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.
USE AND DISCLOSURE OF HEALTH INFORMATION
Adult Day Services at Oakland Centre [“ADSOC”] may use your health information, 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 health care operations. ADSOC has established policies to guard against unnecessary disclosure of your health information. ADSOC is a program of Hospice Care of Southwest Michigan and certain members of the staff have responsibilities at both Oakland Centre and Hospice Care of Southwest Michigan. This notice of privacy also applies to those situations when health information from ADSOC is shared within the system. A specific example is billing staff have access to your health information from ADSOC and Hospice Care of Southwest Michigan.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED
To Provide Treatment. ADSOC may use your health information to coordinate care within ADSOC and with others involved in your care, such as your attending physician, members of ADSOC interdisciplinary team and other health care professionals who have agreed to assist ADSOC in coordinating care. For example, ADSOC may disclose your health care information to individuals outside of ADSOC involved in your care including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment, or other health care professionals or entities.
To Obtain Payment. ADSOC may include your health information in invoices to collect payment from third parties for the care you receive from ADSOC. For example, ADSOC may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or ADSOC. ADSOC also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for adult day services and the services that will be provided to you.
To Conduct Health Care Operations. ADSOC may use and disclose health information for its own operations in order to facilitate the function of ADSOC and as necessary to provide quality care to all of ADSOC guests. Health care operations include such activities as:
- Quality assessment and improvement activities.
- Activities designed to improve health or reduce health care costs.
- Protocol development, case management, and care coordination.
- Professional review and performance evaluation.
- Training programs, including those in which students, trainees or practitioners in health care learn under supervision.
- Training of non-health care professionals.
- Accreditation, certification, licensing or credentialing activities.
- Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
- Business planning and development, including cost management and planning related analyses and formulary development.
- Business management and general administrative activities of ADSOC.
For example, ADSOC may use your health information to evaluate its performance, combine your health information with other ADSOC guests in evaluating how to more effectively serve all ADSOC guests, disclose your health information to ADSOC staff and contracted personnel for training purposes, use your health information to contact you as a reminder regarding a visit to you, or contact you as part of general community information mailings (unless you tell us you do not want to be contacted).
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED
When Legally Required. ADSOC will disclose your health information when it is required to do so by any Federal, State, or local law.
When There Are Risks to Public Health. ADSOC may disclose your health information for public activities and purposes in order to:
- Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death, and to facilitate public health surveillance, investigations, and interventions.
- Report adverse events, product defects, to track products, enable product recalls, repairs, and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
- Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
- Notify an employer about an individual who is a member of the workforce as legally required.
To Report Abuse, Neglect, or Domestic Violence. ADSOC is allowed to notify government authorities if ADSOC believes a guest is the victim of abuse, neglect, or domestic violence. ADSOC will make this disclosure only when specifically required or authorized by law or when the guest agrees to the disclosure.
To Conduct Health Oversight Activities. ADSOC may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. ADSOC, however, may not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.
In Connection With Judicial and Administrative Proceedings. ADSOC may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order, or in response to a subpoena, discovery request or other lawful process, but only when ADSOC makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. As permitted or required by State law, ADSOC may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:
- As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process.
- For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
- Under certain limited circumstances, when you are the victim of a crime.
- To a law enforcement official if ADSOC has a suspicion that your death was the result of criminal conduct including criminal conduct at ADSOC.
- In an emergency in order to report a crime.
To Coroners and Medical Examiners. ADSOC may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
For Research Purposes. ADSOC may, under very select circumstances, use your health information for research. Before ADSOC discloses any of your health information for such research purposes, the project will be subject to an extensive approval process.
Limited Data Set. ADSOC may use or disclose a limited data set of your health information, that is, a subset of your health information for which all identifying information has been removed, for purposes of research, public health, or health care operations. Prior to our release, any recipient of that limited data set must agree to appropriately safeguard your health information.
In the Event of a Serious Threat to Health or Safety. ADSOC may, consistent with applicable law and ethical standards of conduct, disclose your health information if ADSOC, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public. ADSOC may also disclose information in cooperation with an ongoing APS/CPS investigation.
For Specified Government Functions. In certain circumstances, the Federal regulations authorize ADSOC to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations, and inmates and law enforcement custody.
For Worker’s Compensation. ADSOC may release your health information for worker’s compensation or similar programs.
OTHER USES AND DISCLOSURES OF YOUR HEALTH INFORMATION TO WHICH YOU MAY AGREE OR OBJECT
Disclosures to Relatives, Close Friends, and Other Caregivers. ADSOC may disclose your health information to a family member, other relative, a close personal friend, or any other person identified by you when you are present for, or otherwise available prior to, the disclosure, if ADSOC: (1) obtains your agreement; (2) provides you with the opportunity to object to the disclosure and you do not object; or (3) reasonably infers that you do not object to the disclosure.
If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, ADSOC may exercise its professional judgment to determine whether a disclosure is in your best interests. If ADSOC discloses information to a family member, other relative, or a close personal friend, ADSOC will disclose only information that it believes is directly relevant to the person’s involvement with your health care or payment related to your health care. ADSOC may also disclose your health information in order to notify (or assist in notifying) such persons of your location, general condition, or death.
You may ask ADSOC at any time to not disclose your health information to any person(s) involved in your care. ADSOC will agree to your request unless circumstances constitute an emergency.
Fundraising Activities. ADSOC or its Business Associate may use information about you, including your name, address, telephone number, and the dates you received care, in order to contact you or your family to raise money for our organization. You have the right to opt out of receiving these communications from ADSOC or its Business Associate for fund raising purposes. If you or your family does not wish to be contacted for fundraising activities, notify the Director of Community Relations and Development at (269) 345-0273 and indicate that you do not wish to receive fund raising communications.
AUTHORIZATIONS TO USE OR DISCLOSE YOUR HEALTH INFORMATION
Other than the permitted uses and disclosures described above, ADSOC will not use or disclose our health information without an authorization signed by you or your personal representative. If you or your representative sign a written authorization allowing us to use or disclose your health information, you may cancel the authorization (in writing) at any time. If you cancel your authorization, ADSOC will follow your instructions, except to the extent that ADSOC has already relied upon your authorization and take action.
The following uses and disclosures of your health information will only be made with your signed authorization:
- Uses and disclosures for marketing purposes;
- Uses and disclosures that constitute a sale of health information;
- Most uses and disclosures of psychotherapy notes, if ADSOC maintains psychotherapy notes; and
- Any other uses and disclosures not described in this Notice.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that ADSOC maintains:
Right to request restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on ADSOC’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, ADSOC is not required to agree to your request. If you wish to make a request for restrictions, please contact the Chief Quality and Compliance Officer of Hospice Care of Southwest Michigan at (269) 345-0273.
Right to receive confidential communications. You have the right to request that ADSOC communicate with you in a certain way. For example, you may ask that ADSOC only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact the Chief Quality and Compliance Officer at (269) 345-0273.
ADSOC will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
Right of access to inspect and copy your health information. You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information may be made to the Chief Quality and Compliance Officer at (269) 345-0273. If you request a copy of your health information, ADSOC may charge a reasonable fee for copying and assembling costs associated with your request.
You have the right to request that ADSOC provide you, an entity, or a designated individual with an electronic copy of your electronic health record containing your health information, if ADSOC uses or maintains electronic health records containing your health information. ADSOC may require you to pay the labor costs incurred by the ADSOC in responding to your request.
Right to amend your health care information. You or your representative have the right to request that ADSOC amend your records, if you believe that your health information is incorrect or incomplete. That request may be made as long as the information is maintained by ADSOC. A request for an amendment of records must be made in writing to the Chief Quality and Compliance Officer at 222 North Kalamazoo Mall, Suite 100, Kalamazoo, Michigan 49007. ADSOC may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if your health information records were not created by ADSOC, if the records you are requesting are not part of ADSOC’s 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 the opinion of ADSOC, the records containing your health information are accurate and complete.
Right to an accounting. You or your representative have the right to request an accounting of disclosures of your health information made by ADSOC for the previous seven (7) years. The accounting will not include disclosures made for treatment, payment, or health care operations unless ADSOC maintains your health information in an electronic health record. The request for an accounting must be made in writing to the Chief Quality and Compliance Officer at the address listed below. The request should specify the time period for the accounting starting on or after April 14, 2003. ADSOC 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.
Right to a paper copy of this notice. You or your representative have a right to a separate paper copy of this Notice at any time even if you or your representative have received this Notice previously. To obtain a separate paper copy, please contact the Chief Quality and Compliance Officer at (269) 345-0273. The guest or guest’s representative may also obtain a copy of the current version of the Notice of Privacy Practices at its website at https://oaklandcentre.org.
Right to opt out of fundraising. You or your representative have the right to opt out of receiving fundraising communications. Instructions for how to opt out are included in each fundraising solicitation you receive.
Right to receive notification of breach. If ADSOC determines that there has been a breach of your health information, ADSOC will provide you or your representative with notice by first class mail or by email if you agree to receive electronic notices. The notification will be provided as soon as possible but no later than 60 calendar days following the discovery of the breach except as required by law enforcement. The notification will include a description of the breach; description of the type of information involved in the breach; the steps that you or your representative should take to protect you from harm; a brief description of what ADSOC is doing to investigate the breach, mitigate the harm, and prevent further breaches; and the contact information for ADSOC.
ADSOC may notify you by telephone as well as written notice in cases deemed by ADSOC to require urgency because of possible imminent misuse of your health information.
Right to have genetic health information kept private. In accordance with the Genetic Information Nondiscrimination Act (GINA) of 2008, ADSOC considers genetic information your personal health information and will not use it to determine eligibility for coverage of adult day services, nor report to companies for underwriting purposes.
CHANGES TO THIS NOTICE
ADSOC is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices. ADSOC reserves the right to change this Notice. ADSOC reserves the right to make the revised Notice effective for health information we already have about you, as well as any health information we receive in the future. ADSOC will post a copy of the current Notice in a clear and prominent location to which you have access. The notice is also available to you upon request. The Notice will contain, at the end of this document, the effect date. In addition, if ADSOC revises the Notice, ADSOC will offer you a copy of the current Notice in effect.
You or your personal representative have the right to express complaints to ADSOC and to the Secretary of Department of Health and Human Services if you or your representative believe that your privacy rights have been violated. Any complaints to ADSOC should be made in writing the Chief Quality and Compliance Officer at 222 North Kalamazoo Mall, Suite 100, Kalamazoo, Michigan 49007. ADSOC encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
ADSOC has designated the Chief Quality and Compliance Officer as its contact person for all issues regarding your privacy and your rights under the Federal Privacy Standards. You may contact this person at Hospice Care of Southwest Michigan, Chief Quality and Compliance Officer, 222 N. Kalamazoo Mall, Suite 200, Kalamazoo, Michigan, 49007-3882, 269-345-0273.
This Notice is effective September 23, 2013
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT: Hospice Care of Southwest Michigan, Chief Quality and Compliance Officer, 222 N. Kalamazoo Mall, Suite 100, Kalamazoo, MI, 49007 at (269) 345-0273 or at www.hospiceswmi.org.