NEW HOPE VILLAGE
PRIVACY NOTICE
Effective Date: April 14, 2003
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.
If you have any questions about this notice, please contact our Privacy Officer at (712) 792-5500.
WHO WILL FOLLOW THIS NOTICE:
This notice describes New Hope Village’s practices and that of:
· Any health care professional authorized to enter information into your record at New Hope Village.
· All employees of New Hope Village.
· Any member of a volunteer group or intern we allow to help you while you are at New Hope Village.
· Any member of a board which governs, advises or reviews the activities of New Hope Village.
· New Hope Village includes the following entities: New Hope Village, Inc., New Hope Village Foundation, Carroll Enterprise Systems, Employment Resources, New Hope Enterprises, New Hope Village Bargain Shoppes.
· All these entities, sites and locations will follow the terms of this notice. In addition, these entities, sites, and locations may share protected health information (PHI) with each other for treatment, payment, or operations purposes described in this notice.
OUR PLEDGE REGARDING PROTECTED HEALTH INFORMATION:
We understand that information about you and your health is personal. We are committed to protecting protected health information about you. We create a record of the care and services you receive at New Hope Village. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by New Hope Village, whether made by New Hope Village personnel or your personal doctor or other practitioners involved in your care. Your personal doctor/practitioner may have different policies or notices regarding the doctor’s/practitioner’s use and disclosure of your medical information created in their office or clinic.
This notice will tell you about the ways in which we may use and disclose protected health information about you. We also describe your rights and certain obligations we have regarding the use and disclosures of protected health information.
We are required by law to:
· Make sure that protected health information that identifies you is kept private;
· Give you this notice of our legal duties and privacy practices with respect to protected health information about you; and
· Follow the terms of the notice that is currently in effect.
HOW YOUR PROTECTED HEALTH INFORMATION MAY BE USED OR DISCLOSED WITHOUT YOUR AUTHORIZATION:
The following categories describe different ways that we use and disclose protected health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. If you do not agree to any of these uses or disclosures, you must notify the Privacy Officer in writing of any objections.
· For Treatment: We may use protected health information about you to provide you with health treatment or services. We may disclose protected health information about you to others who are involved in your care. This may include administrative, supervisory, direct support, professional and para-professional staff. For example, the nurse may need to tell the dietitian you have diabetes so that we can arrange for appropriate meals. Different departments of NHV also may share protected health information about you in order to coordinate the different things you need. For example, direct support staff may need to be aware of your diagnosis so they can assist with appropriate diet, activities, and medical care. We also may disclose protected health information about you to people outside NHV who may be involved in your care, such as a hospital, a physician, and/or another facility. NHV may disclose protected health information to a medical supply company or assistive device supplier to obtain needed equipment/supplies and professional care. Insurance and health care payment information will be shared with other providers of medical care as needed.
· For Payment: We may use and disclose protected information about you so that the treatment and services you receive at New Hope Village may be billed to and payment collected from you, the county/state, an insurance company or a third party. For example, NHV may release information about you and your services to the county case worker/manager.
· For Healthcare Operations: We may use and disclose protected health information about you for New Hope Village operations. These uses and disclosures are necessary to run the facility and make sure that all of our clients receive quality care. For example, we may use protected health information about you to review our treatment and services and to evaluate the performance of our staff in caring for you, or we may send you a satisfaction survey. We may also combine protected health information about many NHV clients to decide what additional services NHV should offer, what services are not needed, etc. We may also disclose information to NHV personnel for review purposes. We may also combine the protected health information we have with protected health information from other facilities to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of protected health information so others may use it to study health care and health care delivery without learning who the specific clients are. NHV is required by regulation to have a committee which monitors client rights. It is mandated that this committee have some members who are not NHV staff. This committee may include a parent or client, and the committee does review protected health information about clients when a program is being proposed that may restrict rights. NHV is also required to have a committee composed exclusively of non-staff members who observe and informally monitor our services.
·
Business
Associates: We may use and
disclose information about you with Business Associates of NHV. These are individuals or businesses whose
services are necessary for New Hope Village to operate. We have a signed agreement in place with
them, which binds them to abide by the confidentiality requirements established
by NHV, and specified in this document.
For example, NHV is required to make certain information available to an
independent auditing firm to conduct an annual audit of our financial
operations. As another example, NHV uses
the services of an outside company to maintain our computer equipment.
· Treatment Alternatives: We may use and disclose protected health information to inform you of and/or recommend possible treatment options or alternatives that may be of interest to you.
· Health-Related Benefits and Services: We may use and disclose protected health information to tell you about health-related benefits, services, or education classes that may be of interest to you.
· Research: Under certain conditions, we may use and disclose protected health 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.
· As Required by Law: We will disclose protected health information about you when required to do so by federal, state or local law.
· Organ & Tissue Donation: If you are an organ donor, we may release protected health information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
· Military: If you are a member of the armed forces, we may release protected health information about you as required by military command authorities. We may also release protected health information about foreign military personnel to the appropriate foreign military authority.
· Workers’ Compensation: We may release protected health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
· Public Health Risks (Health & Safety to you and/or others): We may disclose protected health information about you for public health activities. We may use and disclose protected health information about you to agencies when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. These activities generally include the following:
- to prevent or control disease, injury, or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe a client has been the victim of abuse, neglect or domestic violence. We will only make this disclosure when required or authorized by law.
· Health Oversight Activities: We may disclose protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, government agencies that oversee the health care system, government programs such as Medicare or Medicaid, other government programs regulating health care, and compliance with civil rights laws.
· Legal Proceedings: We may disclose your protected health information in the course of a judicial or administrative proceeding, in response to an order of a court or administrative tribunal, or in certain conditions in response to a subpoena, discovery request, or other lawful process.
· Law Enforcement: We may release protected health information if asked to do so by a law enforcement official:
- in response to a court order, subpoena, warrant, summons or similar process;
- to identify or locate a suspect, fugitive, material witness, or missing person;
- about the victim of a crime, if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- about a death we believe may be the result of criminal conduct;
- about criminal conduct at the facility; and
- 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.
· Coroners, Medical Examiners and Funeral Directors: We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release protected health information about clients of NHV to funeral directors as necessary to carry out their duties.
· Threats to Health or Safety: We may disclose protected health information if we believe it is necessary to prevent or lessen a serious and imminent threat to you or to the public.
· Specialized Government Functions: We may disclose your protected information for the following government functions: (1) Military and veterans activities; (2) National security and intelligence activities; (3) Protective services for the president and others; (4) Medical suitability determinations; (5) Correctional institutions and other law enforcement custodial situations, including information about inmates of correctional facilities if necessary to protect the health and safety of the inmate or others; and (6) Government programs providing public benefits as authorized by law and for purposes of sharing eligibility or enrollment information or for other covered functions.
Victims of Abuse, Neglect, or Domestic Violence: We may disclose your protected health information to the appropriate governmental entity if we believe that you have been a victim of abuse, neglect, or domestic violence. The disclosure will be made consistent with the requirements of state and federal law.
Emergencies: We may disclose your protected health
information in an emergency treatment situation. If this happens, your physician will try to
obtain your acknowledgement of receipt of the Notice of Privacy Practices as
soon as reasonably practical after the delivery of treatment.
· Fundraising Activities: We may use information about you to contact you/your guardian/family member in an effort to raise money for New Hope Village and its operations. We may disclose information to the New Hope Village Foundation so that the Foundation may contact you in raising money for the facility. If you do not want NHV to contact you for fundraising efforts, you must notify our Development Department in writing.
· Photos/Incidentals: Your photo or name may appear in connection with New Hope Village. This could be through tours of our facility, newspaper photos and articles about area events, pictures around NHV showing your participation in activities.
For example, if you are involved in community work, you may be introduced to persons at your worksite, and they will be aware of your affiliation with New Hope Village. No medical information about you will be released to them without a signed Authorization for Release of Information Form. Also, New Hope distributes a newsletter to staff and to family members/guardians of clients. This may include the name of persons served, as well as their parent/guardian, and where they are living in order to promote good communications and foster involvement and friendships. (i.e. "Welcome to Jane Doe and her parents, John & Mary Doe, all of Carroll, as new members of the New Hope family. Jane moved into the Main Street home in January. She does various jobs through CES and ER. Jane enjoys going to the movies and bowling.")
If you do not want NHV to release these types of information, please contact our Privacy Officer.
· Facility Directory: Unless you object, we may include certain limited information about you in the NHV directory while you are a client here. This information may include your name, location, general condition, and religious affiliation to members of the clergy. The directory information, except for religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to the clergy even if they don’t ask for you by name. In addition, we may disclose protected health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. If you do not want NHV to include this information in our patient directory, please notify our Privacy Officer.
·
Individuals
Involved in Your Care: Unless
you object, we may release protected health information about you to a
caregiver who may be a friend or family member to the extent necessary for them
to participate in your care. If you wish
to limit or prevent the use of your protected health information for this
purpose, or if you wish to limit the person (s) to whom this information may be
communicated, please contact our Privacy Officer.
OTHER USES OF PROTECTED HEALTH INFORMATION:
Other uses and disclosures of protected health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time (unless we have acted in accordance with an authorization executed by you, or if the authorization was obtained as a condition of obtaining insurance coverage and the law provides the insurer to contest a claim under the policy). If you revoke your permission, we will no longer use or disclose protected health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
You have the following rights regarding protected health information we maintain about you:
· Right to Inspect and Copy: You have the right to inspect and copy protected health information that is contained in a designated record set for as long as we maintain your protected health information. A "designated record set" contains medical and financial records and other records that we use for making decisions about your care.
To inspect
protected health information that may be used to make decisions about you,
please contact the designated staff in writing. We will respond to your request as quickly as
possible, and within 30 days. Program
Coordinator/Community Living Supervisor or nursing staff. Designated staff must be present at the time
of review. 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.
Under federal law, however, you may not inspect or copy the following records: Psychotherapy notes; information related to a civil, criminal, or administrative action or proceeding; and information that is subject to law that prohibits access to protected health information.
We may deny your request to inspect and copy in some circumstances. If you are denied access to protected health information, you may request that the denial be reviewed. Another licensed health care professional chosen by NHV 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.
Please contact our Privacy Officer if you have questions about access to your protected health information.
· Right to Amend: If you feel that protected health 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 or for the facility.
To request an amendment, your request must be made in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request.
In certain cases, we may deny your request for an amendment. If we deny your request for an amendment, you have the right to dispute this decision. Please contact our Privacy Officer if you have questions about amending your protected health information. 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: was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the protected health information kept by or for the facility; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete.
· Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures”. This right does not apply to disclosures for purposes of treatment, payment, or health care operations as described above. It also does not include disclosures made to you, to a facility directory, to those involved in your care, pursuant to your authorization, or to certain other disclosures made by NHV.
To request this
list or accounting of disclosures, you must submit your request in writing to
the Privacy Officer. Your request must
state a time period which may not be longer than six years and may not include
dates before April 14, 2003. Your
request should indicate in what form you want the list (for example, on paper or
electronically). The first
list you request within a 12 month period will be free. For additional lists, wWe 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. Please contact
our Privacy Officer if you have questions about an accounting of your protected
health information.
· Right to Request Restrictions: You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the protected health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend.
We are not required to agree to your requested restriction. If we believe that it is in your best interest to permit the use and disclosure of your protected health information, then this information will not be restricted. If we do agree with your requested restriction, we will comply with your request unless the information is needed to provide emergency treatment to you.
Please contact our Privacy Officer to discuss a request for restriction on uses and disclosures of your protected health information.
· Right to Request Confidential Communications: You have the right to request that we communicate with you about matters in a certain way or at a certain location. For example, you can ask that we only contact you at work. Exceptions may be made in the event of an emergency.
To request confidential communications, you must make your request in writing to the Privacy Officer. 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. We may condition this accommodation by asking you for information on how payment will be handled.
· Right to a Paper Copy of This Notice: You may ask us to give you a copy of this privacy notice at any time by requesting a copy from the Privacy Officer.
We reserve the right to change
this notice. We reserve the right to
make the revised or changed notice effective for protected health 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 at NHV. The notice will
contain the effective date. You may also request a revised Notice by contacting
our Privacy Officer.
If you believe your privacy rights have been violated, you may contact or submit your complaint in writing to the Privacy Officer. If we cannot resolve your concern, you also have the right to file a written complaint with the Secretary of the U.S. Department of Health and Human Services.
The quality of your care will not be jeopardized nor will you be penalized for filing a complaint.