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.
Our agency is required by law to
maintain the privacy of protected health information, to provide you adequate
notice of your rights and our legal duties and privacy practices with respect
to protected health information and to notify affected individuals following a
breach of unsecured protected health information. [45 CFR § 164.520] We will
use or disclose protected health information in a manner that is consistent
with this notice.
The agency maintains a record
(paper/electronic file) of the information we receive and collect about you and
of the care we provide to you. This record includes assessments, medication lists, clinical
progress notes and billing information.
As required by law, the agency
maintains policies and procedures about our work practices, including how we
coordinate care and services provided to our clients. These policies and
procedures include how we create, receive, access, transmit, maintain and
protect the confidentiality of all health information in our workforce and with
contracted business associates and/or subcontractors; security of the agency
building and electronic files; and how we educate staff on privacy of patient
information.
As our clients,
information about you must be used and disclosed to other parties for purposes
of treatment, payment and health care operations. Examples of
information that must be disclosed:
- Treatment: Providing,
coordinating or managing health care and related services, consultation
between healthcare providers relating to a client or referral of a client
for health care from one provider to another. For example, we meet on a
regular basis to discuss how to coordinate care for clients and to
schedule visits.
- Payment: Billing and collecting for
services provided, determining plan eligibility and coverage, utilization
review (UR), medical/non-medical necessity review. For example,
occasionally the insurance company requests a copy of the medical record
be sent to them for a coverage review prior to paying the bill.
- Health Care Operations: General
agency administrative and business functions, quality
assurance/improvement activities; medical review; auditing functions;
developing clinical guidelines; determining the competence or
qualifications of health care professionals; evaluating agency
performance; conducting training programs licensing, survey,
certification, accreditation and credentialing activities; internal
auditing; and certain fundraising activities and with your authorization,
marketing activities. For example, our agency periodically holds clinical
record review meetings where the consulting professional of our record
review committee will audit clinical records for meeting professional
standards and utilization review.
The following uses and
disclosures do not require your consent, and include, but are not limited to, a
release of information contained in financial records and/or medical records,
including information concerning communicable diseases such as Human Immunodeficiency
Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS), drug/alcohol abuse,
psychiatric diagnosis and treatment records and/or laboratory test results,
medical history, treatment progress and/or any other related information as
permitted by state law to:
- Your insurance
company, self-funded or third-party health plan, Medicare, Medicaid or any
other person or entity that may be responsible for paying or processing
for payment any portion of your bill for services;
- Any person or
entity affiliated with or representing us for purposes of administration,
billing and quality and risk management;
- Any hospital,
nursing home or other health care facility to which you may be admitted;
- Any assisted
living or personal care facility of which you are a resident;
- Any physician
providing you care;
- Licensing and
accrediting bodies, including the information contained in the OASIS Data
Set to the state agency acting as a representative of the
Medicare/Medicaid program;
- Contact you to
raise funds for the Agency; you will be given the right to opt out of
receiving such communications;
- Any business
associate or institutionally related foundation for the purpose of raising
funds for the agency (information may include: demographics – name,
address, contact information, age, gender, date of birth; dates of health
care provided; department of services; treating physician; outcome
information; and health insurance status). You will be given the right to
opt out;
- Marketing
communications promoting products, services and information if the
communication is made face to face with you or the only financial gain
consists of a promotional gift of nominal value provided by the agency;
and
- Other health
care providers to initiate treatment.
We are permitted
to use or disclose information about you without consent or authorization in
the following circumstances:
- In emergency treatment situations,
if we attempt to obtain consent as soon as practicable after treatment;
- Where substantial barriers to communicating with you exist
and we determine that the consent is clearly inferred from the
circumstances;
- Where
we are required by law to
provide treatment and we are unable to obtain consent;
- Where
the use or disclosure of medical information about you is required by federal, state or local law;
- To
provide information to state or
federal public health authorities, as required by law to:
prevent or control disease, injury or disability; report births and
deaths; report child abuse or neglect; report reactions to medications or
problems with products; notify persons of recalls of products they may be
using; notify a person who may have been exposed to a disease or may be at
risk for contracting or spreading a disease or condition; and notify the
appropriate government authority if we believe a patient has been the
victim of abuse, neglect or domestic violence (if you agree or when
required or authorized by law);
- Health care oversight activities such
as audits, investigations, inspections and licensure by a government
health oversight agency as authorized by law to monitor the health care
system, government programs and compliance with civil rights laws;
- To business associates regulated
under HIPAA that work on our behalf under a contract that requires
appropriate safeguards of protected health information;
- Certain judicial administrative proceedings in
response to a court or administrative order, a subpoena, discovery request
or other lawful process by someone else involved in the dispute, but only
if efforts have been made to tell you about the request or to obtain an
order from the Court protecting the information requested;
- Certain law enforcement purposes such
as helping to determine whether a crime has occurred, to alert law
enforcement to a crime on our premises or of your death if we suspect it
resulted from criminal conduct, identify or locate a suspect, fugitive,
material witness or missing person, or to comply with a court order or
subpoena and other law enforcement purposes;
- To coroners, medical examiners and funeral directors,
in certain circumstances, for example, to identify a deceased person,
determine the cause of death or to assist in carrying out their duties;
- For certain research purposes under
very select circumstances. We may use your health information for
research. Before we disclose any of your health information for such
research purposes, the project will be subject to an extensive approval
process. We will usually request your written authorization before
granting access to your individually identifiable health information;
- To avert a serious threat to health and safety:
To prevent or lessen a serious and imminent threat to the health or safety
of a particular person or the general public, such as when a person admits
to participation in a violent crime or serious harm to a victim or is an
escaped convict. Any disclosure, however, would only be to someone able to
help prevent the threat;
- For specialized government functions,
including military and veterans’ activities, national security and
intelligence activities, protective services for the President, foreign
heads of state and others, medical suitability determinations,
correctional institution and custodial situations; and
- For Workers’ Compensation purposes:
Workers’ compensation or similar programs provide benefits for
work-related injuries or illness.
We are permitted
to use or disclose information about you provided you are informed in advance
and given the opportunity to individually agree to, prohibit, opt out or
restrict the disclosure in the following circumstances:
- Use of a directory (includes name, location, condition described in
general terms) of individuals served by our Agency;
- Provide a
family member, relative, friend or other identified person, prior to, or
after your death, the information relevant to such person’s involvement in
your care or payment for care; to notify a family member, relative, friend
or other identified person of your location, general condition or death.
Other uses and
disclosures not covered in this notice will be made only with your
authorization. Authorization may be revoked, in writing, at any time, except in
limited situations for the following disclosures:
- Marketing of products or services or treatment alternatives that
may be of benefit to you when we receive direct payment from a third party
for making such communications;
- Psychotherapy
notes under most circumstances, if applicable; and
- Any sale of
protected health information resulting in financial gain by the agency
unless an exception is met.
YOUR
RIGHTS –
You have the right, subject to certain conditions, to:
- Request restrictions on uses and disclosures of your
protected health information for treatment,
payment or health care operations. However, we are not required to agree
to any requested restriction. Restrictions to which we agree will be
documented. Agreements for further restrictions may, however be terminated
under applicable circumstances (e.g., emergency treatment).We must agree
to your request to restrict disclosure of protected health information
about you to a health plan if: 1) the disclosure is for the purpose of
carrying out payment or home care operations and is not otherwise required
by law; and 2) the protected health information pertains solely to a
health care item or service for which you or someone on your behalf paid
the covered entity in full. (164.522 Rights to request privacy protection
for protected health information).
- Confidential communication of protected health
information. We will arrange for you to receive
protected health information by reasonable alternative means or at
alternative locations. Your request must be in writing. We do not require
an explanation for the request as a condition of providing communications
on a confidential basis and will attempt to honor reasonable requests for
confidential communications. If you request your protected health
information to be transmitted directly to another person designated by
you, your written request must be signed and clearly identify the
designated person and where the copy of protected health information is to
be sent.
- Inspect and obtain copies of protected health
information that is maintained in a designated
record set, except for psychotherapy notes, information compiled in
reasonable anticipation of, or for use in, a civil, criminal or
administrative action or proceeding, or protected health information that
may not be disclosed under the Clinical Laboratory Improvements Amendments
of 1988 [42 USC § 263a and 45 CFR § 493 (a)(2)]. If you request a copy of
your health information, we will charge a reasonable, cost-based fee that
includes only the cost of labor for copying, supplies and postage, if
applicable, in accordance with applicable state and federal regulations.
If the requested protected health information is maintained electronically
and you request an electronic copy, we will provide access in an electronic
format you request, if readily producible, or if not, in a readable
electronic form and format mutually agreed upon. If we deny access to
protected health information, you will receive a timely, written denial in
plain language that explains the basis for the denial, your review rights
and an explanation of how to exercise those rights. If we do not maintain
the medical record, we will tell you where to request the protected health
information.
- Request to amend protected health information for
as long as the protected health information is maintained in the
designated record set. A request to amend your record must be in writing
and must include a reason to support the requested amendment. We will act
on your request within sixty (60) days of receipt of the request. We may
extend the time for such action by up to 30 days, if we provide you with a
written explanation of the reasons for the delay and the date by which we
will complete action on the request. We may deny the request for amendment
if the information contained in the record was not created by us, unless
you provide a reasonable basis for believing the originator of the
information is no longer available to act on the requested amendment; is
not part of the designated medical record set; would not be available for
inspection under applicable laws and regulations; or the record is
accurate and complete. If we deny your request for amendment, you will
receive a timely, written denial in plain language that explains the basis
for the denial, your rights to submit a statement disagreeing with the
denial and an explanation of how to submit that statement.
- Receive an accounting of disclosures of protected health
information made by our Agency for up to six (6)
years prior to the date on which the accounting is requested for any
reason other than for treatment, payment or health operations and other
applicable exceptions. The written accounting includes the date of each
disclosure, the name/address (if known)
of the entity or person who received the protected health information, a
brief description of the information disclosed and a brief statement of
the purpose of the disclosure or a copy of the written request for
disclosure. We will provide the accountings within 60 days of receipt of a
written request. However, we may extend the time period for providing the
accounting by 30 days if we provide you with a written statement of the
reasons for the delay and the date by which you will receive the information.
We will provide the first accounting you request during any 12-month
period without charge. Subsequent accounting requests may be subject to a
reasonable cost-based fee.
- Receive notification of any breach in the acquisition,
access, use or disclosure of unsecured protected
health information by the agency, its business associates and/or
subcontractors.
- Obtain a paper copy of this notice,
even if you had agreed to receive this notice electronically, from us upon
request.
COMPLAINTS
– If
you believe that your privacy rights have been violated, you may complain to
the Agency or to the Secretary of the U.S. Department of Health and Human
Services. There will be no retaliation against you for filing a complaint. The
complaint should be filed in writing, and should state the specific incident(s)
in terms of subject, date and other relevant matters.
The Complaint
Administration Unit receives and processes complaints about the quality of care
provided in Florida's health care facilities.
If you wish to
file a complaint against a licensed health care facility regulated by the
Agency for Health Care Administration, please contact us at 1-888-419-3456 /
800-955-8771 Florida Relay Service (TDD number) or use our Licensed
Health Care Facility Complaint Form.
To file a
complaint against an unlicensed health care facility, please contact us at
1-888-419-3456 / 800-955-8771 Florida Relay Service (TDDumber) or submit
an Unlicensed Health Care Facility Complaint Form.
From <https://ahca.myflorida.com/mchq/field_ops/cau.shtml>