ANS Home Health Services, Inc.
|
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. |
As your home health care agency, ANS Home Health Services maintains documentation for each visit from each health care provider that visits you. This documentation typically includes your health history, current symptoms, examination and test results, diagnoses, treatment/cares provided, and a plan for future care or treatment. This documentation makes up your health care record. Your health care record is used for many purposes, such as:
§ Basis for planning your care and treatment
§ Means of communication among the health care providers who contribute to your care
§ Legal document describing the care you received
§ Means for verification that you actually received the services billed for
§ A tool in medical education
§ A source of data for agency planning
§ A tool to assess the appropriateness and quality of care you received and
§ A tool to improve the quality of care we provide
ANS Home Health Services must maintain the privacy of your health care information and give you notice of our legal duties and privacy practices regarding your personal health information. We are required to follow the practices specified in this notice.
We reserve the right to change our privacy practices and to make the new practices effective for all health information we maintain. If changes are made, you will receive a copy of the revised notice and the revised notice will be posted on our website.
We will not use or disclose your
health information without your authorization, except as described below:
§
We will use and disclose your health information
for treatment. This includes
providing, coordinating, and managing your health care and related services. Example: Your homecare nurse will talk to your
physician when there is a change in your condition to receive orders to change
treatment or frequency of visits.
Example: A hospital will give patient information to
our agency when giving us a referral to admit the patient for home care
services.
§
We will use and disclose your health information
to obtain payment for services. This includes determining eligibility or
coverage, billing for services rendered, collection, review of services for
medical necessity, coverage, and appropriateness of care.
Example: Our agency may disclose information to a
payer to determine if the patient meets the requirements for coverage.
Example: Our agency may disclose information to a
managed care case manager to obtain pre-authorization to provide services.
Example: Our agency may send a bill to your insurance
company that identifies you, your diagnosis, and treatment provided to you.
§
We will use and disclose your health information
for health care operations. This
includes general administrative duties of the agency, quality assessment and
performance improvement activities, certification and licensing activities,
medical review, auditing, and business planning activities.
Example: Our agency may share information with the
surveyor during a survey for state licensure.
Example: Our agency may provide patient information to
staff participating in the review of clinical records.
There are some services provided in our agency through contracts with business associates. Examples include Physical Therapy services and collection agencies. When these services are contracted, we may disclose your health information to our business associate so they can perform the job we have asked them to do. We do require our business associates to safeguard your information.
§
We will use and disclose your health information
in other circumstances without your authorization. These circumstances include:
o
When the use/disclosure is required or permitted
by law. There are instances we must
report some of your health information to legal authorities, such as law
enforcement officials, court officials, or government agencies.
o
When the use/disclosure is necessary for public
health activities. We are required to
disclose health information about you if you have been exposed to a
communicable disease or may otherwise be at risk of contracting or spreading a
disease or condition.
o
When the use/disclosure relates to victims of
abuse, neglect or domestic violence.
o
When the use/disclosure is for health oversight
activities. By written request of a
state/federal government agency performing legally authorized functions such as
management audits, financial audits, and program monitoring we will release
information. Private pay patients may
deny access for these purposes.
o
When the use/disclosure is for judicial and
administrative proceedings, such as in response to an order of a court.
o
When the use/disclosure is for law enforcement
purposes, such as reporting certain types of wounds or injuries, or if there is
a good faith belief the disclosure is necessary to prevent or lessen a serious,
imminent threat to the safety of a person or the public.
o
When the use/disclosure is related to death,
such as disclosing your health information to coroners, medical examiner and
funeral directors so they can carry out their duties related to your death.
o
When the use/disclosure is related to cadaveric
organ, eye, or tissue donation purposes.
o
When the use/disclosure relates to medical
research. Under certain circumstances,
we may disclose information about you for medical research.
o
When the use/disclosure relates to military,
national security, or incarceration/law enforcement custody purposes. We may disclose information about you for
military activities, national security and intelligence activities, and for
protective services to the President of the United States. We may disclose information about you to a
correctional institution having lawful custody of you.
o
When the use/disclosure relates to workers’
compensation. We may disclose your
health information, as appropriate, to comply with the laws related to workers’
compensation or other similar programs established by law.
Unless you object, we may use/disclose your health information in the following circumstances:
§ We will use information about you to contact you or your caregiver to provide reminders about home visits, treatment alternatives, or other health-related benefits that may be of interest to you.
§
We will use and disclose your health information
to those involved with your care or payment of your care. If people such as family members, relatives,
or a close personal friend/neighbor are helping to care for you or are helping
to pay for your care, we may release important health information about you to
those people using our best professional judgment in making such
decisions. The information released must
be relevant to the person’s involvement in your care. You have the right to object to such
disclosure, unless you are unable to function or there is an emergency.
§
We may disclose information about you to a
public or private agency (i.e. Red Cross) for disaster relief purposes. Even if you object, we may still share the
information about you in an emergency situation.
If you would like to object to our use/disclosure of your health information in the above circumstances, please call or contact the Health Information Administrator.
NOTE: Except for the purposes listed above, we
must obtain your specific written authorization for any other release of your
health information.
If you sign a written authorization allowing us to disclose health information about you, you can cancel the authorization at any time, as long as the cancellation is in writing. Please submit your written cancellations to the Health Information Administrator. The cancellation will not apply to any releases you authorized that we took action on before we received your cancellation.
Your Rights
Your health care record is the physical property of ANS Home Health Services. The information within the record, however, belongs to you. You have the following rights regarding your health information. If you wish to exercise any of these rights, please contact the Health Information Administrator at 414 481-9800. You have the right to:
§ Request restrictions on certain uses and disclosures. You have the right to ask for restrictions on how your health information is used or to whom we disclose your information to. We are not required to agree to your requested restrictions and in some situations; your restrictions may not be followed (i.e. emergency situations, disclosures to the Secretary of the Department of Health and Human Services, etc.)
§
Request different ways to communicate with you
regarding confidential health information.
§
Inspect and copy your health information. With a few exceptions, you have the right to
inspect and receive a copy of your health information. Your request to receive a copy should be in
writing. We may charge you a reasonable
fee if you want a copy of your health information.
§
Request to amend your health information. If you think your health information is not
correct or is incomplete, you may ask us to amend the information. The request must be in writing and should
explain your reason(s) for the amendment.
If we did not create the health information that you believe is
incorrect, or if we disagree with you and believe your health information is
correct, we may deny your request. If we
accept your request to amend the information, we will include the amendment
with any subsequent authorized release of information.
§
Receive a listing of disclosures of your health
information made by our agency. The
request to receive a listing of disclosures should be written. You may ask for disclosures made during the
previous six years, although the request cannot include disclosures made before
April 14, 2003. The listing will not
include disclosures made to you, or for purposes of treatment, payment, health
care operations, law enforcement/corrections, national security, and health
oversight activities.
§
Receive a paper copy of this notice. You have the right to request a copy of this
notice at any time, although we will provide you with a copy of this notice no
later than the date you first receive service from us.
§
Complain.
If you think your privacy rights have been violated, or you want to
complain to us about our privacy practices, you can file a complaint with us.
You may also send a written complaint to the United States Secretary of the Department of Health and Human Services.
To file a complaint with either entity, please contact the Health Information Administrator, who will provide you with the necessary assistance and paperwork.
If you file a complaint, we will not take any action against you or change our treatment of you in any way.
This Notice of
Health Information Practices is effective April 14, 2003.