Patient Privacy Rights
KAREN ANN QUINLAN MEMORIAL FOUNDATION
d/b/a Karen Ann Quinlan Hospice / Karen Ann Quinlan Home
Care
NOTICE OF PRIVACY PRACTICES
I. 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.
II. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED
HEALTH INFORMATION (PHI).
We are legally required to protect the privacy of your
health information. We call this information “protected
health information,” or “PHI” for short. It includes
information that can be used to identify you and that
we’ve created or received about your past, present, or
future health condition, the provision of health care to
you, or the payment for this health care. We are
required to provide you with this notice about our
privacy practices. It explains how, when, and why we use
and disclose your PHI. With some exceptions, we may not
use or disclose any more of your PHI than is necessary
to accomplish the purpose of the use or disclosure. We
are legally required to follow the privacy practices
that are described in this notice.
We reserve the right to change the terms of this notice
and our privacy policies at any time. Any changes will
apply to the PHI we already have. Whenever we make an
important change to our policies, we will promptly
change this notice, post a new notice in the main
reception area, and provide you with a copy of the new
notice at your next visit. You can also request a copy
of this notice from the contact person listed in Section
IV below at any time and can view a copy of this notice
on our Web site at KarenAnnQuinlanHospice.org.
III. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION.
We use and disclose health information for many
different reasons. For some of these uses or
disclosures, we need your specific authorization. Below,
we describe the different categories of uses and
disclosures.
A. Uses and Disclosures Which Do Not Require Your
Authorization.
We may use and disclose your PHI without your
authorization for the following reasons:
1. For treatment. We may disclose your PHI to hospitals,
physicians, nurses, and other health care personnel in
order to provide, coordinate or manage your health care
or any related services, except where the PHI is related
to HIV/AIDS, genetic testing, or federally funded drug
or alcohol abuse treatment facilities, or where
otherwise prohibited pursuant to State or Federal law.
For example, we may disclose PHI to a pharmacy to fill a
prescription, or to a laboratory to order a blood test.
2. To obtain payment for treatment. We may use and
disclose your PHI in order to bill and collect payment
for the treatment and services provided to you. For
example, we may provide portions of your PHI to our
billing staff and your health plan to get paid for the
health care services we provided to you. We may also
disclose patient information to another provider
involved in your care for the other provider’s payment
activities. For example we may disclose your demographic
information to anesthesia care providers for payment of
their services.
3. For health care operations. We may disclose your PHI,
as necessary, to operate this facility and provide
quality care. For example, we may use your PHI in order
to evaluate the quality of health care services that you
received or to evaluate the performance of the health
care professionals who provided health care services to
you. We may also provide your PHI to our accountants,
attorneys, consultants, and others in order to make sure
we’re complying with the laws that affect us.
4. When a disclosure is required by federal, state or
local law, judicial or administrative proceedings, or
law enforcement. For example, we may disclose PHI when a
law requires that we report information to government
agencies and law enforcement personnel about victims of
abuse, neglect, or domestic violence; when dealing with
gunshot or other wounds; for the purpose of identifying
or locating a suspect, fugitive, material witness or
missing person; or when subpoenaed or ordered in a
judicial or administrative proceeding.
5. For public health activities. For example, we may
disclose PHI to report information about births, deaths,
various diseases, adverse events and product defects to
government officials in charge of collecting that
information; to prevent, control, or report disease,
injury or disability as permitted by law; to conduct
public health surveillance, investigations and
interventions as permitted or required by law; or to
notify a person who has been exposed to a communicable
disease or who may be at risk of contracting or
spreading a disease as authorized by law.
6. For health oversight activities. For example, we may
disclose PHI to assist the government or other health
oversight agency with activities including audits;
civil, administrative, or criminal investigations,
proceedings or actions; or other activities necessary
for appropriate oversight as authorized by law.
7. To coroners, funeral directors, and for organ
donation. We may disclose PHI to organ procurement
organizations to assist them in organ, eye, or tissue
donations and transplants. We may also provide coroners,
medical examiners, and funeral directors necessary PHI
relating to an individual's death.
8. For research purposes. In certain circumstances, we
may provide PHI in order to conduct medical research.
9. To avoid harm. In order to avoid a serious threat to
the health or safety of you, another person, or the
public, we may provide PHI to law enforcement personnel
or persons able to prevent or lessen such harm.
10. For specific government functions. We may disclose
PHI of military personnel and veterans in certain
situations. We may also disclose PHI for national
security and intelligence activities.
11. For workers’ compensation purposes. We may provide
PHI in order to comply with workers’ compensation laws.
12. Appointment reminders and health-related benefits or
services. We may use PHI to provide appointment
reminders or give you information about treatment
alternatives, or other health care services or benefits
we offer. Please let us know if you do not wish to have
us contact you for these purposes, or if you would
rather we contact you at a different telephone number or
address.
B. Uses and Disclosures Where You to Have the
Opportunity to Object:
1. Disclosures to family, friends, or others. We may
provide your PHI to a family member, friend, or other
person that you indicate is involved in your care or the
payment for your health care, unless you object in whole
or in part.
C. All Other Uses and Disclosures Require Your Prior
Written Authorization. Other than as stated above, we
will not disclose your PHI without your written
authorization. You can later revoke your authorization
in writing except to the extent that we have taken
action in reliance upon the authorization.
D. Incidental Uses and Disclosures. Incidental uses and
disclosures of information may occur. An incidental use
or disclosure is a secondary use or disclosure that
cannot reasonably be prevented, is limited in nature,
and that occurs as a by-product of an otherwise
permitted use or disclosure. However, such incidental
uses or disclosure are permitted only to the extent that
we have applied reasonable safeguards and do not
disclose any more of your PHI than is necessary to
accomplish the permitted use or disclosure. For example,
disclosures about a patient within the patient’s home
that might be overheard by persons not involved in the
patient’s care would be permitted.
IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI.
You have the following rights with respect to your PHI:
A. The Right to Request Limits on Uses and Disclosures
of Your PHI. You have the right to request in writing
that we limit how we use and disclose your PHI. You may
not limit the uses and disclosures that we are legally
required to make. We will consider your request but are
not legally required to accept it. If we accept your
request, we will put any limits in writing and abide by
them except in emergency situations. Under certain
circumstances, we may terminate our agreement to a
restriction.
B. The Right to Choose How We Send PHI to You. You have
the right to ask that we send information to you at an
alternate address (for example, sending information to
your work address rather than your home address) or by
alternate means (for example, via e-mail instead of
regular mail). We must agree to your request so long as
we can easily provide it in the manner you requested.
C. The Right to See and Get Copies of Your PHI. In most
cases, you have the right to look at or get copies of
your PHI that we have, but you must make the request in
writing. If we don’t have your PHI but we know who does,
we will tell you how to get it. We will respond to you
within 30 days after receiving your written request. In
certain situations, we may deny your request. If we do,
we will tell you, in writing, our reasons for the denial
and explain your right to have the denial reviewed.
If you request a copy of your information, we may charge
you a reasonable fee for the costs of copying, mailing
or other costs incurred by us in complying with your
request. Instead of providing the PHI you requested, we
may provide you with a summary or explanation of the PHI
as long as you agree to that and to the cost in advance.
D. The Right to Get a List of the Disclosures We Have
Made. You have the right to get a list of instances in
which we have disclosed your PHI. The list will not
include uses or disclosures made for purposes of
treatment, payment, or health care operations, those
made pursuant to your written authorization, or those
made directly to you or your family. The list also won’t
include uses and disclosures made for national security
purposes, to corrections or law enforcement personnel,
or prior to April 14, 2003.
We will respond within 60 days of receiving your written
request. The list we will give you will include
disclosures made in the last six years unless you
request a shorter time. The list will include the date
of the disclosure, to whom PHI was disclosed (including
their address, if known), a description of the
information disclosed, and the reason for the
disclosure. We will provide one (1) list during any
12-month period without charge. Subsequent requests may
be subject to a reasonable cost-based fee.
E. The Right to Correct or Update Your PHI. If you
believe that there is a mistake in your PHI or that a
piece of important information is missing, you have the
right to request, in writing, that we correct the
existing information or add the missing information. You
must provide the request and your reason for the request
in writing. We will respond within 60 days of receiving
your request in writing. We may deny your request if the
PHI is (i) correct and complete, (ii) not created by us,
(iii) not allowed to be disclosed, or (iv) not part of
our records. Our written denial will state the reasons
for the denial and explain your right to file a written
statement of disagreement with the denial. If you don’t
file one, you have the right to have your request and
our denial attached to all future disclosures of your
PHI. If we approve your request, we will make the change
to your PHI, tell you that we have done it, and tell
others that need to know about the change to your PHI.
F. The Right to Get This Notice by E-Mail. You have the
right to get a copy of this notice by e-mail. Even if
you have agreed to receive notice via e-mail, you also
have the right to request a paper copy of this notice.
V. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES.
If you think that we may have violated your privacy
rights, or you disagree with a decision we made about
access to your PHI, you may file a complaint with the
person listed in Section VI below. You also may send a
written complaint to the Secretary of the Department of
Health and Human Services at 200 Independence Ave.,
S.W.; Room 615F; Washington, DC 20201. We will take no
retaliatory action against you if you file a complaint
about our privacy practices.
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE
OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES.
If you have any questions about this notice or any
complaints about our privacy practices, or would like to
know how to file a complaint with the Secretary of the
Department of Health and Human Services, please contact:
Director of Social Services, Karen Ann Quinlan Hospice/KAQ
Home Care, 99 Sparta Avenue, Newton, NJ 07860,
973-383-0115.
VII. EFFECTIVE DATE OF THIS NOTICE
This notice is effective April 14, 2003.
|
