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NOTICE OF PRIVACY PRACTICES
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.
I. Who We Are:
We are a member of Atlantic Health System, Inc. This Notice describes the
privacy practices of Atlantic Health System (its hospitals, other medical
facilities and companies) and the physicians, nurses, technicians and
other individuals that work at or in conjunction with Atlantic Health
System (“AHS”, “we” or “us”).
II. Our Commitment to Your Privacy:
We are dedicated to maintaining the privacy of your medical information.
In conducting our services, we will create records regarding you and the
treatment and services we provide to you (including records relating to
psychiatric treatment, drug and alcohol treatment or abuse or HIV status,
if any). These records are our property, however we are required by law to
maintain the privacy of medical and health information about you
(“Protected Health Information”) and to provide you with this Notice of
our legal duties and privacy practices with respect to Protected Health
Information. When we use or disclose Protected Health Information, we are
required to abide by the terms of this Notice (or other notice in effect
at the time of the use or disclosure).
III. Uses and Disclosures With Your Authorization:
A. Use or Disclosure with Your
Authorization. We may use or disclose Protected Health Information only
when (1) you give us your written authorization on a form that complies
with the Health Insurance Portability and Accountability Act (“Your
Authorization”) or (2) there is an exception described in Section IV
below. Further, except to the extent that we have taken action in
reliance upon it, you may revoke Your Authorization by delivering a
written revocation statement to the Privacy Office identified below.
B. AIDS or HIV Related Information. If Protected Health Information
contains AIDS or HIV related information, that information is
confidential and shall not be disclosed without Your Authorization,
expressly releasing AIDS or HIV related information, except as follows.
Such information may be released without Your Authorization to medical
personnel directly involved in your medical treatment. If you are deemed
to lack decision-making capacity, we may release such information (only
if necessary and unless you request otherwise) to the person responsible
for making health care decisions on your behalf (spouse, primary
caretaking partner, an appropriate family member, etc.). Under certain
circumstances, such information may also be released without your
authorization for scientific research, certain audit and management
functions, and as may otherwise be allowed or required by law or court
order.
C. Alcohol or Drug Abuse Programs. If Protected Health Information
contains information related to treatment provided in alcohol or drug
abuse programs, that information is confidential and shall not be
disclosed without Your Authorization, expressly releasing alcohol or
drug abuse related information except as follows. Under certain
circumstances, such information may be released without Your
Authorization: (1) for internal communications; (2) if there is no
patient-identifying information; (3) for medical emergencies; (4) in
order to report and/or investigate crimes committed at the Program or
against its personnel; and (5) as may otherwise be allowed or required
by law or court order.
D. Psychotherapy Notes. Protected Health Information containing
psychotherapy notes will not be released without Your Authorization,
expressly releasing psychotherapy related information except as follows.
Under certain circumstances, such information may be released without
Your Authorization: (1) To carry out treatment, payment or health care
operations; and (2) a use or disclosure is required by law, regarding
disclosures to individuals as requested by a health care provider,
regarding disclosures to health oversight agencies with respect to the
oversight of the originator of the psychotherapy notes, regarding
disclosures to coroners and medical examiners, or permitted by medical
examiners, or regarding uses and disclosures necessary to prevent or
lessen a serious and imminent threat to the health and safety of a
person or the public.
E. Marketing Communications. We will obtain Your Authorization for the
use or disclosure of your Protected Health Information for marketing
purposes. However, this does not apply to communications that are made:
(1) face-to-face by our staff to you; (2) to describe a health-related
product or service that is offered by us; (3) for your treatment; or (4)
for your care management or to direct or recommend alternative
treatments, health care providers, etc.
IV. Uses and Disclosures Without Your
Authorization:
A. Use and/or Disclosure For Treatment,
Payment and Health Care Operations. Except as noted in III B, C, D, E
above, we may use and/or disclose Protected Health Information without
your authorization for treatment provided to you, obtaining payment for
services provided to you and for health care operations (e.g., internal
administration, quality improvement, customer service, etc.) as detailed
below:
• Treatment. We use and disclose your
Protected Health Information to provide treatment and other services
to you - for example, to diagnose and treat your injury or illness. We
may also disclose your Protected Health Information for the treatment
activities of another health care provider. In addition, we may
contact you to provide appointment reminders or information about
treatment alternatives or other health-related benefits and services
that may be of interest to you.
• Payment. We may use and disclose your Protected Health Information
to obtain payment for services that we provide to you - for example,
disclosures to claim and obtain payment from your health insurer, HMO,
or other company that arranges or pays the cost of some or all of your
health care (“Your Payor”) to verify that Your Payor will pay for
health care. We may also disclose your Protected Health Information to
another health care provider for the payment activities of that health
care provider.
• Health Care Operations: We may use and disclose your Protected
Health Information for our health care operations, which include
internal administration and planning and various activities that
improve the quality and cost effectiveness of the care that we deliver
to you. For example, we may use your Protected Health Information to
evaluate the quality and competence of our physicians, nurses and
other health care workers. We may disclose your Protected Health
Information to our patient representatives in order to resolve any
complaints you may have and ensure that you have a comfortable visit
with us. Under certain circumstances, we may disclose your Protected
Health Information to another health care provider for the health care
operations of that health care provider if they either have treated or
examined you and your Protected Health Information pertains to that
treatment or examination. Lastly, we may disclose information to
doctors, nurses, technicians, medical students and others for review
or learning purposes.
B. Disclosure to Relatives and Close
Friends. We may use or disclose your Protected Health Information to a
family member, other relative, a close personal friend or any other
person identified by you when you are present for, or otherwise
available prior to, the disclosure, if we: (1) obtain your agreement;
(2) provide you with the opportunity to object to the disclosure and you
do not object; or (3) reasonably infer that you do not object to the
disclosure. If you are not present, or the opportunity to agree or
object to a use or disclosure cannot practicably be provided because of
your incapacity or an emergency circumstance, we may exercise our
professional judgment to determine whether a disclosure is in your best
interests. If we disclose information to a family member, other relative
or a close personal friend, we would disclose only information that is
directly relevant to the person’s involvement with your health care.
C. Fundraising Communications. We may contact you to request a
tax-deductible contribution to support important activities of AHS. In
connection with any fundraising, we may disclose to our related
foundation/fundraising staff demographic information about you (e.g.,
your name, address and phone number) and dates of health care that we
provided to you.
D. Public Health Activities. We may disclose Protected Health
Information for the following public health activities and purposes: (1)
to report health information to public health authorities for the
purpose of preventing or controlling disease, injury or disability; (2)
to report child abuse and neglect to public health authorities or other
government authorities authorized by law to receive such reports; (3) to
report information about products under the jurisdiction of the U.S.
Food and Drug Administration; (4) to alert a person who may have been
exposed to a communicable disease or may otherwise be at risk of
contracting or spreading a disease or condition; and (5) to report
information to your employer as required under laws addressing
work-related illnesses and injuries or workplace medical surveillance.
E. Health Oversight Activities. We may disclose your Protected Health
Information to a health oversight agency that oversees the health care
system and ensures compliance with the rules of government health
programs such as Medicare or Medicaid.
F. Judicial and Administrative Proceedings. We may disclose your
Protected Health Information in the course of a judicial or
administrative proceeding in response to a legal order or other lawful
process.
G. Law Enforcement Officials. We may disclose your Protected Health
Information to the police or other law enforcement officials as required
by law or in compliance with a court order.
H. Decedents. We may disclose your Protected Health Information to a
coroner or medical examiner as authorized by law.
I. Organ and Tissue Procurement. We may disclose your Protected Health
Information to organizations that facilitate organ, eye or tissue
procurement, banking or transplantation.
J. Research. We may use or disclose your Protected Health Information
without your consent or authorization if our Institutional Review Board
approves a waiver of authorization for disclosure.
K. Health or Safety. We may use or disclose your Protected Health
Information to prevent or lessen a serious and imminent threat to a
person’s or the public’s health or safety.
L. Specialized Government Functions. We may use and disclose your
Protected Health Information to units of the government with special
functions, such as the U.S. military or the U.S. Department of State
under certain circumstances.
M. Workers’ Compensation. We may disclose your Protected Health
Information as authorized by and to the extent necessary to comply with
laws relating to workers’ compensation or other similar programs.
V. Your Individual Rights:
A. For Further Information, Complaints.
If you desire further information about your privacy rights, are
concerned that we have violated your privacy rights, or disagree with a
decision that we made about access to your Protected Health Information,
you may contact our Privacy Officer. You may also file written
complaints with the Director, Office of Civil Rights of the U.S.
Department of Health and Human Services. Upon request, the Privacy
Officer will provide you with the correct address for the Director. We
will not retaliate against you if you file a complaint with us or the
Director.
B. Right to Request Additional Restrictions. You may request
restrictions on our use and disclosure of your Protected Health
Information: (1) for treatment, payment and health care operations; (2)
to individuals (such as a family member, other relative, close personal
friend or any other person identified by you) involved with your care or
with payment related to your care; or (3) to notify or assist in the
notification of such individuals regarding your location and general
condition. While we will consider all requests for additional
restrictions carefully, we are not required to agree to a requested
restriction. If you wish to request additional restrictions, please
obtain a request form from, and submit the completed form to, our
Privacy Officer. We will send you a written response.
C. Right to Receive Confidential Communications. You may request, and we
will accommodate, any reasonable written request for you to receive your
Protected Health Information by alternative means of communication or at
alternative locations.
D. Right to Inspect and Copy Your Health Information. You may request
access to your medical record file and billing records maintained by us
in order to inspect and request copies of the records. Under limited
circumstances, we may deny you access to a portion of your records. If
you desire access to your records, please obtain a record request form
from, and submit the completed form to, our Privacy Officer. If you
request copies, we will charge you $1.00 (one dollar) for each page.
You should take note that, if you are a parent or legal guardian of a
minor, certain portions of the minor’s medical record will not be
accessible to you (for example, records relating to pregnancy, abortion,
sexually transmitted disease, substance use and abuse, contraception
and/or family planning services).
E. Right to Amend Your Records. You have the right to request that we
amend Protected Health Information maintained in your medical record
file or billing records. If you desire to amend your records, please
obtain an amendment request form from, and submit the completed form to,
our Privacy Officer. We will comply with your request unless we believe
that the information that would be amended is accurate and complete or
other special circumstances apply.
F. Right to Receive An Accounting of Disclosures. Upon request, you may
obtain an accounting of certain disclosures of Protected Health
Information made by us during any period of time prior to the date of
your request provided such period does not exceed six years and does not
apply to disclosures that occurred prior to April 14, 2003. If you
request an accounting more than once during a twelve (12) month period,
we will charge you $1.00 (one dollar) per page for the accounting
statement.
G. Right to Receive Paper Copy of this Notice. Upon request, you may
obtain a paper copy of this Notice, even if you agreed to receive such
notice electronically. You can also access this notice on our website at
www.MorrisHomeCare.com.
VI. Effective Date and Duration of This
Notice:
A. Effective Date. This Notice is
effective on April 14, 2003.
B. Right to Change Terms of this Notice. We may change the terms of this
Notice at any time. If we change this Notice, we may make the new notice
terms effective for all Protected Health Information that we maintain,
including any information created or received prior to issuing the new
notice. If we change this Notice, we will post the new notice on our
Internet site at
www.MorrisHomeCare.com. You also may obtain any new
notice by contacting the Privacy Officer.
VII. Privacy Officer:
You may contact the Privacy Officer at:
Privacy Officer/Administrator
Morris Home Care
200 American Road
Morris Plains, NJ 07950
Telephone Number: (973) 540-9000
E-mail:
Administrator@morrishomecare.com
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