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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.
This Notice describes the practices of Around the
Clock Home Care (“Agency”) and Agency’s employees, staff
and personnel. If you have any questions about this Notice or about your
privacy, please feel free to contact the Privacy Officer at the address
below.
OUR PLEDGE
Agency understands that medical information about
you and your health is personal. Agency is committed to protecting medical
information about you. Agency creates a record of the healthcare services
and supplies you receive from Agency. Agency needs this record to provide
you with quality care and to comply with certain legal requirements. This
Notice applies to all of the records generated and held by Agency regarding
the healthcare services and supplies you receive. Your personal doctor
will have different policies or notices regarding the doctor’s uses
and disclosures of your medical information created in the doctor’s
office or clinic. In addition, any hospital or clinic where you are treated
will also have different policies or notices regarding the hospital’s
or clinic’s uses and disclosures of your medical information created
at the hospital or clinic.
This Notice will tell you about the ways in which Agency may use and disclose
medical information about you. This Notice also describes your rights
and certain obligations Agency has regarding the use and disclosure of
medical information.
USES AND DISCLOSURES
The following categories describe different ways
that Agency uses and discloses medical information. For each category
of uses or disclosures Agency will explain what Agency means and try to
give some examples. Not every use or disclosure in a category will be
listed. However, all of the ways Agency is permitted to use and disclose
information will fall within one of the categories.
For Treatment.
Agency may use medical information about you to provide you with healthcare
services and supplies. Agency may disclose medical information about you
to doctors, nurses, technicians and other Agency personnel who are involved
in providing you with healthcare services and supplies. For example, a
Pharmacist regarding your medications, a Laboratory regarding lab results,
a Medical Supply company regarding equipment for your home, just to name
a few. Agency also may disclose medical information about you to people
outside Agency who may be involved in your medical care, such as hospitals,
clinics, doctors, nurses, other home health care providers, family members
involved in your care or other persons or organizations involved in your
treatment.
For Payment. Agency may use and disclose
medical information about you so that the healthcare services and supplies
you receive from Agency may be billed to and payment may be collected
from you, an insurance company or a third party. For example, Agency may
need to give your health plan information about healthcare services and
supplies you received from Agency so your health plan will pay Agency
or reimburse you for the healthcare services and supplies. Agency may
also tell your health plan about a healthcare service or supply you have
been prescribed to obtain prior approval or to determine whether your
plan will cover the healthcare service or supply. Agency may also disclose
information about you to one of your other providers, so that they may
bill for the services they have or will provide to you.
For Health Care Operations.
Agency may use and disclose medical information about you for Agency’s
operations. These uses and disclosures are necessary to run Agency and
to make sure that all of our patients receive quality care. For example,
Agency may use medical information to review our treatment and services
and to evaluate the performance of our staff in responding to your needs.
Agency may also combine medical information about many Agency patients
to decide what additional services Agency should offer and what services
are not needed. Agency may also disclose information to doctors, nurses,
technicians and other Agency personnel for review and learning purposes.
Agency may also combine the medical information Agency has with medical
information from other healthcare providers to compare how Agency is doing
and see where Agency can make improvements in the healthcare services
and supplies Agency offers. Agency may remove certain information that
identifies you (such as name, address (other than zip code), social security
number, etc.) from this set of medical information so others may use it
to study health care and health care delivery without learning who the
specific patients are. In that case, Agency will obtain a written agreement
from the recipient of your medical information that the recipient will
only use the information for healthcare operations purposes.
Emergencies and Barriers to Communications:
We may make disclosures in the case of an emergency. We may also disclose
your health information when there is a communication barrier if, using
our professional judgment, we determine that you intend to allow the use
or disclosure under the circumstances.
Appointment Reminders.
Agency may use and disclose medical information to contact you as a reminder
that you have an appointment with a home healthcare provider who will
help you with the healthcare services and supplies you need.
Alternatives.
Agency may use and disclose medical information to tell you about or recommend
possible healthcare services and supplies options or alternatives that
may be of interest to you.
Benefits and Services.
Agency may use and disclose medical information to tell you about health-related
benefits or services that may be of interest to you.
Family & Friends.
Agency may release medical information about you to a friend or family
member who is involved in your medical care. Agency may also give information
to someone who helps pay for your care.
Research.
Under certain circumstances, Agency may use and disclose medical information
about you for research purposes. For example, clinical trials for new
drugs or treatments. All research projects, however, are subject to a
special approval process. This process evaluates a proposed research project
and its use of medical information, trying to balance the research needs
with patients’ need for privacy of their medical information. Before
Agency uses or discloses medical information for research, the project
will have been approved through this research approval process. However,
Agency may disclose medical information about you to people preparing
to conduct a research project, for example, diagnosis and medication information.
In addition, Agency may disclose a limited amount of individually identifiable
medical information about you for the purpose of research, so long as
Agency receives a written assurance from the recipient that they will
only use your medical information for research purposes. Agency will almost
always ask for your specific permission if the researcher will have access
to your name, address (other than zip code) or other information that
reveals who you are, or will be involved in your care through Agency.
As Required By Law. Agency will disclose medical information about you
when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety.
Agency may use and disclose medical information about you when necessary
to prevent a serious threat to your health and safety or the health and
safety of the public or another person. Any disclosure, however, would
only be to someone able to help prevent the threat.
For FDA Activities.
Agency may use or disclose medical information about you in relation to
the quality, safety or effectiveness of a Food and Drug Administration
regulated product or activity. For example, Agency may disclose your medical
information to report adverse events or product recalls.
Genetic Testing Information:
Under California law, if we keep genetic testing information about you,
we will release that information only to the California state departments
that monitor our work or if required by law to release that information.
Otherwise, we will give out this information only if you give us your
permission in writing.
Communicable Diseases: If you have a communicable disease, such as HIV/AIDS,
we will provide that information to your health care provider, to providers
engaged in organ procurement, or if required by law. For all other purposes,
we will give out this information only with your permission.
Military and Veterans.
If you are a member of the armed forces, Agency may release medical information
about you as required by military command authorities. Agency may also
release medical information about foreign military personnel to the appropriate
foreign military authority.
Workers’ Compensation.
Agency may release medical information about you for workers’ compensation
or similar programs. These programs provide benefits for work-related
injuries or illness.
Public Health Risks. Agency may disclose
medical information about you for public health activities. These activities
generally include the following: (i) to prevent or control disease, injury
or disability; (ii) to report reactions to medications or problems with
products; (iii) to notify people of recalls of products they may be using;
(iv) to notify a person who may have been exposed to a disease or may
be at risk for contracting or spreading a disease or condition; or (v)
to notify the appropriate government authority if Agency believe a patient
has been the victim of abuse, neglect or domestic violence. Agency will
only make this disclosure if you agree or when required or authorized
by law.
In addition, Agency may remove certain information that identifies you
(such as name, address (other than zip code), social security number,
etc.) from this set of medical information so others may use it for public
health purposes without learning who the specific patients are; Agency
will obtain a written agreement from the recipient of your medical information
that the recipient will only use the information for public health purposes.
Health Oversight Activities.
Agency may disclose medical information to a health oversight agency for
activities authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure. These activities
are necessary for the government to monitor the health care system, government
programs, and compliance with civil rights laws.
Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, Agency may disclose medical
information about you in response to a court or administrative order.
Agency may also disclose medical information about you in response to
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 protecting the information requested.
Law Enforcement. Agency may release medical information if asked to do
so by a law enforcement official: (i) in response to a court order, subpoena,
warrant, summons or similar process; (ii) to identify or locate a suspect,
fugitive, material witness, or missing person; (iii) about the victim
of a crime if, under certain limited circumstances, Agency is unable to
obtain your agreement; (iv) about a death Agency believes may be the result
of criminal conduct; (v) about criminal conduct at Agency; or (vi) in
emergency circumstances to report a crime; the location of the crime or
victims; or the identity, description or location of the person who committed
the crime.
Coroners, Medical Examiners and Funeral
Directors. Agency may release medical information
to a coroner or medical examiner. This may be necessary, for example,
to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities. Agency may release medical
information about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized
by law.
Protective Services for the President and Others.
Agency may disclose medical information about you to authorized federal
officials so they may provide protection to the President, other authorized
persons or foreign heads of state or conduct special investigations.
Inmates. If
you are an inmate of a correctional institution or under the custody of
a law enforcement official, Agency may release medical information about
you to the correctional institution or law enforcement official. This
release would be necessary (i) for the institution to provide you with
health care; (ii) to protect your health and safety or the health and
safety of others; or (iii) for the safety and security of the correctional
institution.
With Your Authorization:
Other uses and disclosures of medical information not covered by this
Notice or the laws that apply to Agency will be made only with your written
permission. If you provide Agency permission to use or disclose medical
information about you, by signing an authorization form, you may revoke
that permission, in writing, at any time. If you revoke your permission,
Agency will no longer use or disclose medical information about you for
the reasons covered by your written authorization. You understand that
Agency is unable to take back any disclosures Agency has already made
with your permission, and that Agency is required to retain our records
of the healthcare services and supplies that Agency provided to you.
YOUR RIGHTS
You have the following rights regarding medical information Agency maintains
about you:
Right to Inspect and Copy. You have the right to inspect and copy medical
information that may be used to make decisions about your care. Usually,
this includes medical and billing records, but does not include psychotherapy
notes.
To inspect and copy medical information that may be used to make decisions
about you, you must submit Agency’s Request for Access Form in writing
at the following address: 5353 Truxtun Avenue, Bakersfield CA 93309. This
Form is available by writing to the Attention of the Privacy Officer at
the address listed above or by calling 661- 395-5800. If you request a
copy of the information, Agency may charge a fee for the costs of copying,
mailing or other services and supplies associated with your request.
Agency may deny your request to inspect and copy your medical information
in certain very limited circumstances. If you are denied access to medical
information, you may request that the denial be reviewed. Another licensed
health care professional chosen by Agency will review your request and
the denial. The person conducting the review will not be the person who
denied your request. Agency will comply with the outcome of the review.
Right to Amend. If you feel that medical information Agency has about
you is incorrect or incomplete, you may ask Agency to amend the information.
You have the right to request an amendment for as long as the information
is kept by or for Agency.
To request an amendment, you must submit Agency’s Request for Amendment
Form in writing at the address below. This Form is available by writing
to Attention Privacy Officer c/o Around the Clock Home Care 5353 Truxtun
Avenue Bakersfield, CA 93309 or calling 661- 395-5800. In addition, you
must provide a reason that supports your request.
Agency may deny your request for an amendment if it is not in writing
or does not include a reason to support the request. In addition, Agency
may deny your request if you ask Agency to amend information that: (i)
was not created by Agency, unless the person or entity that created the
information is no longer available to make the amendment; (ii) is not
part of the medical information kept by or for the Agency; (iii) is not
part of the information which you would be permitted to inspect and copy;
or (iv) is accurate and complete.
Right to Submit Addendum.
For California patients only, you have the right to submit a 250 word
letter (i.e., “addendum”) to be added to your medical records
indicating that you believe information in your medical record is incomplete
or incorrect.
Right to an Accounting of Disclosures.
You have the right to request an “accounting of disclosures.”
This is a list of the disclosures Agency made of medical information about
you. An accounting of disclosures will not include disclosures for treatment
activities of Agency or other healthcare providers, disclosures for payment
activities of Agency or other healthcare providers, disclosures for healthcare
operation activities of Agency, disclosures made pursuant to your authorization,
disclosures made prior to April 14, 2003, and certain other disclosures.
To request this list or accounting of disclosures, you must submit Agency’s
Request for Accounting Form in writing at the address below. This Form
is available by writing to Attention Privacy Officer c/o Around The Clock
Home Care 5353 Truxtun Avenue Bakersfield, CA 93309 or calling 661-395-5800.
The first accounting of disclosures list you request within a 12-month
period will be free. For additional lists, Agency may charge you for the
costs of providing the list. Agency will notify you of the cost involved
and you may choose to withdraw or modify your request at that time before
you have to pay anything.
Right to Request Restrictions. You have
the right to request a restriction or limitation on the medical information
Agency uses or discloses about you for treatment, payment or health care
operations. You also have the right to request a limit on the medical
information Agency discloses about you to someone who is involved in your
care or the payment for your care, like a family member or friend. For
example, you could ask that Agency not use or disclose information about
a healthcare service or supply you received.
Agency is not required to agree to your request.
If Agency does agree, Agency will comply with your request unless the
information is needed to provide you emergency treatment.
To request restrictions, you must submit your request in writing to the
address and number listed in this notice. Only the Privacy Officer of
the Agency can approve a special restriction. In your request, you must
tell Agency: (i) what information you want to limit; (ii) whether you
want to limit Agency’s use, disclosure or both; and (iii) to whom
you want the limits to apply (for example, disclosures to your spouse).
Right to Request Confidential Communications.
You have the right to request that Agency communicate with you about medical
matters in a certain way or at a certain location. For example, you can
ask that Agency only contact you at work or by mail.
To request confidential communications, you may submit your request in
writing at the following address: Attention Privacy Officer c/o Around
The Clock Home Care 5353 Truxtun Avenue Bakersfield, CA 93309 or calling
661-395-5800. Agency will not ask you the reason for your request. Agency
will accommodate all reasonable requests. Your request must specify how
or where you wish to be contacted.
Right to a Paper Copy of This Notice. You
have the right to a paper copy of this Notice. A copy of this notice will
be left with you at the time of your initial visit. To obtain further
copies of this Notice, you may write or call the Agency at the address
and number listed in this notice.
QUESTIONS AND CONCERNS
If you have any questions about this Notice or concerns about your privacy,
please feel free to contact us at the number and address below. If you
believe your privacy rights have been violated, you may file a complaint
with Agency or with the Secretary of the U.S. Department of Health and
Human Services (DHHS). All complaints must be submitted in writing. You
will not be penalized for filing a complaint. Please contact Agency at:
Around the Clock Home Care
5353 Truxtun Avenue
Bakersfield, California 93309
Attention: Privacy Officer
Phone: 661-395-5800
Fax: 661-864-0732
To file a complaint with DHHS, write to: U.S. Department of Health and
Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201.
CHANGES TO THIS NOTICE
Agency reserves the right to change this Notice. Agency reserves the right
to make the revised or changed Notice effective for medical information
Agency already has about you as well as any information Agency receives
in the future. The Notice will contain on the first page, in the top right-hand
corner, the effective date. You may request a copy of this Notice or an
update of this Notice at any time.
SIGNED ACKNOWLEDGEMENT
Agency will seek to obtain your signed acknowledgement that you have received,
read and understand this Notice. If Agency is unable to obtain your signature,
Agency will make a notation in your medical records as to the reason why.
It is your responsibility to fax or mail your signed acknowledgement to
Agency at the address below.
Around the Clock Home Care
5353 Truxtun Avenue
Bakersfield, California 93309
Attention: Privacy Officer
Phone: 661-395-5800
Fax: 661-864-0732
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