NOTICE OF PRIVACY PRACTICES
Health Insurance Portability and Accountability Act of 1996
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.
The terms of this Notice of Privacy Practices apply to Visiting Nurse Service &
Affiliates. The members of this clinically integrated health care arrangement work
and practice at Community Health Ventures, Visiting Nurse Service, Medina County
Visiting Nurse Service, Portage County Visiting Nurse Service & Hospice, Stark
County Visiting Nurse Service & Hospice, Wayne County Visiting Nurse Service,
Hospice of Visiting Nurse Service, Visiting Nurse Service Personal Care Services,
Visiting Nurse Service Equipment & Supplies, Visiting Nurse Service Equipment
& Supplies/Complete Home Care, and Advanced Infusion Services. All of the entities
and persons listed will share personal health information of our patients as necessary
to carry out treatment, payment, and health care operations as permitted by law.
We are required by law to maintain the privacy of our patients' personal health
information and to provide patients with notice of our legal duties and privacy
practices with respect to your personal health information. We are required to abide
by the terms of this Notice so long as it remains in effect. We reserve the right
to change the terms of this Notice of Privacy Practices as necessary and to make
the new Notice effective for all personal health information maintained by us. You
may obtain a copy of any revised notices at Visiting Nurse Service & Affiliates
web site – www.vnsa.com, or a copy may be obtained by mailing a request to Visiting
Nurse Service & Affiliates, Attention Privacy Officer, #1 Home Care Place, Akron,
Ohio 44320.
USES & DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION
Your Authorization
Except as outlined below, we will not use or disclose your personal health information
for any purpose unless you have signed a form authorizing the use or disclosure.
You have the right to revoke that authorization in writing unless we have taken
any action in reliance on the authorization.
Uses and Disclosures for Treatment
We will make uses and disclosures of your personal health information as necessary
for your treatment. For instance, doctors and nurses and other professionals involved
in your care will use information in your medical record and information that you
provide about your symptoms and reactions to plan a course of treatment for you
that may include procedures, medications, tests, etc. We may also release your personal
health information to another health care facility or professional who is not affiliated
with our organization but who is or will be providing treatment to you. For instance,
if you must be transferred to another home health agency or to a long-term care
facility, we may release your personal health information to them to enable your
continuing care and/or treatment.
Uses and Disclosures for Payment
We will make uses and disclosures of your personal health information as necessary
for the payment purposes for the services provided to you. For instance, we may
forward information regarding your care and treatment to your insurance company
to arrange payment for the services provided to you or we may use your information
to prepare a bill to send to you or to the person responsible for your payment.
Uses and Disclosures for Health Care Operations
We will use and disclose your personal health information as necessary, and as permitted
by law, for our health care operations, which include clinical improvement, professional
peer review, business management, accreditation and licensing, etc. For instance,
we may use and disclose your personal health information for purposes of improving
the clinical treatment and care of our patients. We may also disclose your personal
health information to another health care facility, health care professional, or
health plan for such things as quality assurance and case management, but only if
that facility, professional, or plan also has or had a patient relationship with
you.
Our Facility Directory
At our inpatient facility, The Justin T. Rogers Hospice Care Center, we
maintain a facility directory listing the name, room number, general condition and,
if you wish, your religious affiliation. Unless you choose to have your information
excluded from this directory, the information, excluding your religious affiliation,
will be disclosed to anyone who requests it by asking for you by name. This information,
including your religious affiliation, may also be provided to members of the clergy.
You have the right during registration to have your information excluded from this
directory and also to restrict what information is provided and/or to whom.
Family and Friends Involved in Your Care
With your approval, we may from time to time disclose your personal health information
to designated family, friends, and others who are involved in your care or in payment
of your care in order to facilitate that person’s involvement in caring for you
or paying for your care. If you are unavailable, incapacitated, or facing an emergency
medical situation and we determine that a limited disclosure may be in your best
interest, we may share limited personal health information with such individuals
without your approval. We may also disclose limited personal health information
to a public or private entity that is authorized to assist in disaster relief efforts
in order for that entity to locate a family member or other persons that may be
involved in some aspect of caring for you.
Business Associates
Certain aspects and components of our services are performed through contracts with
outside persons or organizations, such as auditing, accreditation, legal services,
etc. At times it may be necessary for us to provide certain sections of your personal
health information to one or more of these outside persons or organizations who
assist us with our health care operations. In all cases, we require these business
associates to appropriately safeguard the privacy of your information.
Fundraising
We may contact you to donate to a fundraising effort for or on our behalf. You have
the right to "opt-out" of receiving fundraising materials/communications and may
do so by sending your name and address to Visiting Nurse Service & Affiliates,
attention Director of Development, # 1 Home Care Place, Akron, OH 44320, together
with a statement that you do not wish to receive fundraising materials or communications
from us.
Appointments and Services
We may contact you to provide appointment reminders, test results, patient education
materials or discharge instructions. You have the right to request and we will accommodate
reasonable requests by you to receive communications regarding your personal health
information from us by alternative means or at alternative locations. For instance,
if you wish appointment reminders to not be left on voice mail, or education materials
or discharge instructions sent to a particular address, we will accommodate reasonable
requests.
Health Products and Services
We may from time to time use your personal health information to communicate with
you about health products and services necessary for your treatment, to advise you
of new products and services we offer, and to provide general health and wellness
information.
Research
In limited circumstances, we may use and disclose your personal health information
for research purposes. For example, a research organization may wish to compare
outcomes of all patients that received a particular drug and will need to review
a series of medical records. In all cases where your specific authorization has
not been obtained, your privacy will be protected by strict confidentiality requirements
applied by an Institutional Review Board or privacy board which oversees the research
or by representations of the researchers that limit their use and disclosure of
patient information.
Other Uses and Disclosures
We are permitted or required by law to make certain other uses and disclosures of
your personal health information without your consent or authorization.
- We may release your personal health information for any purpose required by law;
- We may release your personal health information for public health activities, such
as required reporting of disease, injury, and birth and death, and for required
public health investigations;
- We may release your personal health information as required by law if we suspect
child abuse or neglect; we may also release your personal health information as
required by law if we believe you to be a victim of abuse, neglect, or domestic
violence;
- We may release your personal health information to the Food and Drug Administration
if necessary to report adverse events, product defects, or to participate in product
recalls;
- We may release your personal health information to your employer when we have provided
health care to you at the request of your employer to determine workplace-related
illness or injury; in some cases you will receive notice that information is disclosed
to your employer;
- We may release your personal health information if required by law to a government
oversight agency conducting audits, investigations, or civil or criminal proceedings;
- We may release your personal health information if required to do so by subpoena
or discovery request; in some cases you will have notice of such release;
- We may release your personal health information to law enforcement officials as
required by law to report wounds and injuries and crimes;
- We may release your personal health information to coroners and/or funeral directors
consistent with law; • We may release your personal health information in limited
instances if we suspect a serious threat to health or safety;
- We may release your personal health information if you are a member of the military
as required by armed forces services; we may also release your personal health information
if necessary for national security or intelligence activities; and
- We may release your personal health information to workers' compensation agencies
if necessary for your workers' compensation benefit determination.
- Ohio law requires that we obtain a consent from you before disclosing your personal
health information to the Long Term Care Ombudsman regarding your services; or disclosing
the performance or results of an HIV test or diagnosis of AIDS or an AIDS-related
condition.
RIGHTS THAT YOU HAVE
Access to Your Personal Health Information
You have the right to receive a copy and/or inspect much of the personal health
information that we retain on your behalf. All requests for access must be made
in writing and signed by you or your representative. You may be charged a medical
record research and photocopying fee consistent with state law if you request a
copy of the information. We will also charge for postage if you request a mailed
copy. You may obtain an access request authorization form from Visiting Nurse Service
& Affiliates, Medical Records Department, #1 Home Care Place, Akron, Ohio 44320.
Amendments to Your Personal Health Information
You have the right to request in writing that personal health information that we
maintain about you be amended or corrected. We are not obligated to make all requested
amendments but will give each request careful consideration. All amendment requests,
in order to be considered by us, must be in writing, signed by you or your representative,
and must state the reasons for the amendment/correction request. If an amendment
or correction you request is made by us, we may also notify others who work with
us, and have copies of the uncorrected record, if we believe that such notification
is necessary. You may obtain an amendment request form from Visiting Nurse Service
& Affiliates, Medical Records Department, #1 Home Care Place, Akron, Ohio 44320.
Accounting for Disclosures of Your Personal Health Information
You have the right to receive an accounting of certain disclosures made by us of
your personal health information after April 14, 2003. Requests must be made in
writing and signed by you or your representative. Accounting request forms are available
from Visiting Nurse Service & Affiliates, Medical Records Department, #1 Home
Care Place, Akron, Ohio 44320. The first accounting in any 12-month period is free;
you will be charged a fee for each subsequent accounting you request within the
same 12-month period.
Restrictions on Use and Disclosure of Your Personal Health Information
You have the right to request restrictions on certain of our uses and disclosures
of your personal health information for treatment, payment, or health care operations.
You can obtain a restriction request form by asking the representative who delivers
this notice. We are not required to agree to your restriction request but will attempt
to accommodate reasonable requests when appropriate and we retain the right to terminate
an agreed-to restriction if we believe such termination is appropriate. In the event
of a termination by us, we will notify you of such termination. You also have the
right to terminate, in writing or orally, any agreed-to restriction by sending such
termination notice to Visiting Nurse Service & Affiliates, Medical Records Department,
#1 Home Care Place, Akron, Ohio 44320.
Complaints
If you believe your privacy rights have been violated, you can file a complaint
with Visiting Nurse Service & Affiliates Privacy Officer, Visiting Nurse Service
& Affiliates, #1 Home Care Place, Akron, Ohio 44320. You may also file a complaint
with the Secretary of the U.S. Department of Health and Human Services in Washington
D.C. in writing within 180 days of a violation of your rights. There will be no
retaliation for filing a complaint.
Acknowledgment of Receipt of Notice
You will be asked to sign an acknowledgment that you received this Notice of Privacy
Practices. For Further Information If you have questions or need further assistance
regarding this Notice, you may contact Visiting Nurse Service & Affiliates Privacy
Officer, Visiting Nurse Service & Affiliates, #1 Home Care Place, Akron, Ohio
44320.
As a patient you retain the right to obtain a paper copy of this Notice of Privacy
Practices, even if you have requested such copy by e-mail or other electronic means.
Effective Date
This Notice of Privacy Practices is effective April 14, 2003.