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Cooper
Home Health, Inc.
NOTICE
OF PRIVACY PRACTICES
Effective: April 14, 2003
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.
This
notice will tell you how we may use and disclose protected health
information about you. Protected health information means any
health information about you that identifies you or for which
there is a reasonable basis to believe the information can be
used to identify you. In this notice, we call all of that protected
health information, “medical information.”
This notice also will tell you about your rights and our duties
with respect to medical information about you. In addition, it
will tell you how to complain to us if you believe we have violated
your privacy rights.
How We May Use and Disclose Medical Information About
You?
We use and disclose medical information about you for a number
of different purposes. Each of those purposes is described below.
For
Treatment
We may use medical information about you to provide, coordinate
or manage your health care and related services by both us and
other health care providers. We may disclose medical information
about you to doctors, nurses, case managers at the Texas
Department of Aging and Disability Services, hospitals and other health facilities who become
involved in your care. We may consult with other health care providers
concerning you, and as part of the consultation share your medical
information with them. Similarly, we may refer you to another
health care provider and as part of the referral share medical
information about you with that provider. For example, we may
conclude you need to receive Medicare covered services from a
Medicare certified home health agency. When we refer you to that
agency, we also will contact that agency’s office and provide
medical information about you to them so they have information
they need to provide services for you. Other healthcare professionals
we may disclose information to may include pharmacists, laboratory
services, radiology services, medical supply/equipment companies,
nursing/rehabilitation facilities, assisted living facilities,
emergency services personnel, and medical transportation personnel.
Information released will be limited to the minimum amount reasonably
necessary to your care.
For Payment
We may use and disclose medical information about you so we can
be paid for the services we provide to you. This can include billing
you, your insurance company, or a third party payor. For example,
we may need to provide your insurance company or a government
program, such as Medicaid, with information about your medical
condition and the health care you need to receive in order to
obtain payment and determine if you are covered by that insurance
or program.
For Health Care Operations
We may use and disclose medical information about you for our
own health care operations. These are necessary for us to operate
Cooper Home Health, Inc. and to maintain quality health care for
our patients. For example, we may use medical information about
you to review the services we provide and the performance of our
employees in caring for you. We may disclose medical information
about you to train our staff and/or informal support individuals
you have selected to participate in your care. We also may use
the information to study ways to more efficiently manage our organization.
How
We Will Contact You
Unless you tell us otherwise in writing, we may contact you by
either telephone or by mail at either your home or your workplace.
At either location, we may leave messages for you on the answering
machine or voice mail. If you want to request that we communicate
to you in a certain way or at a certain location, see “Right
to Receive Confidential Communications” on page 4 of this
Notice.
Appointment Reminders
We may use and disclose medical information about you to contact
you to remind you of an appointment you have with us or another
health care provider.
Treatment Alternatives
We may use and disclose medical information about you to contact
you about treatment alternatives that may be of interest to you.
Health
Related Benefits and Services
We may use and disclose medical information about you to contact
you about health-related benefits and services that may be of
interest to you.
Business Associates
We sometimes provide services through contracts with business
associates. Examples may include therapy services and building
contractors who construct minor home modifications requested and
approved by you. Other business associates may include legal counsel,
computer software/hardware technicians, and accountants. When
we use these services, we may disclose your medical information
to the business associate so that they can perform the function(s)
we have contracted with them to do. To protect your health information,
however, we require the business associate to appropriately safeguard
your information.
Marketing Communications
We may use and disclose medical information about you to communicate
with you about a product or service to encourage you to purchase
the product or service. This may be:
To describe a health-related product or service that may be provided
by us or another provider;
For your treatment;
For case management or care coordination for you;
To direct or recommend alternative treatments, therapies, health
care providers, or settings of care.
We
may communicate to you about products and services in a face-to-face
communication by us to you. We also may communicate about products
or services in the form of a promotional gift of nominal value.
All
other use and disclosure of medical information about you by us
to make a communication about a product or service to encourage
the purchase or use of a product or service will be done only
with your written authorization.
Individuals Involved in Your Care
We may disclose to a family member, other relative, a close personal
friend, or any other person identified by you, medical information
about you that is directly relevant to that person’s involvement
with your care or payment related to your care. We also may use
or disclose medical information about you to notify, or assist
in notifying, those persons of your location, general condition,
or death. If there is a family member, other relative, or close
personal friend that you do not want us to disclose medical information
about you to, please notify the Privacy
Officer at 51 North Side Square, Cooper, TX 75432.
Disaster Relief
We may use or disclose medical information about you to a public
or private entity authorized by law or by its charter to assist
in disaster relief efforts. This will be done to coordinate with
those entities in notifying a family member, other relative, close
personal friend, or other person identified by you of your location,
general condition or death.
Required by Law
We may use or disclose medical information about you when we are
required to do so by law.
Public Health Activities
We may disclose medical information about you for public health
activities and purposes. This includes reporting medical information
to a public health authority that is authorized by law to collect
or receive the information for purposes of preventing or controlling
disease, or one that is authorized to receive reports of child
abuse and neglect. It also includes reporting for purposes of
activities related to the quality, safety or effectiveness of
a United States Food and Drug Administration regulated product
or activity.
Victims of Abuse, Neglect or Domestic Violence
We may disclose medical information about you to a government
authority authorized by law to receive reports of abuse, neglect,
or domestic violence, if we believe you are a victim of abuse,
neglect, or domestic violence. This will occur to the extent the
disclosure is: (a) required by law; (b) agreed to by you; or,
(c) authorized by law and we believe the disclosure is necessary
to prevent serious harm to you or to other potential victims,
or, if you are incapacitated and certain other conditions are
met, a law enforcement or other public official represents that
immediate enforcement activity depends on the disclosure.
Health Oversight Activities
We may disclose medical information about you to a health oversight
agency for activities authorized by law, including audits, investigations,
inspections, licensure or disciplinary actions. These and similar
types of activities are necessary for appropriate oversight of
the health care system, government benefit programs, and entities
subject to various government regulations.
Judicial and Administrative Proceedings
We may disclose medical information about you in the course of
any judicial or administrative proceeding in response to an order
of the court or administrative tribunal. We also may disclose
medical information about you in response to a subpoena, discovery
request, or other legal process but only if efforts have been
made to tell you about the request or to obtain an order protecting
the information to be disclosed.
Disclosures for Law Enforcement Purposes
We may disclose medical information about you to a law enforcement
official for law enforcement purposes:
As required by law:
a. In response to a court, grand jury or administrative order,
warrant or subpoena.
b. To identify or locate a suspect, fugitive, material witness
or missing person.
c. About an actual or suspected victim of a crime and that person
agrees to the disclosure. If we are unable to obtain that person’s
agreement, in limited circumstances, the information may still
be disclosed.
d. To alert law enforcement officials to a death if we suspect
the death may have resulted from criminal conduct.
e. About crimes that occur at our facility.
f. To report a crime in emergency circumstances.
Coroners and Medical Examiners
We may disclose medical information about you to a coroner or
medical examiner for purposes such as identifying a deceased person
and determining cause of death.
Funeral Directors
We may disclose medical information about you to funeral directors
as necessary for them to carry out their duties.
Organ, Eye or Tissue Donation
To facilitate organ, eye or tissue donation and transplantation,
we may disclose medical information about you to organ procurement
organizations or other entities engaged in the procurement, banking
or transplantation of organs, eyes or tissue.
To Avert Serious Threat to Health or Safety
We may use or disclose protected health information about you
if we believe the use or disclosure is necessary to prevent or
lessen a serious or imminent threat to the health or safety of
a person or the public. We also may release information about
you if we believe the disclosure is necessary for law enforcement
authorities to identify or apprehend an individual who admitted
participation in a violent crime or who is an escapee from a correctional
institution or from lawful custody.
Military
If you are a member of the Armed Forces, we may use and disclose
medical information about you for activities deemed necessary
by the appropriate military command authorities to assure the
proper execution of the military mission. We may also release
information about foreign military personnel to the appropriate
foreign military authority for the same purposes.
National Security and Intelligence
We may disclose medical information about you to authorized federal
officials for the conduct of intelligence, counter-intelligence,
and other national security activities authorized by law.
Protective Services for the President
We may disclose medical information about you to authorized federal
officials so they can provide protection to the President of the
United States, certain other federal officials, or foreign heads
of state.
Inmates; Persons in Custody
We may disclose medical information about you to a correctional
institution or law enforcement official having custody of you.
The disclosure will be made if the disclosure is necessary: (a)
to provide health care to you; (b) for the health and safety of
others; or, (c) for the safety, security and good order of the
correctional institution.
Workers Compensation
We may disclose medical information about you to the extent necessary
to comply with workers’ compensation and similar laws that
provide benefits for work-related injuries or illness without
regard to fault.
Other Uses and Disclosures
Other uses and disclosures will be made only with your written
authorization. You may revoke such an authorization at any time
by notifying the Privacy Officer at Cooper Home Health, Inc.,
51 North Side Square, Cooper, TX 75432 in writing of your desire
to revoke it. However, if you revoke such an authorization, it
will not have any effect on actions taken by us in reliance on
it.
Your
Rights With Respect to Medical Information About You
You have the following rights with respect to medical information
that we maintain about you.
Right to Request Restrictions
You have the right to request that we restrict the uses or disclosures
of medical information about you to carry out treatment, payment,
or health care operations. You also have the right to request
that we restrict the uses or disclosures we make to: (a) a family
member, other relative, a close personal friend or any other person
identified by you; or, (b) to public or private entities for disaster
relief efforts. For example, you could ask that we not disclose
medical information about you to your brother or sister.
To request a restriction, you may do so at any time. If you request
a restriction, you should do so to the Privacy Officer at Cooper
Home Health, Inc., 51 North Side Square, Cooper, TX 75432, (903)395-2811
and tell us: (a) what information you want to limit; (b) whether
you want to limit use or disclosure or both; and, (c) to whom
you want the limits to apply (for example, disclosures to your
spouse). It is advisable to submit this request in writing.
We are not required to agree to any requested restriction. However,
if we do agree, we will follow that restriction unless the information
is needed to provide emergency treatment. Even if we agree to
a restriction, either you or we can later terminate the restriction.
Right
to Receive Confidential Communications
You have the right to request that we communicate medical information
about you to you in a certain way or at a certain location. For
example, you can ask that we only contact you by mail or at work.
We will not require you to tell us why you are asking for the
confidential communication.
If you want to request confidential communication, you must do
so in writing to the Privacy Officer at Cooper Home Health, Inc.,
51 North Side Square, Cooper, TX 75432. Your request must state
how or where you can be contacted.
We will accommodate your request. However, we may, when appropriate,
require information from you concerning how payment will be handled.
We also may require an alternate address or other method to contact
you.
Right to Inspect and Copy
With a few very limited exceptions, such as psychotherapy notes,
you have the right to inspect and obtain a copy of medical information
about you.
To inspect or copy medical information about you, you must submit
your request in writing to the Privacy Officer at Cooper Home
Health, Inc., 51 North Side Square, Cooper, TX 75432. Your request
should state specifically what medical information you want to
inspect or copy. If you request a copy of the information, we
may charge a fee for the costs of copying and, if you ask that
it be mailed to you, the cost of mailing.
We will act on your request within thirty (30) calendar days after
we receive your request. If we grant your request, in whole or
in part, we will inform you of our acceptance of your request
and provide access and copies.
We may deny your request to inspect and copy medical information
if the medical information involved is:
a.
Information compiled in anticipation of, or use in, a civil, criminal
or administrative action or proceeding;
b. Protected health information subject to the Clinical Laboratory
Improvements Amendments of 1988 (CLIA), 42 U.S.C.§263a, to
the extent the provision of access to the individual would be
prohibited by law.
If
we deny your request, we will inform you of the basis for the
denial, how you may have our denial reviewed, and how you may
complain. If you request a review of our denial, it will be conducted
by a licensed health care professional designated by us who was
not directly involved in the denial. We will comply with the outcome
of that review.
Right to Amend
You have the right to ask us to amend medical information about
you. You have this right for so long as the medical information
is maintained by us.
To request an amendment, you must submit your request in writing
to the Privacy Officer at Cooper Home Health, Inc., 51 North Side
Square, Cooper, TX 75432. Your request must state the amendment
desired and provide a reason in support of that amendment.
We will act on your request within sixty (60) calendar days after
we receive your request. If we grant your request, in whole or
in part, we will inform you of our acceptance of your request
and provide access and copying.
If we grant the request, in whole or in part, we will seek your
identification of and agreement to share the amendment with relevant
other persons. We also will make the appropriate amendment to
the medical information by appending or otherwise providing a
link to the amendment.
We may deny your request to amend medical information about you.
We may deny your request if it is not in writing and does not
provide a reason in support of the amendment. In addition, we
may deny your request to amend medical information if we determine
that the information:
a. Was not created by us, unless the person or entity that created
the information is no longer available to act on the requested
amendment;
b. Is not part of the medical information maintained by
us;
c. Would not be available for you to inspect or copy; or,
d. Is accurate and complete.
If
we deny your request, we will inform you of the basis for the
denial. You will have the right to submit a statement of disagreeing
with our denial. Your statement may not exceed three (3) pages.
We may prepare a rebuttal to that statement. Your request for
amendment, our denial of the request, your statement of disagreement,
if any, and our rebuttal, if any, will then be appended to the
medical information involved or otherwise linked to it. All of
that will then be included with any subsequent disclosure of the
information, or, at our election, we may include a summary of
any of that information.
If you do not submit a statement of disagreement, you may ask
that we include your request for amendment and our denial with
any future disclosures of the information. We will include your
request for amendment and our denial (or a summary of that information)
with any subsequent disclosure of the medical information involved.
You
also will have the right to complain about our denial of your
request.
Right to an Accounting of Disclosures
You have the right to receive an accounting of disclosures of
medical information about you. The accounting may be for up to
six (6) years prior to the date on which you request the accounting
but not before April 14, 2003.
Certain types of disclosures are not included in such an accounting:
Disclosures to carry out treatment, payment and health care operations;
Disclosures of your medical information made to you;
Disclosures that are incident to another use or disclosure;
Disclosures that you have authorized;
Disclosures to persons involved in your care;
Disclosures for disaster relief purposes;
Disclosures for national security or intelligence purposes;
Disclosures to correctional institutions or law enforcement officials
having custody of you;
Disclosures that are part of a limited data set for purposes of
research, public health or health care operations (a limited data
set is where things that would directly identify you have been
removed.)
Disclosures made prior to April 14, 2003.
Under
certain circumstances your right to an accounting of disclosures
to a law enforcement official or a health oversight agency may
be suspended. Should you request an accounting during the period
of time your right is suspended, the accounting would not include
the disclosure or disclosures to a law enforcement official or
to a health oversight agency.
To request an accounting of disclosures, you must submit your
request in writing to the Privacy Officer at Cooper Home Health,
Inc., 51 North Side Square, Cooper, TX 75432. Your request must
state a time period for the disclosures. It may not be longer
than six (6) years prior to the date we receive your request and
may not include dates before April 14, 2003.
Usually, we will act on your request within sixty (60) calendar
days after we receive your request. Within that time, we will
either provide the accounting of disclosures to you or give you
a written statement of when we will provide the accounting and
why the delay is necessary.
There is no charge for the first accounting we provide to you
in any twelve (12) month period. For additional accountings, we
may charge you for the cost of providing the list. If there will
be a charge, we will notify you of the cost involved and give
you an opportunity to withdraw or modify your request to avoid
or reduce the fee.
Right to Copy of this Notice
You have the right to obtain a paper copy of our Notice of Privacy
Practices. You may obtain a paper copy even though you agree to
receive the notice electronically. You may request a copy of our
Notice of Privacy Practices at any time.
You may obtain a copy of our Notice of Privacy Practices over
the Internet at our web site, www.cooperhh.com.
To obtain a paper copy of this notice, contact the Privacy Officer
at Cooper Home Health, Inc., 51 North Side Square, Cooper, TX
75432, (903)395-2811.
Our
Duties
Generally,
We are required by law to maintain the privacy of medical information
about you and to provide individuals with notice of our legal
duties and privacy practices with respect to medical information.
We
are required to abide by the terms of our Notice of Privacy Practices
in effect at the time.
Our Right to Change Notice of Privacy Practices
We reserve the right to change this Notice of Privacy Practices.
We reserve the right to make the new notice’s provisions
effective for all medical information that we maintain, including
that created or received by us prior to the effective date of
the new notice. In the event this notice is revised we will mail
or deliver the revised notice to the address you have supplied.
Availability
of Notice of Privacy Practices
A copy of the current notice will be posted on our web site, www.cooperhh.com.
At
any time, you may obtain a copy of the current Notice of Privacy
Practices by contacting the Privacy Officer at Cooper Home Health,
Inc., 51 North Side Square, TX 75432, (903)395-2811.
Effective Date of Notice
The effective date of the notice will be stated on the first page
of the notice.
Complaints
You may complain to us and to the United States Secretary of Health
and Human Services if you believe your privacy rights have been
violated by us.
To file a complaint with us, contact the Administrator at Cooper
Home Health, Inc., 51 North Side Square, Cooper, TX 75432, (903)395-2811.
All complaints should be submitted in writing.
To file a complaint with the United States Secretary of Health
and Human Services, send your complaint to him or her in care
of: Office for Civil Rights, U.S. Department of Health and Human
Services, 200 Independence Avenue SW, Washington, D.C. 20201.
You
will not be retaliated against for filing a complaint.
Questions and Information
If you have any questions or want more information concerning
this Notice of Privacy Practices, please contact the Privacy Officer
at Cooper Home Health, Inc., 51 North Side Square, Cooper, TX
75432, (903)395-2811.
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