Notice of Privacy Practices
Protected Health Information (PHl), about you, is maintained as a record of your contacts or visits for services at Grand Mere’s Adult Day Health Club. Specifically, “PHl” is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present, or future physical or mental health condition.
Grand Mere’s Adult Day Health Club is required to follow specific rules on maintaining the confidentiality of your protected health information, using your information, and disclosing or sharing this information with other professionals involved in your care and treatment.This Notice describes your rights to access and control your protected health information. lt also describes how we follow applicable rules and use and disclose your protected health information to provide you services, obtain payment for services you receive, manage our operations and for other purposes that are permitted or required by law.
If you have any questions about this Notice, please contact our Administrator (Security Officer), Hope Lovell: 517-489-7107.
YOUR RIGHTS UNDER THE PRIVACY RULE
Following is a statement of your rights, under the Privacy Rule, in reference to your protected health information. Please feel free to discuss any questions with our staff.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices
We are required to follow the terms of this notice. We reserve the right to change the terms of our notice, at any time. If needed, new versions of this notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next visit. The Notice will also be posted in a conspicuous place within our facility and on our website (www.lovejoysnc.org).
You have the right to authorize other use and disclosure – This means you have the right to authorize any use or disclosure of PHI that is not specified within this notice. For example, we would need your authorization to use or disclose your PHI for marketing purpose or for any use or disclosure of psychotherapy notes. You may revoke an authorization, at any time, in writing, except to the extent that your Healthcare Provider or our office has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to designate a personal representative
This means you may designate a person with the delegated authority to consent to, or authorize the use or disclosure of protected health information.
You have the right to request an alternative means of confidential communication
This means you have the right to ask us to contact you about medical matters using a method (i.e. email, telephone, etc.), and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. We will follow all reasonable requests. You must inform us in writing how you wish to be contacted (using a form provided by Grand Mere’s).
You have the right to inspect and copy your protected health information
This means you may inspect and obtain a copy of protected health information about you that is contained in your patient record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.
You have the right to request a restriction of your protected health information
This means you may ask us, in writing, not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You will have the right to request, in writing, that we restrict communication regarding a specific treatment or service that you, or someone on your behalf, has paid for, in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction.
You may have the right to request an amendment to your protected health information
This means you may request an amendment of your protected health information for as long as we maintain this information. In certain cases, we may deny your request for an amendment.
You have the right to request disclosure accountability
This means that you may request a listing of disclosures that we have made, of your protected health information, to entities or persons outside of our office.
You have the right to be notified following a breach of your protected health information
HOW WE MAY USE OR DISCLOSE PROTECTED HEALTH INFORMATION
Following are examples of uses and disclosures of your protected health care information that we are permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by Grand Mere’s Adult Day Health Club.
Treatment – We may use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your protected health information, as necessary, to a pharmacy that would fill your prescriptions We will only disclose all of this protected health information to healthcare providers who may be involved in your care and treatment.
Special Notices – We may contact you to provide information about health-related benefits and services offered by our facility or for fund-raising activities. You have the right to opt out of such special notices, by notifying our office in writing.
Payment -Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
Operations – We may use or disclose, as-needed, your protected health information in order to support the business activities of our facility. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, and auditing functions.
Regional Information Organizations – Grand Mere’s Adult Day Health Club may elect to use a regional information organization or other such organization to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.
OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES
We may also use and disclose your protected health information in the following instances as outlined below.
To Others Involved in Your Healthcare
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person, that you identify, your protected health information that directly relates to that person’s involvement in your healthcare. lf you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care, general condition, or death. lf you are not present or able to agree or object to the use or disclosure of the protected health information, then Grand Mere’s may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your care will be disclosed.
As Required By Law
We may use or disclose your protected health information to the extent that the use or disclosure is required by law.
For Public Health
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information.
For Communicable Diseases
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
For Health Oversight
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.
In Cases of Abuse or Neglect
We may disclose your protected health information to a public health authority that is authorized by law to receive reports of abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect, or domestic violence to the governmental entity or agency authorized to receive such information.
To The Food and Drug Administration
We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, to monitor product defects or problems, to report biologic product deviations, to track products, to enable product recalls, to make repairs or replacements, or to conduct post-marketing surveillance, as required.
To Law Enforcement
We may also disclose protected health information, as long as applicable legal requirements are met, for law enforcement purposes.
For Legal Proceedings
We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request, or other lawful process.
To Coroners, Funeral Directors, and Organ Donation
We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out his/her duties. Protected health information may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.
We may disclose your protected health information to researchers when an institutional review board has reviewed and approved the research proposal and established protocols to ensure the privacy of your protected health information.
In Cases of Criminal Activity
Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
For Military Activity and National Security
When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service.
For Workers’ Compensation
Your protected health information may be disclosed by us, as authorized, to comply with workers’ compensation laws and other similar legally-established programs.
Required Uses and Disclosures
Under the law, we must make disclosures about you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Privacy Rule.
You may address complaints to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Manager of your complaint at:
Attn: HIPAA Privacy Manager
1038 Eastbury Drive
Lansing, Ml 48917
HIPAA Hotline (complaints): 517-489-7107