Our agency is required by law to maintain the privacy of protected health information and to provide you adequate notice of your rights, and our legal duties and privacy practices with respect to the uses and disclosures of protected health information. (45 CFR § 165.520) We will use or disclose protected health information that is consistent with this notice.
The agency maintains a record, in paper and electronic form, of the information we receive and collect about you and of the care we provide to you. This record includes physician’s orders, assessments, medication lists, clinical progress notes and billing information.
As required by law, the agency maintains policies and procedures about our work practices, including how we provide and coordinate care provided to our patients. These policies and procedures include how we create, maintain and protect medical records; access to medical records and information about our patients; how we maintain the confidentiality of all information related to our patients; security of our office and electronic files; and how we educated staff on privacy of patient information.
Uses and Disclosures: As our patient, information about you must be used and disclosed to other parties for purposes of treatment, payment, and other health care operations. Examples of the information that must be disclosed:
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Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.
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Payment. Your health information may be used to seek payment from your health plan, from others sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
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Health care operations. Your health information may be used as necessary to support the day to day activities and management of Prestige Care Health Services, Inc. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
Other purposes: for which your protected health information may be used or disclosed without your individual written consent or authorization.
- Law enforcement. Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, to comply with government mandated reporting or to comply with a court or administrative order, a subpoena , discovery request or other law enforcement purposes. Your health information may be disclosed when required by federal, state or local law.
- Public health reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable disease to the state’s public health department. We are also required to report abuse, neglect, exploitation and reportable conduct to the appropriate government authorities.
- Emergency treatment situations. Your health information may be disclosed in an emergency treatment situation if you are in need of emergency treatment and the protected health information is needed to provide the emergency treatment. We will attempt to obtain consent as soon as practicable after treatment.
- Health care oversight activities. Your health information may be disclosed to government agencies for activities such as audits, investigations, inspections, and licensure by a government health oversight agency as authorized by law to monitor the health care system, government programs and compliance with civil rights laws.
- Coroners, medical examiners, and funeral directors. Your health information may be disclosed in certain circumstances, for example, to identify a deceased person, determine the cause of death to assist in carrying out their duties.
- Certain research purposes. Your health information may be disclosed under very select circumstances for research. Before we disclose any of your health information for such research purposes, the project will be subject to an extensive approval process. We will usually request your written authorization before granting access to your individually identifiable health information.
Other uses and disclosures require your authorization. Disclosure of your health information or its use for any other purpose requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.
Additional Uses of Information
Appointment reminders. Your health information will be used by our staff to send you appointment reminders.
Information about treatment. Your health information may be used to send you information about treatment alternatives or other health related benefits and services that may be of interest to you.
Other uses and disclosures which do not require your consent or authorization, but do require that you be informed in advance and be given the opportunity to agree to or prohibit or restrict disclosure in the following circumstances:
- use of a directory (includes name, location, condition described in general terms) of individuals served by our Agency; and
- to a family member, relative, friend, or other identified person, the information relevant to such person’s involvement in your care or payment for care; to notify family member, relative, friend, or other identified person of the individual’s location, general condition or death.
Individual Rights
You have certain rights under the federal privacy standards. These include:
- The right to request restrictions on the use and disclosure of your protected health information for treatment, payment or health care operations. However, we are not required to agree to any requested restriction. Restrictions to which we agree will be documented. Agreements for further restrictions may, however, be terminated under applicable circumstances (e.g., emergency treatment)
- The right to receive confidential communications concerning your medical condition and treatment. We will arrange for you to receive protected health information by reasonable alternative means or at alternative locations. Your request must be in writing. We do not require an explanation for the request as a condition of providing communications on a confidential basis and will attempt to honor reasonable requests for confidential communications.
- The right to inspect and copy your protected health information which is maintained in a designated record set, except for psychotherapy notes, information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding, or protected health information that is subject to the Clinical Laboratory Improvements Amendments of 1988 (42 USC § 263a and 45 CFR § 493 (a)(2)). If you request a copy of your health information, we will charge a reasonable fee for copying of $.25 per page copied.
- If we deny access to protected health information, you will receive a timely, written denial in plain language that explains the basis for the denial, your review rights and an explanation of how to exercise those rights. If we do not maintain the medical record, we will tell you where to request the protected health information.
- The right to amend or submit corrections to your protected health information for as long as the protected health information is maintained in the designated record set. A request to amend your record must be in writing and must include a reason to support the requested amendment. We will act on your request within seven (7) days of receipt of the request. We may extend the time for such action by up to 30 days, if we provide you with a written explanation of the reasons for the delay and the date by which we will complete action on the request.
- We may deny the request the request for amendment if the information contained in the record was not created by us, unless the originator of the information is no longer available to act on the requested amendment; is not part of the designated medical record set; would not be available for inspection under applicable laws and regulations; and the record is accurate and complete. If we deny your request for amendment, you will receive a timely, written denial in plain language that explains the basis for the denial, your rights to submit a statement disagreeing with the denial and an explanation of how to submit that statement.
- The right to receive an accounting of disclosures of protected health information made by our Agency for up to six (6) years prior to the date on which the accounting is requested for any reason other than for treatment, payment or health care operations and other applicable exceptions. The written accounting includes the date of each disclosure, the name/address (if known) of the entity or person who received the protected health information, a brief description of the information disclosed and a brief statement of the purpose of the disclosure or a copy of your written authorization or a written request for disclosure. We will provide the accountings within 60 days of receipt of a written request. However, we may extend the time period for providing the accounting by 30 days if we provide you with a written statement of the reasons for the delay and the date by which you will receive the information. We will 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.
- The right to receive a printed copy of this notice.
Prestige Care Health Services, Inc. Duties
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices.
We also are required to abide by the privacy policies and practices that are outlined in this notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice as soon as practicable. The revised policies and practices will be applied to all protected health information that we maintain.
Request to Inspect
Protected Health Information
As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Director of Operations who is the HIPAA Compliance Officer.
Complaints
If you believe that your privacy rights have been violated, you may complain to the agency or the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation against you for filing a complaint. The complaint should be filed in writing, and should state the specific incident (s) in terms of subject, date and other relevant matters. A complaint to the Secretary must be filed in writing within 180 days of when the act or omission complained of occurred, and must describe the acts or omissions believed to be in violation of applicable requirements. (45 CFR § 160.306)
Contact Person
The name and address of the person you can contact for further information concerning our privacy practices is:
Director of Operations
Prestige Care Health Services, Inc.
8313 Southwest Frwy., Suite 235
Houston, Texas 77074
(713) 271-0105
Effective Date
This notice is effective on April 14, 2003.