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Important Information for Our Clients
Intouch Home Care Services℠, a Program of Lutheran Social Services of Illinois
NOTICE OF PRIVACY PRACTICES
The effective date of this Notice is January 1, 2011.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Your client record contains personal information about you and your health. State and federal law protects the confidentiality of this information. Protected Health Information (“PHI”) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related services. The confidentiality of client records is specifically protected by state law. Intouch Home Care Services℠, a program of Lutheran Social Services of Illinois, is required to comply with these additional restrictions. This includes a prohibition, with very few exceptions, on informing anyone outside the program that you are participating in our program or disclosing any information that identifies you as a client. The violation of these laws or regulations by this program is a crime. If you suspect a violation you may file a report to the appropriate authorities in accordance with applicable law.
How We May Use and Disclose Health Information About You
- For Treatment. We may use PHI about you to provide you with treatment or services.
- For Payment. We may use and disclose PHI about you so that we can receive payment for the treatment services provided to you.
- For Health Care Operations. We may use and disclose your PHI for certain purposes in connection with the operation of our program.
- Without Authorization. Applicable law also permits us to disclose information about you without your authorization in a limited number of other situations, such as with a court order. These situations are explained on the following pages.
- With Authorization. We must obtain written authorization from you for other uses and disclosures of your PHI.
Your Rights Regarding Your PHI. You have the following rights regarding PHI we maintain about you:
- Right of Access to Inspect and Copy. You have the right, which may be restricted in certain circumstances, to inspect and copy PHI that may be used to make decisions about your care. We may charge a reasonable, cost-based fee for copies.
- Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment.
- Right to an Accounting of Disclosures. You have the right to request an accounting of the disclosures that we make of your PHI.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the use or of your PHI for treatment, payment, or health care operations. We are not required to agree to your request.
- Right to Request Confidential Communication. You have the right to request that we communicate with you about health matters in a certain way or at a certain location.
- Right to a Copy of this Notice. You have the right to a copy of this notice.
- Complaints. You have the right to file a complaint in writing to us or to the Secretary of Health and Human Services if you believe we have violated your privacy rights. We will not retaliate against you for filing a complaint.
If you have any questions about this Notice of Privacy Practices, please contact our Privacy Officer:
HIPAA Privacy Officer
Lutheran Social Services of Illinois
Case Coordination Unit
1901 First Avenue
Sterling, Illinois 61081
This Notice of Privacy Practices describes how we may use and disclose your protected health information (“PHI”) in accordance with all applicable law. It also describes your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will make available a revised Notice of Privacy Practices by posting a copy on our website [http://www.lssi.org], sending a copy to you in the mail upon request, or providing one to you at your next appointment.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
Listed below are examples of the uses and disclosures that Intouch Home Care Services℠, a program of Lutheran Social Services of Illinois, may make of your protected health information (“PHI”). These examples are not meant to be exhaustive. Rather, they describe the types of uses and disclosures that may be made without your authorization.
Uses and Disclosures of PHI for Treatment, Payment and Health Care Operations:
Treatment. Your PHI may be used and disclosed by your physician, home care aide and supervisor, other program staff and others outside of our program that are involved in your care for the purpose of providing, coordinating, or managing your health care and any related services. This includes coordination or management of your health care with a third party, consultation with other health care providers or referral to another provider for health care and related services. For example, your protected health information may be provided to your physician to confirm that you are participating in services. In addition, we may disclose your protected health information from time-to-time to other providers of health care and related services (e.g., a specialist, home health agency staff, hospice) who, at the request of you or the program, becomes involved in your care and service. Except for emergency services, we will not send your PHI to an outside health care provider unless you or your designated representative give us written authorization to do so.
Payment. Examples of payment-related activities are: providing your insurance carrier with verification that you are receiving services and the types of services you are receiving or other requested information to assist you in filing your claim.
Healthcare Operations. We may use or disclose, as needed, your PHI in order to support the business activities of our program including, but not limited to, quality assessment activities, employee review activities, training of new staff, licensing, accreditation, and conducting or arranging for other business activities. For example, a request from a personal representative who may assist you in obtaining care, or a report to proper authorities for Public health purposes to control disease. We may also call you by name in the hall or meeting room where you live. We may share your PHI with third parties that perform various business activities (e.g., billing or typing services) for Lutheran Social Services of Illinois, provided we have a written contract with the business that prohibits it from re-disclosing your PHI and requires it to safeguard the privacy of your PHI. We may contact you to remind you of service dates and/or times to provide information to you about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also contact you concerning Lutheran Social Services of Illinois’s fundraising activities.
Additional Uses and Disclosures That Do Not Require Your Authorization:
Required by Law. We may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures. Under the law, we must make disclosures of your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.
Health Oversight. We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors) and peer review organizations performing utilization and quality control.
Emergency Circumstances. We may use or disclose your PHI to emergency personnel or your authorized representative in an emergency situation, when the specific PHI disclosed is relevant to your immediate health care needs and determined by the professional judgment of staff to be in your best interests. Our staff will notify you of this disclosure as soon as reasonably practicable after the resolution of the emergency.
Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of abuse or neglect. However, the information we disclose is limited to only that authorized by law, and only that information which is necessary to make the initial mandated report.
Deceased Clients. We may disclose PHI regarding deceased clients for the purpose of determining the cause of death, in connection with laws requiring the collection of death or other vital statistics, or permitting inquiry into the cause of death.
Organ Donation. We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues
Research. Information that has no identifying information or is part of a limited data set may be used for research purposes without your authorization. PHI may also be used for research purposes with your written authorization.
Criminal Activity on Program Premises/Against Program Personnel. We may disclose your PHI to law enforcement officials if you have committed a crime on program premises or against program personnel.
Court Order. We may disclose your PHI if the court issues an appropriate order and follows required procedures.
Interagency Disclosures. Limited PHI may be disclosed for the purpose of coordinating services among government programs that provide mental health, counseling or developmental disabilities services where those programs have entered into an interagency agreement.
Public Safety. We may disclose PHI to the appropriate resources under duty to warn in order to avert a serious threat to health or safety, such as physical or mental injury being inflicted on you or by you to someone else.
Worker’s Compensation. We may disclose your health information as necessary to comply with worker compensation laws.
Uses and Disclosures of PHI With Your Written Authorization:
Other uses and disclosures of your PHI will be made only with your written authorization. You may revoke this authorization at any time, unless the program or its staff has taken an action in reliance on the authorization of the use or disclosure you permitted.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Your rights with respect to your protected health information are explained below. Any requests with respect to these rights must be in writing. A brief description of how you may exercise these rights is included.
You have the right to inspect and copy your Protected Health Information:
You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as we maintain the record. A “designated record set” contains medical and billing records and any other records that the program uses for making decisions about you. We may require you to request access to your information in writing. We may charge you a reasonable cost-based fee for the copies. We can deny you access to your PHI in certain circumstances. In some of those cases, you will have a right to appeal the denial of access. Please contact the Program Director if you have questions about access to your client record.
You may have the right to request amendment of your Protected Health Information:
You may request, in writing, that we amend your PHI that has been included in a designated record set. 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. We may prepare a rebuttal to your statement and will provide you with a copy of it. Please contact the Program Director if you have questions about amending your client record.
You have the right to receive an accounting of some types of Protected Health Information disclosures:
You may request an accounting of disclosures for a period of up to six years, excluding disclosures made to you, made for treatment purposes, made as a result of your authorization, and certain other disclosures. We may charge you a reasonable fee if you request more than one accounting in any 12-month period. Please contact the Program Director if you have questions about accounting of disclosures.
You have the right to request added restrictions on disclosures and uses of your Protected Health Information:
You have the right to ask us not to use or disclose any part of your PHI for treatment, payment or health care operations or to family members involved in your care. Your request for restrictions must be in writing. We are not required to agree to your requested restrictions. Please contact the Program Director if you would like to request restrictions on the disclosure of your PHI.
You have a right to request confidential communications:
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable, written requests. We may also condition this accommodation by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact. We will not ask you why you are making the request. Please contact the Program Director if you would like to make this request.
You have a right to receive a paper copy of this notice:
You have the right to obtain a copy of this notice from us. Any questions should be directed to our Privacy Officer.
If you believe we have violated your privacy rights, you may file a complaint in writing to us by notifying our Privacy Officer. We will not retaliate against you for filing a complaint.
HIPAA Privacy Officer
Lutheran Social Services of Illinois
Case Coordination Unit
1901 First Avenue
Sterling, Illinois 61081
You may also file a complaint with the U.S. Secretary of Health and Human Services as follows:
200 Independence Avenue, S.W.
Washington, D.C. 20201
The undersigned acknowledges receipt of this “Notice of Privacy Practices” as provided at the time of initial service delivery. *
Client or Authorized Representative
* Maintain original in file. Provide copy to client.