This statement gives you advice required by law – (the Privacy Act of 1974).
Medicare and Medicaid participating home health agencies must do a complete assessment that accurately reflects your current health and includes information that can be used to show your progress toward your health goals. The home health agency must use the “Outcome and Assessment Information Set” (OASIS) when evaluating your health. To this date, the agency must get information from every patient. This information is used by the Health Care Financing Administration. (HCFA, the federal Medicare and Medicaid agency) to be sure that the home health agency meets quality standards and gives appropriate healthcare to its patients. You have the right to refuse to provide information for the assessment to the home health agency. If your information is included in an assessment, it is protected under the federal Privacy Act of 1974 and the “Home Health Agency Outcome and Assessment Information Set” (HHA OASIS) System of Records. You have the right to see, copy, review, and request correction of your information in the HHA OASIS System of Records.
The information collected will be entered into the Home Health Agency Outcome and Assessment Information Set (HHA OASIS) System No. 09-70-9002. Your health care information in the HHA OASIS System of Records will be used for the following purposes:
These “routine uses” specify the circumstances when the Health Care Financing Administration may release your information from the HHA OASIS System of Records without your consent. Each prospective recipient must agree in writing to ensure the continuing confidentiality and security of your information. Disclosures of the information may be to:
The home health agency needs the information contained in the Outcome and Assessment Information Set in order to give you quality care. It is important that the information be correct. Incorrect information could result in payment errors. Incorrect information also could make it hard to be sure that the agency is giving you quality services. If you choose not to provide information, there is no federal requirement for the home health agency to refuse you services.
Note: This statement may be included in the admission packet for all new home health agency admissions. Home health agencies may request you or your representative to sign this statement to document that this statement was given to you. Your signature is NOT required. If you or your representative sign the statement, the signature merely indicates that you received this statement. You or your representative must be supplied with a copy of this statement.
If you want to ask the Health Care Financing Administration to see, review, copy, or correct your personal health information which that Federal agency maintains in its HHA OASIS System of Records:
Call 1-800-MEDICARE, toll free, for assistance in contacting the HHA OASIS System Manager.
TTY for the hearing and speech impaired: 1-877-486-2048.
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.
Nurse-On-Call may use your 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. Your health information may be used or disclosed only after the Agency has obtained your written consent. The Agency has established policies to guard against unnecessary disclosure of your health information.
The following is a summary of the circumstances and purposes for which your health information may be used and disclosed after you have provided your written consent:
To provide treatment: Nurse-On-Call may use your health information to coordinate care within Nurse-On-Call and with others involved in your care, such as your attending physician and other health care professionals. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Nurse-On-Call also may disclose your health care information to individuals outside of Nurse-On-Call involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.
To obtain payment: Nurse-On-Call may include your health information in invoices to collect payment from third parties for the care you received from Nurse-On-Call. For example, Nurse-On-Call may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Nurse-On-Call. Nurse-On-Call 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: Nurse-On-Call may use and disclose health information for its own operations in order to facilitate the function of Nurse-On-Call and as necessary to provide quality care to all of Nurse-On-Call’s patients. Health care operations include such activities as:
The following is a summary of the circumstances and purposes for which your health information may be used and disclosed without first receiving your written consent.
When legally required: Nurse-On-Call 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: Nurse-On-Call must disclose your health information for public activities and purposes in order to:
1. 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
2. Report adverse events, 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
3. Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading disease
4. Notify an employer about an individual who is a member of the workforce as legally required
To report abuse, neglect or domestic violence: Nurse-On-Call is required to notify government authorities if Nurse-On-Call believes a patient is the victim of abuse, neglect or domestic violence. Nurse-On-Call will make this disclosure only when specifically required or authorized by law. Disclosure outside the bounds of legal requirements may be requested by the patient.
To conduct health oversight activities: Nurse-On-Call may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Nurse-On-Call, 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: Nurse-On-Call 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 Nurse-On-Call 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, Nurse-On-Call may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:
1. 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
2. For the purpose of identifying or locating a suspect, fugitive, material witness or missing person
3. Under certain limited circumstances, when you are the victim of a crime
4. To a law enforcement official if Nurse-On-Call has suspicion that your death was the result of criminal conduct including criminal conduct at Nurse-On-Call
5. In an emergency in order to report a crime
To coroners and medical examiners: Nurse-On-Call 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: Nurse-On-Call 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, Nurse-On-Call may disclose your health information prior to and in reasonable anticipation of your death.
For organ, eye or tissue donation: Nurse-On-Call may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplant of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.
For research purposes: Nurse-On-Call may, under very select circumstances, use your health information for research. Before Nurse-On-Call discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. Nurse-On-Call will almost always request your written authorization before granting access to your individually identifiable health information.
In the event of a serious threat to health or safety: Nurse-On-Call may, consistent with applicable law and ethical standards or conduct, disclose your health information if Nurse-On-Call, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or the health and safety of the public.
For specified government functions: In certain circumstances, the Federal regulations authorize Nurse-On-Call 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 workers compensation: Nurse-On-Call may release your health information for worker’s compensation or similar programs.
Authorization to use or disclose health information: Other than is stated above, Nurse-On-Call will not disclose your health information other than with your written authorization. If you or your representative authorize Nurse-On-Call 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 Nurse-On-Call maintains.
1. 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 Nurse-On-Call’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, Nurse-On-Call is not required to agree to your request. If you wish to make a request for restrictions, please contact the Privacy Officer.
2. Right to receive confidential communications: You have the right to request that Nurse-On-Call communicate with you in a certain way. For example, you may ask that Nurse-On-Call 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 the Privacy Officer. Nurse-On-Call will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
3. 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 the Accounts Receivable Manager. If you request a copy of your health information, Nurse-On-Call will charge a reasonable fee for copying and assembling costs associated with your request.
4. Right to amend health care information: You or your representative have the right to request that Nurse-On-Call 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 Nurse-On-Call. A request for an amendment of records must be made in writing to the Privacy Officer. Nurse-On-Call will deny the request if it is not in writing or does not include a reason for the amendment. The request also will be denied if your health information records were not created by Nurse-On-Call, if the records you are requesting are not part of Nurse-On-Call’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 Nurse-On-Call, the records containing your health information are accurate and complete.
5. Right to an accounting: You or your representative have the right to request an accounting of disclosures of your health information made by Nurse-On-Call for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to the Privacy Officer. The request should specify the time period for the accounting starting on or after October 2003. Accounting requests may not be made for periods of time in excess of six (6) years. Nurse-On-Call 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.
6. Right to paper copy of this notice: You or your representative has a right to 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 the Privacy Officer.
Duties of Nurse-On-Call: Nurse-On-Call is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices. Nurse-On-Call is required to abide by the terms of this Notice as may be amended from time to time. Nurse-On-Call 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 Nurse-On-Call changes its notice, Nurse-On-Call will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative has the right to express complaints to Nurse-On-Call or to the Secretary of DHHS if you or your representative believes that your privacy rights have been violated. Any complaints to Nurse-On-Call should be made in writing to the Privacy Officer. Nurse-On-Call 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: Nurse-On-Call 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: 561-649-0830
Effective date: This notice is effective October 2003