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Agency on
Aging of South Central Connecticut
Notice of
Privacy Practices
This
Notice Describes How Medical/Health Information about You May Be Used and
Disclosed and How You Can Get Access to this Information. Please Review It
Carefully. If you have any questions about this notice, please call our Privacy Officer: Agency on Aging of South Central Connecticut at (203) 752-3040 or 1-888-811-1222 The effective date of this privacy notice
is April 14, 2003 Agency
on Aging of South Central Connecticut respects the privacy and
confidentiality of your health information.
This Notice applies to uses and disclosures we may make of all your
health information whether created or received by us. OUR RESPONSIBILITIES TO
YOU We are required by law to: 1. Maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices. 2. Comply with the terms of our Notice currently in effect. We reserve the right to
change our practices and to make the new provisions effective for all health
information we maintain, including both health information we already have
and health information we create or receive in the future. Should we make material changes, we will
provide you with a revised Notice upon request. HOW WE WILL USE AND DISCLOSE YOUR HEALTH
INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS 1.
We may use and disclose your health information in
order to provide care management services and to coordinate, monitor and
revise your plan of care. This
includes making disclosures to contracted service providers, other providers
involved in or who may become involved in your plan of care, community and
institutional providers who are related to your plan of care and those from whom we are requesting services,
care or benefits on your behalf. Unless you object, we may disclose health
information to members of your family
who are involved in your care or who potentially could render care to you. 2.
We may use and disclose your health information in
order to bill and receive payment for the home care services and other health
related services or equipment you may receive. For billing and payment purposes, we will disclose your health
information to third party payers such as the Department of Social Services,
Medicaid, Electronic Data Services, the Centers for Medicare and Medicaid
Services and their intermediaries, private insurers and those agencies
providing direct home care or other services to you. We bill both for our care management
services and on behalf of those agencies providing care for you under your
Connecticut Home Care Program for Elder’s plan of care. We may also disclose your health
information in the course of accessing entitlements, payments and benefits on
your behalf, including, but not limited to the Department of Social Services,
the Center for Medicare Advocacy, City Benefit Programs. 3.
We may use and disclose your health information as
necessary for our internal operations, such as for general administration
activities and to monitor the quality of care you receive with us. The State Department of Social Services
retains the right to review your record at any time and during regularly
scheduled audits. Our Quality
Assurance Committee members may review your health information in the course
of performing their duties. OTHER USES AND DISCLOSURES WE MAY MAKE WITHOUT YOUR WRITTEN AUTHORIZATION Under the Privacy Regulations, we may make the following uses and
disclosures without obtaining a written Authorization from you: 1. We
may disclose your health information when required by law to do so. 2.
Unless you object,
we may disclose health information about you to a family member, close
personal friend and/ or other person(s), including clergy, who are or may
become involved in your care or payment for your care. 3.
We may disclose your
health information for public health activities. 4.
If we believe that
you have been a victim of abuse, neglect or domestic violence, we may use and
disclose your health information to notify a government authority, if
required by law, if you agree to the report or if the report is expressly
authorized by law and we believe that the report is necessary to prevent
serious harm to you or other potential victims. 5.
We may disclose your health information to a
health oversight agency for activities authorized by
law. A health oversight agency is a
state or federal agency that oversees the health care system. Some of the activities may include, for
example, audits, investigations, inspections and licensure actions. 6. We may disclose your health information in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process. We may disclose information as part of a probate court proceeding. 7. We may disclose your health information for certain law enforcement purposes. 8. We may release your health information to a coroner, medical examiner, funeral director and, if you are an organ donor, to an organization involved in the donation of organs and tissue. 9. Your health information may be used for research purposes, but only if: (1) the privacy aspects of the research have been reviewed and approved by a special Privacy Board or Institutional Review Board and the Board can legally waive patient authorizations otherwise required by the Privacy Regulations; (2) the researcher is collecting information for a research proposal; or (3) if you give written authorization for the use or disclosure. 10. When necessary to prevent a serious threat to your health or safety, or the health or safety of the public or another person, we may use or disclose your health information to someone able to help lessen or prevent the threatened harm. 11. We may disclose health information to authorized federal officials conducting national security and intelligence activities or for other specialized government functions. 12. We may use or disclose your health information to comply with laws relating to workers' compensation or similar programs. 13. We may disclose health information
about you to an organization assisting in a disaster relief effort 14. We may use or disclose health information to remind you about appointments. 15. We may disclose your health information to our business associates under a Business Associate Agreement, or provider service agreement. YOUR
WRITTEN AUTHORIZATION IS REQUIRED FOR ALL OTHER USES OR DISCLOSURES OF YOUR
HEALTH INFORMATION 1. We will
obtain your written authorization (an "Authorization") prior to
making any use or disclosure other than those described above. 2. A written Authorization is designed to inform you of a specific use or disclosure, other than those set forth above, that we plan to make of your health information. The Authorization describes the particular health information to be used or disclosed and the purpose of the use or disclosure. Where applicable, the written Authorization will also specify the name of the person to whom we are disclosing the health information. The Authorization will also contain an expiration date or event. 3. You may revoke a written
Authorization previously given by you at any time but you must do so in
writing. If you revoke your
Authorization, we will no longer use or disclose your health information for
the purposes specified in that Authorization except where we have already
taken actions in reliance on your Authorization. YOUR RIGHTS REGARDING YOUR HEALTH
INFORMATION You have the following rights regarding your health information: 1. You have the right to request that we
restrict the way we use or disclose your health information for treatment,
payment or health care operations.
However, we are not required to agree to the restriction. If we do agree to a restriction, we will
honor that restriction except in the event of an emergency or other limited
instances and will only disclose the restricted information to the extent
necessary for your treatment. 2. You have the right to request that we
communicate with you concerning your health matters in a certain manner. 3. You have the right to inspect and, upon written request, obtain a copy of your health information except under certain limited circumstances. For CHCPE clients, all requests to view your record will be forwarded to the State Department of Social Services, Connecticut Home Care Program for Elders. 4. You have the right to request that we
amend your health information. Your
request must be made in writing and must state the reason for the requested
amendment. We may deny your request
for amendment if the information: (a) was not created by us, unless you
provide reasonable information that the originator of the information is no
longer available to act on your request; (b) is not part of the health
information maintained by us; (c) is information to which you do not have a
right of access; or (d) is already accurate and complete, as determined by
us. If we deny your request for
amendment, we will give you a written denial notice, including the reasons
for the denial. In that event, you
have the right to submit a written statement disagreeing with the
denial. Your letter of disagreement
will be attached to your medical record. 5. You have the right to request an
“accounting” of certain disclosures of your health information. This is a listing of disclosures made by
us or by others on our behalf, but does not include disclosures for treatment
(care management), payment and health care operations or certain other
exceptions. You
must submit your request in writing and you must state the time period for
which you would like the accounting.
The accounting will include the disclosure date(s); the name of the
person or entity(s) that received the information and address, if known; a
brief description of the information disclosed; and a brief statement of the
purpose of the disclosure. The first
accounting provided within a 12-month period will be free; for further
requests, we may charge you our costs for completing the accounting. For
CHCPE clients, all such requests will be forwarded to the State Department of
Social Services, Connecticut Home Care Program for Elders. SPECIAL REGULATIONS REGARDING DISCLOSURE OF
PSYCHIATRIC, SUBSTANCE ABUSE AND HIV-RELATED INFORMATION For disclosures concerning health information relating to
care for psychiatric conditions, substance abuse or HIV-related information,
special restrictions may apply. For
example, we generally may not disclose this specially protected information
in response to a subpoena, warrant or other legal process unless you sign a
special Authorization or a court orders the disclosure. A general release of your health
information will not be sufficient for purposes of disclosing psychiatric,
substance abuse or HIV-related information. 1. Psychiatric information. We will not disclose records relating to a
diagnosis or treatment of your mental condition between the patient and
psychiatrist, or which are prepared at a mental health facility, without
specific written Authorization or as required or permitted by law. 2. HIV-related information. HIV-related information will not be
disclosed, except under limited circumstances set forth under state or
federal law, without your specific written Authorization. A general authorization for release of
medical or other information will not be sufficient for purposes of releasing
HIV-related information. 3. Substance abuse treatment. If you are treated in a specialized
substance abuse program, information which could identify you as an alcohol
or drug-dependant patient will not be disclosed without your specific
Authorization, except where specifically required or allowed under state or
federal law. COMPLAINTS 1. If you believe that your privacy rights have been violated,
you may file a complaint in writing with us or with the Office of Civil
Rights in the U.S. Department of Health and Human Services at 200
Independence Avenue, S.W., Room 509 F, HHH Building, Washington D.C. 20201. 2. To file
a complaint with us, you should contact: Agency on Aging of South Central Connecticut Connecticut Home Care Program for Elders Privacy Officer 419 Whalley Avenue, New Haven, CT 06511 (203) 752-3040
or 1-888-811-1222 3. We will not retaliate against you in any way for
filing a complaint against Agency on Aging of South Central Connecticut. |
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