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Privacy Practices

NOTICE OF PRIVACY PRACTICES
Mid-Delta Home Health and Hospice 405 North Hayden Street
Belzoni, MS 39038

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 describes how we may use and disclose your protected health information to carryout 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. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health care condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with a revised Notice of Privacy Practices by calling 1-800-543-9055 and requesting that a copy be sent to you in the mail or by asking for a copy at the time of your next treatment.

 

1. Uses and Disclosures of Protected Health Information

Uses and Disclosures of Protected Health Information based upon your written consent

You will be asked by your Health Care Practitioner to sign a consent form. Once you have consented by signing the consent form, we may use and disclose medical information about you for any purpose regarding:

a. Treatment- We will disclose your Protected Health Information to provide, coordinate, or manage your health care and any related services. For example, your protected health information may be disclosed as necessary to others involved in your health care, such as your attending physician, family members, pharmacists, suppliers of medical equipment, clergy, and others that may be used in order to coordinate your care.

b. Payment- Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for services may require that your information be disclosed to the health plan.

c. Health Care Operations- Your protected health information may be disclose in order to support the business activities of your health care facilities practice. For example, your information may be used in quality assessment and improvement activities, evaluating provider performance, accreditation, certification, licensing or credentialing activities. We may also use or disclose your information in order to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your information for other marketing activities . For example, your name and address may be used to send you a newsletter. You may contact the health care facility to request that these materials not be sent to you.

Uses and Disclosures of Protected Health Information based upon your written authorization

Other uses and disclosures that do not fall under treatment, payment or health care operations will require your written authorization. You may revoke your authorization (in writing) through our practice at any time.

Other permitted and required uses and disclosures that may be made with your consent, authorization or opportunity to object

You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. We may disclose your Protected Health Information in the following instances:

Others Involved in Your Health Care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, your location, general condition or death. Finally we may disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation.

Communication Barriers: We may use and disclose your protected health information if we are unable to obtain consent from you due to substantial communication barriers and it is determined, in our professional judgement, that you intend to consent to use or disclosure under the circumstances.

Other permitted and required uses and disclosures that may be made without your consent, authorization or opportunity to object

We may use or disclose your protected health information in the following situations without your consent or authorization:

Required by Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law.

Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive this information.

Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, and other government regulatory programs and civil rights laws.

Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information.

Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products, to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required.

Legal 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, in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement: We may disclose your protected health information for law enforcement purposes. These include (1) legal processes required by law, (2) for identification and location purposes, (3) pertaining to victims of crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises, (6) medical emergency and it is likely that a crime has occurred.

Coroners, Funeral Directors, and Organ Donation: We may disclose your protected health information to coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties as required by law. We may also disclose your protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

Criminal Activity: We may disclose your protected health information to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Military Activity and National Security: we may disclose your protected health information if you are an Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities, (2) determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Worker’s Compensation: Your protected health information may be disclosed to comply with workers compensation laws and other similar legally-established programs.

Inmates: We my use or disclose your protected health information if you are an inmate of a correctional facility and your protected health information was created or received in the course of providing care for you.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. Seq.

2. Your Rights

Following is a statement of your rights with respect to your protected health information:

You have the right to inspect and copy your protected health information: This means that, in most cases you may inspect and obtain a copy (a fee may be charged for the cost of copying, mailing or related supplies) of your information contained in a “designated record set”. A designated record set contains medical and billing records and any other records that is used for making decisions about you. You may not inspect or copy the following records; psychotherapy notes; information compiled in anticipation of a civil, criminal, or administrative action or proceeding, or that which is prohibited by law. If denied access, you have the right to have the decision reviewed. This may be done by contacting the Privacy Officer.

You have the right to request a restriction of your protected health information: You may request, in writing, that we not disclose or use any part of your protected health information for the purpose of treatment, payment or health care operations or to persons involved in your care, except when specifically authorized by you, when required by law, or in an emergency. We are not legally required to accept your request but will consider it and inform you of our decision.

You have the right to receive confidential communications from us by alternative means or at an alternative location: We will accommodate reasonable request that are made in writing. We may condition this accommodation by asking for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis of your request.

You have the right to request an amendment of your protected health information: You may request that your protected health information, located in a designated record set, be changed as long as we maintain this information. This request must be in writing and we may, in certain cases ( example: information is correct) deny your request. If denied, you may 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.

You have the right to receive an account of certain disclosures we have made, if any, of your protected health information: This right applies to disclosures other than treatment, payment, health care operations or where you specifically authorized the disclosure. You must submit a written request stating the time period desired for the accounting, which must be less than a six-month period and starting after April 14, 2003. A fee may be charged for copying, mailing, or related supplies.

You have a right to obtain a paper copy of this notice: Upon request, a copy of this notice will be provided to you.

3. Complaints: You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our privacy officer at 1-800-543-9055. You may send a written complaint to the U.S. Department of Human Services Office of Civil Rights. We will be happy to provide the address. Under no circumstances will you be retaliated against or penalized in any way.

This notice was published and becomes
effective on April 14, 2003.