Notice of Privacy Practices
NOTICE OF PROVIDER PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND YOUR RIGHTS WITH RESPECT TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
RIGHT AT HOME must maintain the privacy of your personal health information and give you this
notice that describes our legal duties and privacy practices concerning your personal health
information. We must follow the privacy practices described in this notice and as outlined in the
Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If you have any questions
about this notice, please contact the Privacy Officer or security official (referred to in this
Notice as the “POX”) whose contact information is at the end of this Notice under the heading
Complaints. The POX is responsible for the development and implementation of the policies and
procedures necessary for compliance with HIPAA.
Our Obligations
We are required by law to:
• Maintain the privacy of personal health information.
• Give you this notice of our legal duties and privacy practices regarding health information
about you.
• Follow the terms of our notice that is currently in effect.
How We May Use And Disclose Protected Health Information
The following describes the ways we may use and disclose health information that identifies you
(“Protected Health Information”). Disclosure includes divulging via online services and Web
portals. Except for the purposes described below, we will use and disclose Protected Health
Information only with your written permission. You may revoke your written permission at any time
by writing to our POX.
For Treatment. We may use and disclose Protected Health Information for your treatment and to
provide you with treatment-related health care services. For example, we may disclose Protected
Health Information to doctors, nurses, technicians, or other personnel, including people outside
our office, who are involved in your medical care and need the information to provide you with
medical care.
For Payment. We may use and disclose Protected Health Information so that we or others may bill and
receive payment from you, an insurance company or a third party for the treatment and services you
received. For example, we may give your health plan information about you so that they will pay for
your treatment.
For Health Care Operations. We may use and disclose Protected Health Information for health care
operations. These uses and disclosures are those we deem necessary as we strive to have all of our
clients receive quality care and to proficiently operate and manage our offices. For example, we
may use your Protected Health Information or your answers to a client satisfaction survey in
evaluating the quality of services provided by our staff. We may also disclose your Protected
Health Information to our auditors, attorneys, or other professional advisors. We also may share
information with other entities that have a relationship with you (for example, your health plan)
for their health care operation activities.
Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services. We may use
and disclose Protected Health Information to contact you to remind you that you have an appointment
with us. We also may use and disclose Protected Health Information to tell you about treatment
alternatives or health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose your
Protected Health Information to your family, relatives, friends or any other person involved in
your care or the payment for your care or any other person you identify. If you are unable to agree
or object to such a disclosure, we may disclose such information as necessary if we determine that
it is in your best interest based on our professional judgment.
Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations
that seek your Protected Health Information to coordinate your care, or notify family and friends
of your location or condition in a disaster.
Research. Under certain circumstances, we may use and disclose Protected Health Information for
health-related research. For example, a research project may involve comparing the health of
clients who received one treatment to those who received another, for the same condition. Before we
use or disclose Protected Health Information for research, the project will go through a special
approval process. Even without special approval, we may permit researchers to look at records to
help them identify clients who may be included in their research project or for other similar
purposes, as long as they do not remove or take a copy of any Protected Health Information.
Special Situations
As Required by Law. We will disclose Protected Health Information when required to do so by
international, federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose Protected Health Information
when necessary to prevent a serious threat to your health and safety or the health and safety of
the public or another person.
Disclosures, however, will be made only to someone who may be able to help prevent the threat.
Business Associates. We may use and disclose Protected Health Information in connection with our
business associates that perform functions on our behalf or who provide us with services if the
information is necessary for such functions or services. For example, we may use a vendor/business
associate to provide services such as: (i) legal, (ii) debt collection, (ii) data aggregation and
processing, (iv) billing and collection functions, (v) conducting client satisfaction surveys, and
(vi) developing a blended care model for delivery of care services for persons needing care in
their homes through a combination of technologies, remote services and in home services. All of our
business associates are obligated to protect the privacy of your information and are not allowed to
use or disclose any information other than as specified in our contract with them.
Organ and Tissue Donation. If you are an organ donor, we may use or disclose Protected Health
Information to organizations that handle organ procurement or other entities engaged in
procurement, banking or transportation of organs, eyes or tissues to facilitate organ, eye or
tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may disclose Protected Health
Information as required by military command authorities. We also may disclose Protected Health
Information to the appropriate foreign military authority if you are a member of a foreign
military.
Workers’ Compensation. We may disclose Protected Health Information for workers’ compensation or
similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose Protected Health Information for public health activities.
These activities generally include disclosures to prevent or
control disease, injury or disability; report births and deaths; report child abuse or neglect;
report reactions to medications or problems with products; notify people of recalls of products
they may be using; a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition; and 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 if you agree or 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, audits,
investigations, inspections, and licensure. These activities are necessary for the government to
monitor the health care system, government programs, and compliance with civil rights laws.
Data Breach Notification Purposes. We may use or disclose your Protected Health Information to
provide legally required notices of unauthorized access to or disclosure of your Protected Health
Information.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Protected
Health Information in response to a court or administrative order. We also may disclose Protected
Health Information in response to a subpoena, discovery request, or other lawful process by someone
else involved in the dispute, but only if efforts have been made to tell you about the request or
to obtain an order protecting the information requested.
Law Enforcement. We may disclose Protected Health Information if asked by a law enforcement
official if the information is: (1) in response to a court order, subpoena, warrant, summons or
similar process; (2) limited information to identify or locate a suspect, fugitive, material
witness, or missing person; (3) about the victim of a crime even if, under certain very limited
circumstances,
we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of
criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency 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 disclose 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 also may disclose Protected Health Information to funeral
directors as necessary for their duties.
National Security and Intelligence Activities. We may disclose Protected Health Information to
authorized federal officials for intelligence, counter- intelligence, and other national security
activities authorized by law.
Protective Services for the President and Others. We may disclose Protected Health Information to
authorized federal officials so they may provide protection to the President, other authorized
persons or foreign heads of state or to conduct special investigations.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may disclose Protected Health Information to the
correctional institution or law enforcement official. This disclosure would be if necessary: (1)
for the institution to provide you with health care; (2) to protect your health and safety or the
health and safety of others; or (3) the safety and security of the correctional institution.
Uses And Disclosures That Requires Us To Give You An Opportunity To Object And Opt Out
If a question about disclosure of your Protected Health Information comes about and you are present
and capable of making a decision, we will endeavor
to provide you with an opportunity to object to a disclosure, or, in the alternative, we will use our professional judgment to determine that you do not object.
Your Written Authorization Is Required For Other Uses And Disclosures
The following uses and disclosures of your Protected Health Information will be made only with your written authorization:
1. Uses and disclosures of Protected Health Information for marketing purposes; and
2. Disclosures that constitute a sale of your 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 authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our PO and we will no longer disclose Protected Health Information under the authorization. But disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.
Your Rights
You have the following rights regarding Protected Health Information we have about you:
Right to Inspect and Copy. You have a right to inspect and copy Protected Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Protected Health Information, you must make your request, in writing, to the POX. We have up to 30 days to make your Protected Health Information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured Protected Health Information.
Right to Amend. If you feel that Protected Health Information we have 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 our office. To request an amendment, you must make your request, in writing, to the POX.
Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Protected Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to the POX.
Right to Request Restrictions. You have the right to request a restriction or limitation on the Protected Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Protected Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to the POX. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your Protected Health Information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. To request confidential communications, you must make your request, in writing, to our POX. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our Web site. To obtain a paper copy of this notice, you must make your request to the POX.
Changes To This Notice
We reserve the right to change this notice and make the new notice apply to Protected Health Information we already have as well as any information we receive in the future. We will post a copy of our current notice at our office. The notice will contain the effective date on the first page, in the top right-hand corner.
Right at Home
As used in this Notice, Right at Home refers to both the franchisor, Right at Home, Inc., and the franchisee Right at Home which is the independently owned and operated business with whom you have entered into a Services Agreement. The franchisee operates its business pursuant to a franchise licensed to it by the franchisor.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services Office of Civil Rights. All complaints must be made in writing. To file a complaint with our office, you should contact and write to the POX at the address on your Services Agreement. To file a complaint with our franchisor you should contact and write to the POX at Right at Home, Inc., 6464 Center Street, Suite 150, Omaha, NE 68106. You will not be penalized for filing a complaint.