Notice of Privacy Practices

Effective April 14, 2003

This notice describes how health information about you may be used and disclosed (shared) and how you can get access to (see and copy) this information.

Please review this carefully:

This is a joint notice covering all entities of the Clarion Forest Visiting Nurse Association, Inc. including Clarion Forest VNA, Clarion Forest VNA Hospice, Clarion Forest VNA Extended Care, Clarion Forest VNA Adult Daily Living, and Serenity House.   All services are carried out from either the Clarion Main Office or the Shippenville Office.  Most of the services provided take place in the individual’s home with the exception of Serenity House, Adult Daily Living Center and also the Community Clinics.  It is possible that these entities may need to share protected health information with each other, as necessary to carry out treatment, payment, or healthcare operations relating to the organized health care arrangement.

Our commitment to your Privacy

Our organization is dedicated to maintaining the privacy of your identifiable health information.  In conducting our business, we will create and maintain records regarding you and the treatment and services we provide to you.  We are required by law to maintain the confidentiality of health information that identifies you.  We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information.  By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

To summarize, this notice provides you with the following important information:

  • How we may use and disclose you identifiable health information;
  • Your privacy rights in your identifiable health information; and
  • Our obligations concerning the use and disclosure of you identifiable health information.
 

How we may use and share your health information with others

1.  Treatment.    Our organization may use your identifiable health information to determine the course of treatment that should work best for you.  For example, we may collect laboratory tests (such as blood or urine tests) as ordered by your physician who may then use the results to make changes to your plan of care.  Many of the people who work for our organization may use or disclose your identifiable health information in order to treat you or to assist others in your treatment.  You may note in the VNA’s “In Home Patient Folder” is an assessment information flow sheet designed to assist in communication of your important physical findings among our staff visiting you.  Additionally, we may disclose your identifiable health information to others who may assist in your care, such as your physician, therapist, spouse, children, or parents, possibly during a case management conference.  Last, as we plan your discharge from the VNA, we may use your identifiable health information as we contact support agencies in the community to assist you after discharge.

2.  Payment.    Our organization may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.  We also may use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your identifiable health information to bill you directly for services and items.

3.  Health Care Operations.    Our organization may use and disclose your identifiable health information to operate our business.  Examples of the ways in which we may use and disclose your information for our operations include to evaluate the quality of care you received from us or to conduct cost-management and business planning activities for our agency. We may share information with our students, trainees, and staff for review and learning purposes.

4.  Business Associates.  We have professionals we work with  called “business Associates,” who come may come in incidental contact with your health information.  The business associate must agree in writing to protect the confidentiality of the information. Some examples of those business  associates are our software company, our storage and shredding company, and our accounting firm.

5.  Appointment Reminders.    Our organization may use and disclose your identifiable health information to contact you and remind you of visits/deliveries.

6.  Release of Information to Family/Friends.    Our organization may release your identifiable health information to a friend or family member that is helping you pay for you health care, or who assists in taking care of you.

7.  Disclosures Required By Law.  Our organization will use and disclose your identifiable health information when we are required to do so by federal, state, or local law.

8.  Fund-Raising Activities.  We may use and share your name, address, phone number, and other such information (called “demographic information”) and dates that health care was provided to you within our agency or the agency’s foundation as we perform our newsletter mailings or fundraising activities.  You may be asked for a donation to Clarion Forest VNA to support enhanced patient care, treatment, and education at the VNA.  Any fund-raising materials will explain how you can tell us, that you do not want to be contacted in the future, whether it be the agency itself or  it’s foundation.  If you do so, we will use reasonable efforts to avoid contacting you in the future.

9.  Marketing Activities.  We may use or share your health information for marketing purposes with your authorization only.  We will not utilize any of your personal healthcare information for any marketing purposes without your consent to do so.  We will discuss such events with you and you will make the decision on what healthcare information you may want to disclose.

How we may use and Disclose your health information in certain special circumstances

1. Public Health Risks.  Our organization may disclose your identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:

  • maintaining vital records, such as births and deaths;
  • reporting child abuse or neglect;
  • preventing or controlling disease, injury or disability;
  • notifying a person regarding potential exposure to a communicable disease;
  • notifying a person regarding a potential risk for spreading or contracting a disease or condition;
  • reporting reactions to drugs or problems with products or devices;
  • notifying individuals if a product or device they may be using has been recalled;
  • notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information; and
  • notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
 

2.  Health Oversight Activities.    Our organization may disclose your identifiable health information to a health oversight agency for activities authorized by law.  Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3.  Lawsuits and Similar Proceedings.    Our organization may use and disclose your identifiable health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  We also may disclose you identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

4.  Law enforcement.    We may release identifiable health information if asked to do so by a law enforcement official:

  • regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement;
  • concerning a death we believe might have resulted from criminal conduct;
  • regarding criminal conduct at our offices;
  • in response to a warrant, summons, court order, subpoena or similar legal process;
  • to identify/locate a suspect, material witness, fugitive or missing person; and
  • in an emergency to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).
 

5.  Serious Threats to Health or Safety.    Our organization may use and disclose your identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.  Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

6.  Military.    Our organization may disclose your identifiable health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.

7.  National Security.    Our organization may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law.  We also may disclose you identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

8.  Inmates.    Our organization may disclose your identifiable health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.  Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

9.  Workers’ Compensation.    Our organization may release/disclose your identifiable health information to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

10. Coroners, Medical Examiners, and Funeral Directors.  We may share your health information with a coroner or medical examiner in order to identify a deceased person, to determine the cause of death, or for other reasons allowed by law.  We may also share your health information with funeral directors, as necessary, so they can carry out their duties.

Your Rights Regarding Your Identifiable Health Information

     You have the following rights regarding the identifiable health information that we maintain about you:

1.  Right to Ask For Confidential Communications.   You have the right to request that our organization communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact you at home, rather than work. Your must make your request in writing to Clarion Forest VNA, Attention Medical Records Department, at 271 Perkins Road, Clarion, PA 16214.  You do not need to provide a reason for your request.  We will comply with all reasonable requests.

2.  Right to Ask for Limits on Use and Sharing.  You have the right to request a restriction in our use or disclosure of your identifiable health information for treatment, payment, of health care operations.  Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payment for your care, such as family members and friends.  We are not required to agree to your request;however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.  In order to request a restriction in our use or disclosure or you identifiable health information, you must make you request in writing to Clarion Forest VNA, Attention Medical Records Coordinator, 271 Perkins Road Clarion, PA 16214.  Your request must describe in a clear concise fashion: (a) the information you wish restricted; (b) whether you  are requesting to limit our agency’s use, disclosure or both; and (c) to whom you want the limits to apply.

3.  Right to Ask to See and Copy.    You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including  patient medical records and billing records, but not including psychotherapy notes.  Your request must be in writing and submitted to the Clarion Forest VNA, Attention Medical Records Coordinator, 271 Perkins Road Clarion, PA 16214.  If you ask to see or copy your health information, you may have to pay the costs for copying, mailing, or other costs such as supplies associated with your request.  Our agency may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial.  All reviews will be conducted by the Chief Executive Officer of Clarion Forest VNA.

4.  Right to Ask for a Correction.  You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our organization.  To request an amendment, your request must be made in writing and submitted to Clarion Forest VNA Medical Records Coordinator, 271 Perkins Road Clarion, PA 16214.  You must provide us with a reason that supports your request for amendment.  Our organization will deny your request if you fail to submit your request (and the reason supporting you request) in writing.  Also, we may deny your request if you ask us to amend information that: (a) we feel is accurate and complete; (b) not part of the identifiable health information kept by or for the organization; (c) not part of the identifiable health information which you would be permitted to inspect and copy; or (d) not created by our organization, unless the individual or entity that created the information is not available to amend the information.

5.  Right to Ask for Accounting of Disclosures.  All of our patients have the right to request an “accounting of disclosures.”  An “accounting of disclosures” is a list of certain disclosures our organization has made of you identifiable health information. In order to obtain an accounting of disclosures, you must submit you request in writing to Clarion Forest VNA, Attention Medical Records Coordinator, 271 Perkins Road Clarion, PA 16214.  All requests for an “accounting of disclosures” must state a time period which may not be  longer than six years and may not include dates before April 14, 2003.  The first list you request within a 12-period is free of charge, but our organization may charge you for additional lists within the same 12-month period.  Our organization will notify you of the costs involved with additional request, and you may withdraw you request before you incur any costs.

6.  Right to Ask for a Paper Copy of This Notice.  You are entitled to receive a paper copy of our notice of privacy practices.  You may ask us to give you a copy of this notice at any time.  To obtain a paper copy of this notice, contact the Medical Records Coordinator at the Clarion Forest  VNA office, 271 Perkins Road Clarion, PA 16214 (phone: 814-297-8400).

7.  Right to File a Complaint.  If you believe your privacy rights have been violated, you may file a complaint directly with us. You can do this by contacting the Chief Executive Officer or the HIPAA Privacy Officer at this organization by calling 1-800-262-2118.

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services.  To file a complaint with the Secretary of Health and Human Services, you must  (1) give the name of the agency and/or person that you believed violated your  privacy rights and describe how the agency or person violated you privacy rights, and (2) file the complaint within 180 days of when you knew or should have known that the violation occurred.  All complaints to the Secretary of the U.S. Department of Health and Human Services must be in writing and addressed to:

Department of Health and Human Services,
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C.  20201
E-mail:  www.hhs.gov/ocr/hipaa

          You will not be penalized for filing a complaint.

8.  Right to Provide an Authorization for Other Uses and Disclosures.    Our organization will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.  Any authorization you provide to us regarding the use and disclosure of your identifiable health information may be revoked at any time in writing.  After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization.  Please note, we are required to retain records of your care.

Changes to this Notice
The terms of this notice apply to all records containing your identifiable health information that are created or retained by this agency.  We reserve (have) the right to change this Notice.  We reserve (have) the right to make the revised or changed Notice effective for health information we already have about you and for any future health information.   Our organization will post a copy of our current notice in our offices in a prominent location.  We will provide you with a copy of the Notice that is currently in effect each time you become a patient for treatment and healthcare services.  You may request a copy of our most current and/or revised notice during any home visit or visit to our office.

If you have questions about this Notice

If you have any questions about this Notice, please contact the VNA office at 1-800-262-2118 and ask to talk with the Chief Executive Officer of the HIPAA Privacy Officer.

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