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.
Senior Abilities Unlimited, LLC, “Company”, is required to maintain the privacy of your health information and to provide you with this Notice about our privacy practices, legal duties and your rights concerning your protected health information (“PHI”). If you have questions about any part of this Notice or if you want more information about the privacy practices at Company, please contact:
Senior Abilities Unlimited, LLC
7401 Metro Boulevard
Edina, MN 55439
Effective Date of This Notice: 4/14/2003
I. HOW COMPANY MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION (“PHI”). Company collects protected health information (“PHI”) from you and stores it in one or more ways including, but not limited to, paper charts and files, electronic media, and computer storage. This is your medical record. The medical record is the property of Company, but the PHI in the medical record belongs to you. Company protects the privacy of your PHI. Company is legally permitted to use or disclose your PHI for the following purposes:
Treatment: Company may use and disclose your PHI to provide, coordinate or manage your health care and related services. We may consult with other health care providers regarding your treatment and coordinate and manage your health care with others. For example, we may use and disclose your PHI with your care manager. In addition, we may use and disclose your PHI about you when referring you to another health care provider. For example, if you are referred to an orthotist, we may disclose your PHI to him or her regarding your level of function, time since start of care and progress.
Payment: Company may use and disclose your PHI so that we can bill and collect payment for the treatment and services provided to you. 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. We may use and disclose your PHI for billing, claims management, and collection activities. We may disclose limited parts of your PHI to consumer reporting agencies relating to collection of payments owed to us.
Health Care Operations: Company may use your PHI in connection with our health care operations. Health care operations include quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, and certification, licensing and credentialing activities.
Your Authorization: In addition to Company’s use of your PHI for treatment, payment and health care operations, you may give us written authorization to use or disclose your PHI to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosure of your PHI permitted while the authorization was in effect. Unless you give us a written authorization, we cannot use or disclose your PHI except as set forth in this Notice.
Disclosures to you, your family and friends: Company will disclose your PHI to you as described in the Patient Rights section of this Notice. We may disclose your PHI to a family member, friend or other person to the extent necessary to help with your health care, but only if you agree that we may do so. For example, we may send a written progress report to your nominated family members and friends.
Notification and communication with family: Company may disclose your PHI to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
Required by law: Company may use and disclose your PHI information when required to do so by law.
Public health: Company may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting a vulnerable adult abuse or neglect; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
Health oversight activities: Company may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
Law enforcement: Company may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
Deceased person information: Company may disclose your health information to coroners, medical examiners and funeral directors.
Public safety: Company may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or
the general public.
Worker’s compensation: Company may disclose your health information as necessary to comply with worker’s compensation laws.
Appointment Reminders and Treatment Information: Company may contact you to provide
appointment reminders or to give you information about other treatments or health-related
services that may be of interest to you. This may include voice mail messages, postcards, letters, e-mail and other forms of communications.
II. WHEN COMPANY MAY NOT USE OR DISCLOSE YOUR HEALTH INFORMATION. Except as described in this Notice of Privacy Practices, Company will not use or disclose your health information without your written authorization. If you do authorize Company to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
III. YOUR HEALTH INFORMATION RIGHTS.
1. You have the right to request restrictions on certain uses and disclosures of your health
information. Company is not required to agree to the restriction that you requested.
2. You have the right to receive your health information through reasonable alternative means or at an alternative location.
3. You have the right to inspect and copy your health information. Company may impose a
charge for copying expenses.
4. You have a right to request that Company amend your health information that is incorrect or incomplete. Company is not required to change your health information and will provide you with information about Company denial and how you can disagree with the denial.
5. You have a right to receive an accounting of disclosures of your health information made by Company, except that Company does not have to account for the disclosures for treatment, payment, health care operations, information provided to you, and certain government functions described above.
6. You have a right to a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact the Company as detailed on page one.
IV. CHANGES TO THIS NOTICE OF PRIVACY PRACTICES. Company reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment. Until such amendment is made, Company is required by law to comply with this Notice.
V. COMPLAINTS. Complaints about this Notice of Privacy Practices or how Company handles your health information should be directed to Company as detailed on page one.
If you are not satisfied with Company’s response, you may file a complaint with:
Region V, Office for Civil Rights
U.S. Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601
Ph: 312-886-2359 Fax: 3l2-886-1807 TDD: 312-353-5693
Alternatively, you may email a complaint to: OCRComplain@hhs.gov
For further information, contact:
Office for Civil Rights
Department of Health and Human Services Mail Stop Room 506F
Hubert H. Humphrey Building
200 Independence Avenue SW, Washington, DC 20201