As
a private duty healthcare company providing individual and personalized care,
Angels On Loan, Inc. is committed to meeting your needs. That commitment includes protecting personal
information we obtain about you.
Angels On Loan, Inc. keeps your Protected
Health Information (PHI) confidential to the extent required by law. An example of PHI would be your name,
address, telephone number, social security number, medical history and physical
condition. Be assured that Angels On
Loan, Inc. has a policy regarding the confidentiality of client PHI and we
require each employee to sign a Confidentiality Agreement when they begin
working with Angels On Loan, Inc. We
restrict access to your personal health information to those employees who need
to know that information in order to provide personalized care for you. We maintain physical, electronic, and
procedural safeguards in order to ensure that your PHI is adequately protected.
Angels On Loan, Inc. does
not require your written authorization to disclose your Protected
Health Information (PHI) when necessary or appropriate for your care or
treatment, for operation of our services and business or other related
activities. Examples of how we use your
personal information include:
Ø
Coordination
of your care with your physician, dentist, nurse practitioner, therapist, RN
case manager and your caregivers
Ø
Providing
copies of your physician’s signed Plan of Care and copies of caregiver notes
and flow sheets in order to obtain payment from your insurance company on your
behalf
Ø
Activities
authorized by law for Health Oversight agencies
Ø
In
response to a court or administrative order
Ø
To
reduce or prevent a serious threat to your health and safety or the health and
safety of another individual or the public
Ø
Federal
officials for intelligence and national security activities authorized by law
Angels
On Loan, Inc. does require your written authorization in order to
disclose your Protected Health Information (PHI) for any purposes other than
those listed above.
The
Privacy Rule under the Health Insurance Portability and Accountability Act of
1996 provides that you have the right to:
Ø
Request
restrictions on use of your information
Ø
Request
confidential communications by an alternate means or alternate location
Ø
Inspect
and copy your health information, except as excluded by law
Ø
Request
personal health information be corrected or amended
Ø
Request
an accounting of disclosures
Ø
Request
a copy of the Privacy Notice
If you believe
your rights have been violated, please contact the Privacy Officer at Angels On
Loan, Inc. Complaints may also be made
to the Secretary of Health and Human Services at (866) 627-7748.
We
understand that medical information about you and your health is personal. We
are committed to protecting medical information about you.
This notice describes how medical
information about you may be used and disclosed and how you can get access to
this information.
If you have any questions about this
Notice please contact:
Health Information Systems Manager
4024 Central Avenue, P.O. Box 10970
St. Petersburg, FL 33733-0970
(727) 327-7656, ext. 4139
This Notice of Privacy Practices describes how we may use and disclose your
protected health information to carry out treatment, payment or health care
operations and for other purposes that are permitted or required by law. It
also describes your rights to access and control your protected health
information. “Protected health information” is information about you, including
demographic information, that may identify you and that relates to your past,
present or future physical or mental health or condition and related health
care services.
We are required by law to:
HOW WE MAY USE AND DISCLOSE PERSONAL
HEALTH INFORMATION ABOUT YOU
You will be asked by the medical staff, clinical staff
or case manager to sign a consent form. Once you have consented to use and
disclosure of your protected health information for treatment, payment and
health care operations by signing the consent form, agency staff will use or
disclose your protected health information as described in this section. Your
protected health information may be used and disclosed by the medical staff,
our office staff and others outside of our office that are involved in your
care and treatment for the purpose of providing health care services to you.
Your protected health information may also be used and disclosed to pay your
health care bills and to support the operation of the agency’s practice.
Following are examples of the types of uses and disclosures of your protected
health care information that the Suncoast Center is
permitted to make once you have signed our consent form. These examples are not
meant to be exhaustive, but to describe the types of uses and disclosures that
may be made by our office once you have provided consent.
Treatment: We will use and
disclose your protected health information to provide, coordinate, or manage
your health care and any related services. This includes the coordination or
management of your health care with a third party that has already obtained
your permission to have access to your protected health information. For
example, we may disclose your protected health information, as necessary, to
another agency that provides care to you. We may also disclose protected health
information to other physicians who may be treating you when we have the
necessary permission from you to disclose your protected
health information. For example, your protected health information may be
provided to a physician to whom you have been referred to ensure that the
physician has the necessary information to diagnose or treat you.
Payment: We will use your health information for payment. 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. For example: A bill may be sent to you or a
third-party payer. The information on or accompanying the bill may include
information that identifies you, as well as your diagnosis, procedures, and
supplies used. Information may also be used for obtaining approval for day treatment
may require that your relevant protected health information be disclosed to the
health plan to obtain approval for day treatment services.
Health Care Operations: We
may use and disclose medical information about you for agency operations. These
uses and disclosures are necessary to run the agency and make sure that all of
our clients receive quality care. For example:
Members of the medical staff, the risk or quality improvement manager, or
members of the quality improvement team may use information in your health
record to assess the care and outcomes in your case and others like it. This
information will then be used in an effort to continually improve the quality
and effectiveness of the healthcare and service we provide. We may remove information
that identifies you from this set of medical information so others may use it
to study health care and health care delivery without learning who the specific
clients are.
We may disclose your protected health information to interns or students that see
clients at our agency locations. In addition, we may also call you by name in
the waiting room when staff is ready to see you. We may use or disclose your
protected health information, as necessary, to contact you to remind you of
your appointment.
We will share your protected health information with third party “business
associates” that perform various activities (e.g., pharmacy, billing, transcription services) for the practice. Whenever an
arrangement between our office and a business associate involves the use or
disclosure of your protected health information, we will have a written
contract that contains terms that will protect the privacy of your protected
health information.
OTHER USES AND
DISCLOSURES BASED UPON YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of all or part of your
protected health information will be made only with your written authorization,
unless otherwise permitted or required by law as described below. You have the
opportunity to agree or object to the use or disclosure of protected health
information. If you are not present or able to agree or object to the use or
disclosure of the protected health information, then your physician 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
health care will be disclosed. You may revoke this authorization, at any time,
in writing.
Individuals Responsible for Your
Care: Florida Statute 394.4615 states that your clinical record shall
be released when: the patient or the patient's guardian authorizes the release.
If you have a guardian or guardian advocate shall be provided access to the
appropriate clinical records of the patient. The patient or the patient's guardian
or guardian advocate may authorize the release of information and clinical
records to appropriate persons to ensure the continuity of the patient's health
care or mental health care. The parent, next of kin, or guardian of a person
who is treated under a mental health facility or program may receive a limited
to a summary of that person's treatment plan and current physical and mental
condition. Release of such information shall be in accordance with the code of
ethics of the profession involved.
Emergencies: We may use or
disclose your protected health information in an emergency treatment situation.
If this happens, the agency shall try to obtain your consent as soon as
reasonably practicable after the delivery of treatment. If your agency staff is
required by law to treat you and the agency has attempted to obtain your
consent but is unable to obtain your consent, he or she may still use or
disclose your protected health information to treat you.
Research: Under certain
circumstances, we may use and disclose medical information about you for
research purposes. For example, a research project may involve comparing the
health and recovery of all patients who received one medication to those who
received another, for the same condition. 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 we use or disclose medical information for research, the project will
have been approved through this research approval process, but we may, however,
disclose medical information about you to people preparing to conduct a
research project, for example, to help them look for patients with specific
medical needs, so long as the medical information they review does not leave
the agency. We will almost always ask for your specific permission if the
researcher will have access to your name, address or other information that
reveals who you are, or will be involved in your care at the agency.
OTHER
PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR
CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT
Required By Law: We may use
or disclose your protected health information to the extent that the use or
disclosure is required by law. The use or disclosure will be made in compliance
with the law and will be limited to the relevant requirements of the law. You
will be notified, as required by law, of any such uses or disclosures.
To Avert a Serious Threat to Health
or Safety: We 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.
Public Health Risks: We may
disclose medical information about you for public health activities.
These activities generally include the following:
Abuse or
Neglect:
We may disclose your protected health information to a public health authority
that is authorized by law to report the abuse or neglect of children, elders
and dependent adults; to notify the appropriate government authority if we
believe a patient has been the victim of abuse, neglect or domestic violence.
We will only make this disclosure if you agree or when required or authorized
by law.
Health Oversight: We may
disclose protected health information to a health oversight agency for
activities authorized by law, such as audits, investigations, and inspections.
Oversight agencies seeking this information include government agencies that
oversee the health care system, government benefit programs, other government
regulatory programs and civil rights laws.
Legal Proceedings: The court
orders such release. In determining whether there is good cause for disclosure,
the court shall weigh the need for the information to be disclosed against the
possible harm of disclosure to the person to whom such information pertains;
Information may be released if the patient is represented by counsel and the
records are needed by the patient's counsel for adequate representation.
(Florida Statute 394.4615)
A patient has declared an intention to harm other persons. When such
declaration has been made, the administrator may authorize the release of
sufficient information to provide adequate warning to the person threatened
with harm by the patient. These law enforcement purposes include (1) legal
processes and otherwise required by law, (2) limited information requests for
identification and location purposes, (3) pertaining to victims of a crime, (4)
suspicion that death has occurred as a result of criminal conduct, (5) in the
event that a crime occurs on the premises of the practice, and (6 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.
Military and Veterans: When
the appropriate conditions apply, we may use or disclose protected health
information of individuals who are Armed Forces personnel for the purpose of a
determination by the Department of Veterans Affairs of your eligibility for
certain benefits.
National Security: We may
also disclose your protected health information to authorized federal officials
for conducting national security and intelligence activities, including for the
provision of protective services to the President of the United States or
others legally authorized.
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.
These programs provide benefits for work-related injuries or illness.
Coroners: We 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.
Research: Information from
clinical records may be used for statistical and research purposes if the
information is abstracted in such a way as to protect the identity of
individuals.
Inmates: The patient is
committed to, or is to be returned to, the Department of Corrections from the
Department of Children and Family Services, and the Department of Corrections
requests such records. These records shall be furnished without charge to the
Department of Corrections.
Required Uses and Disclosures:
Under the law, we must make disclosures to 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 Section 164.500 et. seq.
CLIENT RIGHTS
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, unless such access is determined by the
patient’s psychiatrist to be harmful to the patient..
Usually, this includes medical and billing records, but may not include the
following records: psychotherapy notes; information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative action or
proceeding, and protected health information that is subject to law that
prohibits access to protected health information.
To inspect and copy medical information that may be used to make decisions
about you, you must submit your request in writing to the HIS Supervisor at the
address listed at the top of this notice. If you request a copy of the
information, we may charge a fee for the costs of copying, mailing or other
supplies associated with your request.
We may deny your request to inspect and copy in certain circumstances. You will
be notified in writing of the reason your request is denied. In addition, the
restriction will be recorded in the medical record. If you are denied access to
medical information, you may request that the denial be reviewed. Another
licensed health care professional chosen by the agency will review your request
and the denial. The person conducting the review will not be the person who
denied your request. We will comply with the outcome of the review. The
restriction of a patient’s right to inspect his or her clinical record shall
expire after 7 days but may be renewed, after review, for subsequent 7-day
periods (Fla. Statute 394.4615).
Right to Request Restrictions:
You have the right to request a restriction or limitation on the medical
information we use or disclose about you for treatment, payment or health care
operations. You also have the right to request a limit on the medical
information we disclose about you to someone who is involved in your care or
the payment for your care, like a family member or friend.
We are not required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide you emergency
treatment. To request restrictions, you must make your request in writing to
the HIS Supervisor at the address listed at the top of this notice. In your
request, you must tell us (1) what information you want to limit; (2) whether
you want to limit our use, disclosure or both; and (3) to whom you want the
limits to apply, for example, disclosures to your spouse.
Right to Amend
your Protected Health Information: If you feel that medical information
we have about you is incorrect or incomplete, you may ask us to amend the
information. You have the right to request an amendment for as long as the
information is kept by the agency.
To request an amendment, your request must be made in writing and submitted to
the HIS Supervisor at the address listed at the top of this notice. In
addition, you must provide a reason that supports your request.
We 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, we may deny your request
if you ask us to amend information that:
Right to an
Accounting of Disclosures: You have the right to request an
“accounting of disclosures.” This is a list of the disclosures we made of
medical information about you other than our own uses for treatment, payment
and health care operations, as those functions are described above. The right
to receive this information is subject to certain exceptions, restrictions and
limitations.
To request this list or accounting of disclosures, you must submit your request
in writing to the HIS Supervisor at the address listed at the top of this
notice. Your request must state a time period which may not be longer than six
years and may not include dates before April 14, 2003. We may charge you for
the costs of providing the list. We will notify you of the cost involved and
you may choose to withdraw or modify your request at that time before any costs
are incurred.
Right to Request Confidential
Communications: You have the right to request that we communicate with
you about medical matters in a certain way or at a certain location. For
example, to request confidential communications, you must make your request in
writing to HIS Supervisor at the address listed at the top of this notice. We
will not ask you the reason for your request. We will accommodate all
reasonable requests. Your request must specify how or where you wish to be
contacted.
COMPLAINTS
You may complain 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 contact of your
complaint.
You will not be penalized for filing a complaint.
You may contact our Compliance Officer at (727) 327-7656 extension 4145 or
planeval@suncoastcenter.com for further information about the complaint
process.
CHANGES TO
THIS NOTICE
We reserve the right to change this notice. We reserve
the right to make the revised or changed notice effective for medical
information we already have about you as well as any information we receive in
the future. We will post a copy of the current notice. The notice will contain
the effective date. In addition, we will offer you a copy of the current notice
in effect.