NOTICE OF PRIVACY PRACTICESEach Home Instead Senior Care franchise office is independently owned and operatedTHIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY OR WILL BE USED OR DISCLOSED BY HOME INSTEAD SENIOR CARE, AND HOW YOU CAN OBTAIN ACCESS TO YOUR HEALTH INFORMATION RECORDS. PLEASE READ THIS NOTICE CAREFULLY.
USE AND DISCLOSURE OF HEALTH INFORMATION: We may use your health information, that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting our home care operations. We have established a policy to guard against unnecessary disclosure of your health information.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH, AND THE PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY OR WILL BE USED OR DISCLOSED: TO PROVIDE TREATMENT: We may use or disclose your health information internally to coordinate your home care and to other professionals involved with your care, such as your attending physician and other health care professionals who assist in coordinating your care, as well as to others involved in your care including family members, pharmacists, suppliers of medical equipment, emergency response personnel or other health care practitioners.
TO OBTAIN PAYMENT: We may include your health information in our Invoices to collect payment for the home care services that you receive from third parties such as a long-term care insurer.
TO CONDUCT HOME CARE OPERATIONS/OVERSIGHT: We may use and disclose health information for our own operations in order to assure that we provide quality care to all of our home care client’s, as well as for: case management and care coordination; training; accreditation, certification and licensing; professional review and performance evaluation; or as required to licensing and/or regulatory authorities for oversight activities including audits, investigations, inspections, licensure or disciplinary actions.
FOR APPOINTMENT REMINDERS: We may use and disclose your health information to contact you as a reminder that you have an appointment for a home care or physician’s visit.
FOR TREATMENT AND/OR H OME CARE ALTERNATIVES: We may use and disclose your health information to tell you about or recommend possible treatment options and/or home care alternatives that may be of interest to you.
WHEN LEGALLY REQUIRED, PERMITTED OR AUTHORIZED: We will disclose your health information to law enforcement officials and regulatory authorities, or as otherwise required, permitted or authorized by any Federal, State or local law; or as required in the course of any administrative or judicial proceeding in response to an order, subpoena or discovery demand; or as required to notify government authorities of abuse, neglect or domestic violence; or as required for the purpose of determining the cause of your death; or as authorized for specific governmental functions relating to military and veterans affairs, national security, intelligence activities or protective services; or as required for worker’s compensation or disability purposes.
WHEN THERE IS A RISK TO PUBLIC HEALTH OR SAFETY: We will disclose your health information to prevent, report or control disease, injury or disability, or as necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health or safety of the public.
FOR SPECIFIED GOVERNMENTAL FUNCTIONS: We may disclose your health information as authorized to facilitate specified government functions relating to military and veterans, national security, intelligence activities and protective services.
YOU HAVE THE FOLLOWING RIGHTS REGARDING YOUR HEALTH INFORMATION: RIGHT TO REQUEST RESTRICTIONS: You may request that we limit the disclosure of your health information to someone involved in and/or responsible for the payment of your care. We are not required to agree to your request.
NOTICE OF PRIVACY PRACTICESEach Home Instead Senior Care franchise office is independently owned and operated
RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATIONS: You may request that we only communicate with you regarding your health information confidentially in private with no family members present. We will not ask that you provide any reason(s) for such a request and we will attempt to honor any such reasonable request for confidential communications.
RIGHT TO INSPECT AND COPY YOUR HEALTH INFORMATION: You have the right to inspect and copy your health information, including billing records. We may charge a reasonable fee for copying and assembling costs associated with any such request.
RIGHT TO AMEND YOUR HEALTH INFORMATION RECORDS: You or your representative may request that we amend your health information if the records that we create are incorrect or incomplete. Any request to amend your health information records must be made in writing. We may deny the request if it is not in writing or does not include a reason for the amendment. The request may also be denied if we did not create the records containing your health information, if the records you are requesting are not part of our records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in our opinion, the records containing your health information are accurate and complete.
RIGHT TO AN ACCOUNTING: You or your representative has the right to request an accounting of our disclosures of your health information, including reasons for such disclosures if related to public purposes or if required, authorized or permitted by law. The request for accounting must be made in writing. The request should specify the time period for the accounting starting no earlier than April 14, 2003, and the request may not be made for periods of time in excess of six (6) years. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests will be subject to a reasonable cost-based fee.
RIGHT TO A PAPER COPY OF THIS NOTICE: You or your representative has a right to a separate paper copy of this Notice or Privacy Practices at any time even if you or your representative have received this Notice previously. A copy of our current Notice of Privacy Practices is also available on our website at www.homeinstead.com/322.
TO EXERCISE ANY OF THE ABOVE RIGHTS, OR TO OBTAIN ADDITIONAL INFORMATION, PLEASE CONTACT OUR PRIVACY OFFICER, Steve Sussman, Executive Director, SNS,LLC dba Home Instead Senior Care AT (973)446-5447.
OUR DUTIES AND RESPONSIBILITIES: We are required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of Privacy Practices. We are required to abide by the terms of this Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that we subsequently maintain. If we change this Notice, we will provide the revisions to you or your appointed representative. You or your representative have the right to express complaints to us or the Agency and/or to the Secretary of United States Department of Health and Human Services if you or your representative contend that your privacy rights have been violated. Any complaint to us should be made in writing to our Privacy Officer, Steve Sussman, at Home Instead Senior Care 109 Main St. #3 Succasunna, NJ 07876. We encourage you to express any concerns that you may have regarding the privacy of your health information. You will not be retaliated against in any way for expressing such concerns or for filing a complaint. OUR CONTACT PERSON: We have designated our Privacy Officer, Steve Sussman, as our contact person for all issues regarding your privacy and your rights. You may contact Steve Sussman in writing at Home Instead Senior Care 109 Main St. #3 Succasunna, NJ 07876, or by e-mail at email@example.com, or by telephone at (973)446-5447. EFFECTIVE DATE: This Notice of Privacy Practices is effective as of ____________________.
Each Home Instead Senior Care franchise office is independently owned and operated