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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.
USE AND DISCLOSURE OF HEALTH INFORMATION
Ruidoso Home Care &
Hospice may use your health information, information that
constitutes protected health information as defined in the Privacy Rule of
the Administrative Simplification provisions of the Health Insurance
Portability and Accountability Act of 1996, for purposes of providing you
treatment, obtaining payment for your care and conducting health care
operations. Ruidoso Home Care & Hospice has established policies to guard
against unnecessary disclosure of your health information.
THE FOLLOWING IS A
SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR
HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To Provide Treatment.
Ruidoso Home Care & Hospice may use your health information to coordinate
care within Ruidoso Home Care & Hospice and with others involved in your
care, such as your attending physician, other health care professionals
and volunteers who have agreed to assist Ruidoso Home Care & Hospice in
coordinating care. For example, physicians involved in your care will
need information about your symptoms in order to prescribe appropriate
medications. Ruidoso Home Care & Hospice also may disclose your health
care information to individuals outside of Ruidoso Home Care & Hospice
involved in your care including family members, pharmacists, suppliers of
medical equipment or other health care professionals.
To Obtain Payment.
Ruidoso Home Care & Hospice may include your health information in
invoices to collect payment from third parties for the care you receive
from Ruidoso Home Care & Hospice. For example, Ruidoso Home Care &
Hospice may be required by your health insurer to provide information
regarding your health care status so that the insurer will reimburse you
or Ruidoso Home Care & Hospice. Ruidoso Home Care & Hospice also may need
to obtain prior approval from your insurer and may need to explain to the
insurer your need for home care and the services that will be provided to
you.
To Conduct Health
Care Operations. Ruidoso Home Care & Hospice may use and disclose
health information for its own operations in order to facilitate the
function of Ruidoso Home Care & Hospice and as necessary to provide
quality care to all of Ruidoso Home Care & Hospice patients. To the
extent possible, this information will not include personal identifiers,
such as your name, address, social security number, etc.
Health care operations
includes such activities as:
- Quality assessment and improvement activities.
- Activities designed to improve health or reduce health care costs.
- Protocol development, case management and care coordination.
- Contacting health care providers and patients with information
about treatment alternatives and other related functions that do not
include treatment.
- Professional review and performance evaluation.
- Training of non-health care professionals.
- Accreditation, certification, licensing or credentialing
activities.
- Review and auditing, including compliance reviews, medical
reviews, legal services and compliance programs.
- Business management and general administrative activities of
Ruidoso Home Care & Hospice.
For example
Ruidoso Home Care & Hospice may
use your health information to evaluate its staff or volunteer
performance, combine your health information with other Agency
patients in evaluating how to more
effectively serve all Agency
patients, disclose your health information to Agency
staff and contracted personnel for
training purposes, use your health information to contact you as a
reminder regarding a visit to you. .
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES
FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED
When Legally Required.
Ruidoso Home Care & Hospice will disclose your health information when it
is required to do so by any Federal, State or local law.
When There Are Risks to Public
Health. Ruidoso Home Care & Hospice may disclose your health
information for public activities and purposes in order to:
- Prevent or control disease, injury or disability, report disease,
injury, vital events such as birth or death and the conduct of public
health surveillance, investigations and interventions.
- Report adverse events or product defects, to track products or
enable product recalls, repairs and replacements; and to conduct
post-marketing surveillance and compliance with requirements of the Food
and Drug Administration.
- Notify a person who has been exposed to a communicable disease or
who may be at risk of contracting or spreading a disease.
-
Notify an employer about an individual who is a member of the
workforce as legally required.
To Report Abuse,
Neglect Or Domestic Violence. Ruidoso Home Care & Hospice is
required to notify government authorities if Ruidoso Home Care & Hospice
believes a patient is the victim of abuse, neglect or domestic violence.
Ruidoso Home Care & Hospice will make this disclosure only when
specifically required or authorized by law.
To Conduct Health
Oversight Activities. Ruidoso Home Care & Hospice may disclose
your health information to a health oversight agency for activities
including audits, civil administrative or criminal investigations,
inspections, licensure or disciplinary action. Ruidoso Home Care &
Hospice, however, may not disclose your health information if you are the
subject of an investigation and your health information is not directly
related to your receipt of health care or public benefits.
In Connection With
Judicial And Administrative Proceedings. Ruidoso Home Care &
Hospice may disclose your health information in the course of any judicial
or administrative proceeding in response to an order of a court or
administrative tribunal as expressly authorized by such order or in
response to a subpoena, discovery request or other lawful process, but
only when Ruidoso Home Care & Hospice makes reasonable efforts to either
notify you about the request or to obtain an order protecting your health
information.
For Law Enforcement
Purposes. As permitted or required by State law, Ruidoso Home
Care & Hospice may disclose your health information to a law enforcement
official for certain law enforcement purposes as follows:
- As required by law for reporting of certain types of wounds or
other physical injuries pursuant to the court order, warrant, subpoena or
summons or similar process.
- For the purpose of identifying or locating 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 Ruidoso Home Care & Hospice has a
suspicion that your death was the result of criminal conduct including
criminal conduct at Ruidoso Home Care & Hospice.
- In an emergency in order to report a crime.
To Coroners And
Medical Examiners. Ruidoso Home Care & Hospice may disclose your
health information to coroners and medical examiners for purposes of
determining your cause of death or for other duties, as authorized by law.
To Funeral Directors.
Ruidoso Home Care & Hospice may disclose your health information to
funeral directors consistent with applicable law and if necessary, to
carry out their duties with respect to your funeral arrangements. If
necessary to carry out their duties, Ruidoso Home Care & Hospice may
disclose your health information prior to and in reasonable anticipation
of your death.
In the Event of A
Serious Threat To Health Or Safety. Ruidoso Home Care & Hospice
may, consistent with applicable law and ethical standards of conduct,
disclose your health information if Ruidoso Home Care & Hospice, in good
faith, believes that such 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.
For Specified
Government Functions. In certain circumstances, the Federal
regulations authorize Ruidoso Home Care & Hospice to use or disclose your
health information to facilitate specified government functions relating
to military and veterans, national security and intelligence activities,
protective services for the President and others, medical suitability
determinations and inmates and law enforcement custody.
For Worker's
Compensation. Ruidoso Home Care & Hospice may release your health
information for worker's compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH
INFORMATION
Other than is stated above, Ruidoso
Home Care & Hospice will not disclose your health information other than
with your written authorization. If you or your representative authorizes
Ruidoso Home Care & Hospice to use or disclose your health information,
you may revoke that authorization in writing at any time.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH
INFORMATION
You have the following rights
regarding your health information that Ruidoso Home Care & Hospice
maintains:
-
Right to request restrictions. You may request
restrictions on certain uses and disclosures of your health information.
You have the right to request a limit on Ruidoso Home Care & Hospice ‘s
disclosure of your health information to someone who is involved in your
care or the payment of your care. However, Ruidoso Home Care & Hospice is
not required to agree to your request. If you wish to make a request for
restrictions, please contact Janice Mansfield, Privacy Officer at
(505) 258-0028
- Right to receive confidential communications. You
have the right to request that Ruidoso Home Care & Hospice communicate
with you in a certain way. For example, you may ask that Ruidoso Home
Care & Hospice only conduct communications pertaining to your health
information with you privately with no other family members present. If
you wish to receive confidential communications, please contact
Janice Mansfield, Privacy Officer, (505) 258-0028. Ruidoso Home
Care & Hospice will not request that you provide any reasons for your
request and will attempt to honor your reasonable requests for
confidential communications.
- Right to inspect and copy your health information.
You have the right to inspect and copy your health information, including
billing records. A request to inspect and copy records containing your
health information may be made to Janice Mansfield,
Privacy Officer, (505) 258-0028. If you request a copy of your
health information, Ruidoso Home Care & Hospice may charge a reasonable
fee for copying and assembling costs associated with your request.
- Right to amend health care information. You or your
representative have the right to request that Ruidoso Home Care & Hospice
amend your records, if you believe that your health information is
incorrect or incomplete. That request may be made as long as the
information is maintained by Ruidoso Home Care & Hospice. A request for
an amendment of records must be made in writing to to Janice
Mansfield, Privacy Officer,Ruidoso Home Care & Hospice, PO Box
2019 Ruidoso NM 88355. Ruidoso Home Care & Hospice may deny the
request if it is not in writing or does not include a reason for the
amendment. The request also may be denied if your health information
records were not created by Ruidoso Home Care & Hospice, if the records
you are requesting are not part of Ruidoso Home Care & Hospice‘s records,
if the health information you wish to amend is not part of the health
information you or your representative are permitted to inspect and copy,
or if, in the opinion of Ruidoso Home Care & Hospice, the records
containing your health information are accurate and complete.
- Right to an accounting. You or your representative
have the right to request an accounting of disclosures of your health
information made by Ruidoso Home Care & Hospice for certain reasons,
including reasons related to public purposes authorized by law and certain
research. The request for an accounting must be made in writing to:
Janice Mansfield, Privacy Officer, Ruidoso Home Care & Hospice, PO Box
2019, Ruidoso NM 88355. The request should specify the
time period for the accounting starting on or after January 1, 2003.
Accounting requests may not be made for periods of time in excess of six
(6) years. Ruidoso Home Care & Hospice would 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.
-
Right to a paper copy of this notice. You or your
representative has a right to a separate paper copy of this Notice at any
time even if you or your representative have received this Notice
previously. To obtain a separate paper copy, please contact : Janice
Mansfield Privacy Officer, (505) 258-3116.
DUTIES OF RUIDOSO HOME CARE & HOSPICE
Ruidoso Home Care & Hospice is
required by law to maintain the privacy of your health information and to
provide to you and your representative a copy of this Notice of its duties
and privacy practices. Ruidoso Home Care & Hospice is required to abide
by the terms of this Notice. It may be amended from time to time. Ruidoso
Home Care & Hospice reserves the right to change the terms of its Notice
and to make the new Notice provisions effective for all health information
that it maintains. If Ruidoso Home Care & Hospice changes its Notice,
Ruidoso Home Care & Hospice will provide a copy of the revised Notice to
you or your appointed representative. You or your personal representative
have the right to express complaints to Ruidoso Home Care & Hospice and to
the Secretary of DHHS if you or your representative believe that your
privacy rights have been violated. Any complaints to Ruidoso Home Care &
Hospice should be made in writing to : Janice Mansfield, Privacy
Officer, Ruidoso Home Care & Hospice, PO Box 2019, Ruidoso NM 88355.
Ruidoso Home Care & Hospice encourages you to express any concerns
you may have regarding the privacy of your information. You will not be
retaliated against in any way for filing a complaint.
Contact Person
RHCH has designated the PRIVACY
OFFICER as its contact person for all issues regarding patient privacy
and your rights under the Federal privacy standards. You may contact this
person at PO Box 2019, Ruidoso NM 88355.
Effective Date
This Notice is effective April 1,
2003
IF YOU HAVE ANY
QUESTIONS REGARDING THIS NOTICE,. PLEASE CONTACT :
JANICE
MANSFIELD, PRIVACY OFFICER
RUIDOSO
HOME CARE & HOSPICE
PO BOX
2019
RUIDOSO
NM 88355
(505)
258-0028
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