosure is required by Federal, State, or local law, in Judicial or Administrative Proceedings, or by Law Enforcement. For example, we may disclose your information if ordered by a court or if the law requires reporting of that type of information to a government agency or law enforcement agency.
Abuse or Neglect:
We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, or neglect, or domestic violence or the possible victim of other crimes.
Public Health:
We are required by law to report information about certain diseases and about any deaths, to government agencies that collect that information. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
Health Oversight:
We will need to provide your health information if requested to do so by a County or State when they oversee the program in which you receive care. We will also need to provide information to government agencies that have the right to inspect our offices and or investigate health care practices.
National Security:
We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counter intelligence, and other national security activities. We may disclose to a correctional institution or law enforcement official having lawful custody of protected health information of an inmate or consumer under certain circumstances.
Death and Organ Donation:
We may disclose the medical information of a deceased person to a coroner, medical examiner, funeral director, or organ procurement organization for certain purposes.
Worker's Compensation:
We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to Worker's Compensation or other similar programs established by law.
Required Uses and Disclosures:
We must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance.
To Your Family and Friends:
We must disclose your health information to you, as described in the Consumer Rights section of this Notice. If you agree that we may do so, we may disclose your health information to a family member, friend, or other person to the extent necessary to help with your healthcare or with payment to your healthcare provider.
Persons Involved in Care:
We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the persons involved in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x- rays, or other similar forms of health information.
We may contact you to provide appointment reminders.
We may use or disclose Protected Health Information to contact you to provide a reminder to you about an appointment you have for service or medical care.
Marketing:
We may contact you with information about treatment, services, or products. We may use or disclose Protected Health Information to manage or coordinate your healthcare. This may include telling you about treatment, services or products. For example, if you are diagnosed with diabetes we may tell you about nutritional and other counseling services that may be of interest to you.
Fundraising:
We may contact you as part of a fundraising effort. We will limit our use and disclosure of your demographic information and the dates of your service. We may disclose this information and the dates of your health care. We may disclose this information to a business associate or foundation as part of our fundraising activities.
Your Authorization:
For uses and disclosures other than for treatment, payment or healthcare operations, and those listed above, you may give us your authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice. You may also authorize us to share information with certain individuals who assist in or who are responsible for your care.
YOUR CONSUMER RIGHTS
Access:
You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this Notice. You may also request access by sending us a letter to the address at the end of this Notice. If you request copies, we will charge you the prevailing fee allowed by law for copying and for staff time to locate and copy your health information, and postage if you want the copies mailed to you. If you request an alternative format, we will charge a cost-based fee for providing your health information in that format. If you prefer, we will prepare a summary or an explanation of your health information for a fee. Contact us using the information listed at the end of this Notice for a full explanation of our fee structure.
Disclosure Accounting:
You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years, but not before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
Restriction:
You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
Alternative Communication:
You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. For example, you may prefer to communicate with us via email or you may prefer to have us call you at work. Your request must be in writing. You must specify the alternative means or location and tell us how payments will be handled under the alternative communication plan you request.
Amendment:
You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.
Electronic Notice:
If you receive this Notice on our web site or by electronic mail (email), you are entitled to receive this Notice in written form.
_________________________ QUESTIONS AND COMPLAINTS___________________________
If you have questions or concerns regarding the privacy of your health information, or if you believe that we have violated your privacy rights, or you disagree with any decision we made in response to a request you made to access, amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice.
You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Elizabeth A. Burgwin, Privacy Officer
Southwestern Pennsylvania Area Agency on Aging
305 Chamber Plaza
Charleroi, PA 15022-1607
Tel: 724 489-8080 ext 4424
Fax: 724 483-9360
Email: burgwin@swpa-aaa.org
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