BROE
REHABILITATION SERVICES, INC.
(referred
to in this document as “the practice”
NOTICE
OF PRIVACY PRACTICES
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 of Privacy Practices is being provided to you as a requirement of the
Health Insurance Portability and Accountability Act (HIPAA). This Notice 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 in some cases. Your “protected health information” means any
of your written and oral health information, including demographic data that
can be used to identify you. This is
health information that is created or received by your health care provider,
and that relates to your past, present, or future physical or mental health or
condition.
I.
How
We May Use and Disclose Protected Health Information About You
The
Practice will share protected health information as necessary to carry out
treatment, obtain payment for treatment, or conduct health care
operations. Your protected health
information may be used or disclosed only for these purposes unless the
Practice has obtained your authorization or the use and disclosure is otherwise
permitted by the HIPAA Privacy Regulations or State law. Disclosures of your protected health
information for the purposes described in this Notice may be made in writing,
orally, or by facsimile.
A.
For
Treatment. We will use and
disclose your protected health information to provide, coordinate, or manage
your health care and related services.
This includes the coordination or management of your health care with a
third party for treatment purposes. For
example, we may disclose your protected health information to doctors, nurses,
hospitals and other health facilities who become involved in your care. We may consult with other health care
providers concerning you and, as part of the consultation, share your protected
health information with them. Similarly,
we may refer you to another health care provider and, as part of the referral,
share your protected health information with that provider. For example, we may conclude you need to
receive services from a physician with a particular specialty. When we refer you to that physician, we also
will contact that physician’s office and provide protected health information
about you to them so they have information they need to provide services for
you.
B.
For
Payment. Your protected
health information will be used, as needed, to obtain payment for the services
that we provide. This may include
billing you, your insurance company, or a third party payor. For example, we may need to give your
insurance company information about the health care services we provide to you
so your insurance company will pay us for those services or reimburse you for
amounts you have paid. We also may need
to provide your insurance company or a government program, such as Medicare or
Medicaid, with information about your medical condition and the health care you
need to receive to determine if you are covered by that insurance or
program. We may also disclose protected
health information to another provider involved in your care for the other
provider’s payment activities.
C.
For Health Care Operations. We may use or disclose your protected health
information, as necessary, for our own health care operations in order to
facilitate the function of the practice and to provide quality care to all
consumers. For example, we may use your
protected health information to review the services we provide and the
performance of our employees in caring for you.
We may disclose protected health information about you to train our
staff, volunteers and students working in Broe Rehabilitation Services, Inc. We also may use the information to study ways
to more efficiently manage our organization.
In certain situations, we may also disclose patient information to
another provider or health plan for their heath care operations.
D.
How
We Will Contact You. Unless you tell us otherwise in writing, we
may contact you by either telephone or by mail at either your home or your
workplace. At either location, we may
leave messages for you on the answering machine or voice mail. If you want to request that we communicate to
you in a certain way or at a certain location, see the section of this Notice
entitled “Right to Receive Confidential Communications”.
E.
Appointment Reminders. We may use and disclose protected health
information about you to contact you to remind you of an appointment or team
meeting you have with us.
F.
Treatment Alternatives. We may use and disclose protected health
information about you to contact you about treatment alternatives that may be
of interest to you.
G.
Health Related Benefits and
Services. We may use and
disclose protected health information about you to contact you about
health-related benefits and services that may be of interest to you.
H.
Marketing Communications. We may use and disclose protected health
information about you to communicate with you about a product or service to
encourage you to purchase the product or service. This may be:
·
To describe a health-related product or service that is
provided by us;
·
For your treatment;
·
For case management or care coordination for you;
·
To direct or recommend alternative treatments, therapies,
health care providers, or settings of care.
We may communicate to you about products and services in a face-to-face
communication by us to you. We also may
communicate about products or services in the form of a promotional gift of
nominal value.
All other use and disclosure of protected health information about you
by us to make a communication about a product or service to encourage the
purchase or use of a product or service will be done only with your written
authorization.
I.
Fundraising. We may use and disclose protected health
information about you to contact you to raise funds for Broe Rehabilitation
Services, Inc. We may disclose protected
health information to a business associate of Broe Rehabilitation Services,
Inc. or a foundation related to Broe Rehabilitation Services, Inc. so that
business associate or foundation may contact you to raise money for the benefit
of Broe Rehabilitation Services, Inc. We
will only release demographic information, such as your name and address, and
the dates you received treatment or services from Broe Rehabilitation Services,
Inc. If you do not want Broe
Rehabilitation Services, Inc. or its foundation to contact you for fundraising,
you must notify the Privacy Officer. Contact information for the Privacy
Officer is on the last page of this Notice.
J.
Individuals
Involved in Your Care. We may disclose to a family member, other
relative, a close personal friend, or any other person identified by you,
protected health information about you that is directly relevant to that
person’s involvement with your care or payment related to your care. We also may use or disclose protected health
information about you to notify, or assist in notifying, those persons of your
location, general condition, or death.
If there is a family member, other relative, or close personal friend
that you do not want us to disclose protected health information about you to,
please tell our staff member who is providing care to you, or notify the
Privacy Officer. Contact
information for the Privacy Officer is on the last page of this Notice.
K.
When
Legally Required. We will disclose
your protected health information when we are required to do so by any Federal,
State or local law.
L.
When
There are Risks to Public Health. We may disclose your protected health
information for the following public activities and purposes. This includes reporting protected health
information to a public health authority that is authorized by law to collect
or receive the information for the purposes of preventing or controlling
disease or, one that is authorized to receive reports of child abuse and
neglect. It also includes reporting for
purposes of activities related to the quality, safety, or effectiveness of a FDA
regulated product or activity.
M.
To
Report Abuse, Neglect, or Domestic Violence. We may notify government authorities
authorized by law to receive reports of abuse neglect, or domestic violence, if
we believe you are a victim of abuse, neglect, or domestic violence. This will occur to the extent the disclosure
is (a) required by law; (b) agreed to by you; or (c) authorized by law and we
believe the disclosure is necessary to prevent serious harm to you or to other
potential victims, or, if you are incapacitated and certain other conditions are
met, a law enforcement or other public official represents that immediate
enforcement activity depends on the disclosure.
N.
To
Conduct Health Oversight Activities. We may disclose your protected health
information to a health oversight agency for activities authorized by law,
including audits, investigations, inspections, licensure or disciplinary
actions. These and similar types of
activities are necessary for appropriate oversight of the health care system,
government benefit programs, and entities subject to various government
regulations.
O.
In Connection With Judicial and Administrative
Proceedings. We may
disclose your protected health information in the course of any judicial or
administrative proceeding in response to an order of a court or administrative
tribunal. We also may disclose
information in response to a subpoena, discovery request, or other legal
process, but only if efforts have been made to tell you about the request or to
obtain an order or a signed authorization protecting the information to be
disclosed.
P.
For
Law Enforcement Purposes. We may disclose your protected health
information to a law enforcement official for law enforcement purposes as
follows:
·
As required by law.
·
In response to a court order, court-ordered warrant,
subpoena, summons or similar process.
·
To identify or locate a suspect, fugitive, material
witness or missing person.
·
Under certain limited circumstances, when you are the
victim of a crime.
·
To a law enforcement official if the practice has a
suspicion that the death was the result of a criminal conduct.
·
In an emergency in order to report a crime.
Q.
To
Coroners, Funeral Directors, and for Organ Donation. We may disclose protected health information
to a coroner or medical examiner for purposes such as identifying a deceased
person and determining cause of death.
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
their duties. We may disclose such
information in reasonable anticipation of death. Protected health information may be used and
disclosed for cadaveric organ, eye or tissue donation purposes.
R.
For
Research Purposes.
We may use or disclose your protected health information for research
when the use or disclosure for research has been approved by an institutional
review board or privacy board that has reviewed the research proposal and
research protocols to address the privacy of your protected health information.
S.
For
Worker’s Compensation.
The practice may release your health information to comply with worker’s
compensation laws or similar programs.
T.
In
the Event of A Serious Threat to Health or Safety. We may, consistent with applicable law and
ethical standards of conduct, use or disclose your protected health information
if we believe, in good faith, that such use or disclosure is necessary to
prevent or lessen a serious and imminent threat to your health or safety or to
the health and safety of the public.
U.
For
Specified Government Functions. In certain circumstances, the Federal
regulations authorize the practice to use or disclose your protected health
information to facilitate specified government functions relating to military
and veterans activities, national security and intelligence activities, protective
services for the President and others, medical suitability determinations,
correctional institutions and law enforcement custodial situations.
II. Uses and Disclosures Permitted Without Authorization But With
We may disclose your
protected health information to your family member or a close personal friend
if it is directly relevant to the person’s involvement in your care or payment
related to your care. We can also
disclose your information in connection with trying to locate or notify family
members or others involved in your care concerning your location, condition or
death.
You may object to these
disclosures. If you do not object to
these disclosures or we can infer from the circumstances that you do not object
or we determine, in the exercise of our professional judgment, that it is in
your best interests for us to make disclosure of information that is directly
relevant to the person’s involvement with your care, we may disclose your
protected health information as described.
III. Uses and
Disclosures Which You Authorize
Other than as stated
above, we will not disclose your health information other than with your
written authorization. You may revoke
your authorization in writing at any time except to the extent that we have
taken action in reliance upon the authorization.
IV. Your Rights
You have the following
rights regarding your health information:
A.
Right to request
restrictions. You have the right to request a restriction
or limitation on the health information we use or disclose about your for
treatment, payment or health care operations.
You may also request that we restrict the uses or disclosures we make to
family members or friends who may be involved in your care or for notifications
purposes as described in the Notice of Privacy Practices. Your request must state the specific
restriction requested and to whom you want the restriction to apply.
To request
a restriction, you should do so to the Privacy Officer and tell us (1) what
information you want to limit; (2) whether you want to limit use or disclosure
or both; and, (3) to whom you want the limits to apply (for example,
disclosures to your spouse). Contact information for the Privacy Officer is on
the last page of this Notice.
We are
not required to agree to any requested restriction. However, if we do agree, we will follow that
restriction unless the information is needed to provide emergency
treatment. Even if we agree to a
restriction, either you or we can later terminate the restriction.
B.
Right to receive
confidential communications. You have
the right to request that we communicate with you in a certain way or at a
certain location. For example, you can
ask that we only contact you by mail or at work. We will not require you to tell us why you
are asking for the confidential communication.
If you want
to request confidential communication, you must do so in writing to the Privacy
Officer. Contact information for the Privacy Officer is on the last page of this
Notice. Your request must state how or
where you can be contacted.
We will
accommodate your request. However, we
may, when appropriate, require information from you concerning how payment will
be handled or specification of an alternative address or other method to
contact you.
C. Right
to inspect and copy. With a few
very limited exceptions, such as psychotherapy notes, you have the right to
inspect and obtain a copy of your protected health information. Usually, this includes medical and billing
records.
To inspect
and your health information, you may be asked to submit a written request to
the Privacy Officer whose contact information is listed on the last page of
this Notice. If you request a copy of
your information, we may charge you a fee for the costs of copying, mailing or
other costs incurred by us in complying with your request
D. Right to amend. You may request an amendment of protected
health information about you in a designated record set for as long as we
maintain this information. In certain
cases, we may deny your request for an amendment. If we deny your request for amendment, you
have the right to file a statement of disagreement with us and we may prepare a
rebuttal to your statement and will provide you with a copy of any such
rebuttal. Requests for amendment must be
in writing and must be directed to our Privacy Officer. In this written request, you must also
provide a reason to support the requested amendments.
E. Right
to receive an accounting. You have the right to request an accounting
of certain disclosures of your protected health information made by the
practice. This right applies to
disclosures for purposes other than treatment, payment or health care
operations as described in this Notice of Privacy Practices. We are also not required to account for
disclosures that you requested, disclosures that you agreed to by signing an
authorization form, disclosures for a facility directory, to friends or family
members involved in your care, or certain other disclosures we are permitted to
make without your authorization. The
request for an accounting must be made in writing to our Privacy Officer. The request should specify the time period
sought for the accounting. We are not
required to provide an accounting the disclosures that take place prior to
April 14, 2003. Accounting requests may
not be made for periods of time in excess of six years. We will provide the first accounting you
request during any 12-month period without charge. Subsequent accounting requests may be subject
to a reasonable cost-based fee.
F. Right to obtain a paper copy of this
notice. Upon request, we will
provide a separate paper copy of this notice even if you have already received
a copy of the notice or have agreed to accept this notice electronically.
V. Our
Duties
The
practice is required by law to maintain the privacy of your health information
and to provide you with this Notice of our duties and privacy practices. We are required to abide by terms of this
Notice as may be amended from time to time.
We reserve the right to change the terms of this Notice and to make the
new Notice provisions effective for all protected health information that we
maintain. If the practice changes its
Notice, we will provide a copy of the revised Notice by sending a copy of the
Revised Notice via regular mail or through in-person contact.
VI. Complaints
You
have the right to express complaints to the practice and to the Secretary of
Health and Human Services if you believe that your privacy rights have been
violated. You may complain to the
practice by contacting the practice’s Privacy Officer verbally or in writing,
using the contact information below. You
will not be retaliated against in any way for filing a complaint.
VII. Contact
Person
The
practice’s contact person for all issues regarding patient privacy and your
rights under the Federal privacy standards is the Privacy Officer. Information regarding matters covered by this
Notice can be requested by contacting the Privacy Officer. Complaints against the practice can be made
to the Privacy Officer at (248) 474-2763, or by sending it to:
Broe Rehabilitation Services, Inc.
Attn: Privacy Officer
33634
IX. Effective
Date
This
Notice is effective April 14, 2003.