Greenbelt Home Care

HIPAA Notice of Information Practices

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

Protected Information. While receiving care from our agency, information regarding your medical history, treatment, and payment for your health care may be originated and/or received by us. Information which can be used to identify you and which relates to your medical care or your payment for medical care is protected by state and federal law (“Protected Information”).

Your Rights. Federal law grants you certain rights with respect to your Protected Information. Specifically, you have the right to:

Receive notice of our policies and procedures used to protect your Protected Information;

Request that certain uses and disclosures of your Protected Information be restricted; provided, however, we have the right to refuse your request;

Access to your Protected Information; provided, however, the request must be in writing and may be denied in certain limited situations;

Request that your Protected Information be amended;

Obtain an accounting of certain disclosures by us of your Protected Information for the past six years;

Revoke in writing any prior authorizations for use or disclosure of Protected Information, except to the extent that action has already been taken; and

Request communications of your Protected Information are done by reasonable alternative means or at alternative locations

Our Responsibilities. Federal law also imposes certain obligations and duties upon us with respect to your Protected Information. Specifically, we are required to:

Provide you with notice of our legal duties and our agency’s policies regarding the use and disclosure of your Protected Information;

Maintain the confidentiality of your Protected Information in accordance with state and federal law;

Review your requested restrictions regarding the use and disclosure of your Protected Information and inform you if these restrictions will be used;

Allow you to inspect and copy your Protected Information during our regular business hours pursuant to any legal restrictions;

Act on your request to amend Protected Information within sixty (60) days and notify you of any delay which would require us to extend the deadline by the permitted thirty (30) day extension. Although this does not guarantee that amendment is appropriate;

Accommodate reasonable request to communicate Protected Information by alternative means or methods; and

Abide by the terms of this notice.

How Your Protected Information May be Used and Disclosed. Generally, your Protected Information may be used and disclosed for treatment, payment or operations or as required by law. This includes a variety of areas:

Treatment Purposes: We may use or disclose your Protected Information for treatment purposes, including continuing care and case or care management. During your care by our agency, it may be necessary for various personnel, including, but not limited to, physicians, nurses, lab technicians, pharmacists or therapists, involved in your care to have access to your Protected Information in order to provide you with quality care. For example, your physician may need to know which medications you are currently taking before prescribing additional medications. It may be necessary for the physician to inform the nurses of the medications you are taking so they can administer the medications and/or monitor any possible side effects.

Situations may also arise when it is necessary to disclose your Protected Information to individuals outside our agency who may also be involved in your current or future care. For example, if you are a resident in an assisted living facility, it may be necessary for your physician to disclose medications prescribed by him/her so that they can be appropriately monitored by the nursing staff. The assisted living facility may disclose information to the hospital if admission is required, or to a specialist. Your physician may call a pharmacist and order a prescription.

Payment Purposes. Your Protected Information may also be used or disclosed for payment purposes. It is necessary for us to use or disclose Protected Information so that treatment and services provided by us may be billed and collected from you, your insurance company, or other third party payor. Bills requesting payment will usually include information which identifies you, your diagnosis, and any procedures or supplies used. It may also be necessary to release Protected Information to obtain prior approval for treatment from your health insurance.

Health Care Operations. Your Protected Information may be used for agency operations, which are necessary to ensure our agency provides the highest quality of care. For example, your Protected Information may be used for learning or quality assurance purposes. We may also remove information which could identify you from your record so as to prevent others from learning who the specific patients are.

Emergency Use. If an emergency situation exists, and providing you with this notice is not practicable, we may use or disclose Protected Information to the extent necessary during the emergency.

Notification. Unless you have informed us otherwise, your Protected Information may be used or disclosed by us to notify or assist in notifying you, a family member, or other person responsible for your care. This may include appointment reminders such as postcards. In most cases, Protected Information disclosed for notification purposes will be limited to your name, location and general condition.

Communication with Family Members and Caregivers. With your permission, we will release Protected Information to a family member, relative or close personal friend who is involved in your care to the extent necessary for them to participate in your care.

Marketing and Fundraising Activities. We may use your Protected Information for the purpose of contacting you regarding health-related benefits and services we feel may be of interest to you. In addition, you may also be contacted as part of a fund-raising effort. You may decline to receive information of this type.

Research Purposes. In some instances, your Protected Information may be used or disclosed for research purposes. All research projects which use Protected Information are subject to a special approval process which will, among other things, evaluate the precautions used to protect patient medical information. In some cases, information which identifies you as the patient will be removed.

Special Circumstances. The law specifically requires us to use or disclose Protected Information in the following special circumstances:

Public Health Activities. We are required to use or disclose your Protected Information for public health activities and purposes. Examples of public health activities which would warrant the use or disclosure of your Protected Information include:

Preventing or controlling disease, injury or disability;

Reporting births or deaths;

Reporting the abuse or neglect of a child or dependent adult;

Reporting reactions to medications or problems with products; or

Notifying individuals exposed to a disease who may be at risk for contracting or spreading the disease.

Health Oversight Activities. Your Protected Information may be used or disclosed to a health oversight agency for activities authorized by law. Examples of health oversight activities include audits, investigations, inspections, or judicial/administrative proceedings which you are not the subject of. In most cases, the oversight activity will be for the purpose of overseeing the care rendered by our facility or our facility’s compliance with certain laws and regulations.

Judicial and Administrative Proceedings. If you are involved in a lawsuit or other administrative proceeding, we may release your Protected Information in response to a court or administrative order requesting the release. In some instances, we may also release Protected Information pursuant to a subpoena or discovery request but only if efforts have been made by the requestor to provide you with notice of the request and you have failed to object or the objection was resolved in favor of disclosure, or in the alternative, the requestor has obtained a protective order protecting the requested information.

Victims of Abuse or Neglect. Other than child and dependent adult abuse which is covered under public health activities, we may use or disclose your Protected Information to a protective services or social services agency or other similar government authority, if we reasonable believe you have been the victim of abuse, neglect or domestic violence as long as you agree to such disclosure and we feel it is necessary to prevent serious harm to you or other individuals. If you are incapacitated and unable to agree to such a disclosure, we may release your Protected Information for this purpose but only if failure to release it would materially and adversely affect a law enforcement activity and the information will not be used, in any way, against you.

Law Enforcement. We may also release your Protected Information to a law enforcement official for the following purposes:

Pursuant to a court order, warrant, subpoena/summons, or administrative request;

Identifying or locating a suspect, fugitive, material witness or missing person;

Regarding a crime victim, but only if the victim consents or the victim is unable to consent due to incapacity and the information is needed to determine if a crime has occurred, non-disclosure would significantly hinder the investigation, and disclosure is in the victim’s best interest.

Regarding a decedent, to alert law enforcement that the individual’s death was caused by suspected criminal conduct; or

By emergency care personnel if the information is necessary to alert law enforcement of a crime, the location of a crime, or characteristics of the perpetrator.

Coroner, Medical Examiners, Funeral Homes. Protected Information regarding a decedent may be released to a coroner or medical examiner for the purpose of identifying a deceased person, determining cause of death or other duties as authorized by law. Protected Information regarding a decedent may also be disclosed to funeral directors if necessary to carry out their duties.

Specialized Government Functions. Your Protected Information may be used or disclosed for a variety of government functions subject to some limitations. These government functions include:

Military and veterans activities;

National security and intelligence activities;

Protective service of the President and others;

Medical suitability determinations for Department of State officials;

Correctional institutions and law enforcement custodial situations; or

Provision of public benefits.

Organ Donation. Your Protected Information may be used or disclosed by us to entities engaged in the procurement, banking or transplantation or organs, eyes or tissues for the purpose of facilitating such donation and transplantation.

Workers’ Compensation. We will disclose your Protected Information and to the extent necessary to comply with laws relating to workers’ compensation or other programs providing benefits for work-related injuries or illness without regard to fault.

Inmates. If you are an inmate of a State or Federal institution or under the custody of law enforcement, we may release medical information about you to the institution, law enforcement official or court, if this release is necessary:

For the institution to provide you with healthcare;

To protect your health and safety, and/or the health safety of others; or

For the safety and security of the correctional institution or agency.

Important Contact Information. This notice has been provided to you as a summary of how we will use your Protected Information and your rights with respect to your Protected Information. If you have any questions or for more information regarding your Protected Information, please contact Greenbelt Home Care at (641) 939-8444.

If you believe your privacy rights have been violated, you may file a complaint with our office by contacting Sheryl Kennedy at (641) 939-8444. You may also file a complaint with the Secretary of Health and Human Services. There will be no retaliation for the filing of a complaint.

Effective Date and Revisions. This notice becomes effective on or after April 14, 2003. Please note, we reserve the right to revise this notice at any time. Should we revise this notice, that revised notice will be posted at Greenbelt Home Care office. In addition, a current copy of our notice of privacy practices may be obtained from Greenbelt Home Care, 1506 Edgington Avenue, Eldora, Iowa 50627.