LUTHERAN SOCIAL SERVICES OF CENTRAL OHIO

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.

       effective date of this noticE:          April 14, 2003                                 

 

 


I. Our Duty to Safeguard Your Protected Health Information

We are committed to preserving the privacy and confidentiality of your health information whether created by us or maintained on our premises. We are required by certain state and federal regulations to implement policies and procedures to safeguard the privacy of your health information. Copies of our privacy policies and procedures are maintained in the business office. We are required by state and federal regulations to abide by the privacy practices described in this notice including any future revisions that we may make to the notice as may become necessary or as authorized by law.

 

Individually identifiable information about your past, present, or future health or condition, the provisions of health care to you, or payment for the health care treatment or services you receive is considered protected health information (PHI). As such, we are required to provide you with this Privacy Notice that contains information regarding our privacy practices that explains how, when and why we may use or disclose your PHI and your rights and our obligations regarding any such uses or disclosures. Except in specified circumstances, we must use or disclose only the minimum necessary PHI to accomplish the intended purpose of the use or disclosure of such information.

 

We reserve the right to change this notice at any time and to make the revised or changed notice effective for PHI we already have about you as well as any information we receive in the future about you. Should we revise/change this Privacy Notice, we will post a copy of the new/revised Privacy Notice in the main lobby. You also may request and obtain a copy of any new/revised Privacy Notice from the business office.

 

Should you have questions concerning our Privacy Notices, the names, addresses, telephone numbers, website addresses, etc., of whom you should contact are listed on the last page of this document.

II. How We May Use and Disclose Your PHI

We use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclose your PHI for purposes of treatment, payment, or for the operations of our Agency. For other uses, you must give us your written authorization to release your PHI unless the law permits or requires us to make the use or disclosure without your authorization.

 

Should it become necessary to release your PHI to an outside party, we will require the party to have a signed agreement with us that the party will extend the same degree of privacy protection to your PHI as we do.

 

The privacy laws permit us to make some uses or disclosures of your PHI without your consent or authorization. The following describes each of the different categories that we may use or disclose your PHI. We may not describe all the different ways we may use of disclosing your PHI, but every category of use or disclosure will be described.  Where appropriate, we have included examples of the different types of uses or disclosures. These include:

 

1.       Use and Disclosures Related to Treatment:

We may use and disclose your PHI to those who are involved in providing medical and nursing care services and treatments to you. For example we may release PHI about you to our nurses, nursing assistants, medication aides/technicians, medical and nursing students, therapists, pharmacists, medical records personnel, consultants, physicians, etc. We may also disclose your PHI to outside entities performing other services relating to your treatment; such as diagnostic laboratories, home health/hospice agencies, family members, etc.

 

2.       Use and Disclosures Related to Payment:

We may use or disclose your PHI to bill and collect payment for services or treatments we provided to you. For example, we may contact your insurance agency, health plan, or another third party to obtain payment for services we provided to you.

 

 

 

3.       Use and Disclosures Related to Health Care Operations:

We may use or disclose your PHI to perform certain functions within our Agency should these uses or disclosures become necessary to operate our Agency and to ensure that you and others we provide care and services to continue to receive quality care and services. For example, we may take your photograph for medication identification purposes or use your PHI to evaluate the effectiveness of the care and services you are receiving. We may disclose your PHI to our staff (nurses, nursing assistants, physicians, staff consultants, therapists, etc.) for auditing, care planning, treatment, and learning purposes. We may also combine your PHI with information from other health care providers to study how our Agency is performing in comparison to like facilities or what we can do to improve the care and services we provide to you. When information is combined, we remove all information that would identify you so that others may use the information in developing research on the delivery of health care services without learning your identity.

 

4.       Use and Disclosures Related to Fundraising Activities:

We may use a limited amount of your PHI when raising money for our Agency and its operations. We may also disclose this information to a foundation related to the Agency so that the foundation may contact you to raise money on behalf of our Agency. The information we may use will be limited to your name, address, telephone number, and dates for which you received treatment or services at our Agency. If you do not wish to be contacted for participation in fundraising activities or have this information provided to our affiliated foundation, you must provide us with a written notification. The name of the person to contact and the method of contacting him/her are listed on the last page of this notice. You may use our Request To Restrict The Use and Disclosure of Protected Health Information form to submit your request to us. Copies of this form are available in the business office.

 

5.       Use and Disclosures Related to Treatment Alternatives, Health-Related Benefits and Services:

We may use or disclose your PHI for purposes of contacting you to inform you of treatment alternatives or health-related benefits and services that may be of interest to you. For example, a newly released medication or treatment that has a direct relationship to the treatment of your medical condition.

 

6.    Uses and Disclosures for Appointments and Other Reminders:

 

We may use or disclose your PHI to remind you of an appointment or the results of a test or procedure, and we may leave this information on an answering machine, voice mail or with someone who answers the phone.

III. Uses and Disclosures Requiring Your Written Authorization

For uses and disclosures of your PHI beyond treatment, payment and operations purposes, we are required to have your written authorization, except as permitted by law. You have the right to revoke an authorization at any time to stop future uses or disclosures of your information except to the extent that we have already undertaken an action in reliance upon your authorization. Your revocation request must be provided to us in writing. The name, address, telephone number of the person to contact is located on the last page of this document. You may use our Authorization for Use or Disclosure of Protected Health Information form and/or our Revocation of an Authorization form to submit your request to us. Copies of these forms are available in the business office.

 

Examples of uses or disclosures that would require your written authorization include, but are not limited to, the following:

 

1.        A request to provide your PHI to an attorney for use in a civil litigation claim.

2.        A request to provide certain information to an insurance or pharmaceutical agency for the purposes of providing you with information relative to insurance benefits or new medications that may be of interest to you.

3.        A request to provide certain information to another individual or agency.

IV. Uses or Disclosures of Information Based Upon Your Verbal Agreement

In the following situations, we may disclose a limited amount of your PHI if we provide you with an advance oral or written notice and you do not object to such release or such release is not otherwise prohibited by law. However, if there is an emergency situation and you are unable to object (because you were not present or you were incapacitated, etc.), disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interest. When a disclosure is made based on these or emergency situations, we will only disclose PHI relevant to the person’s involvement in your care. For example, if you are sent to the emergency room, we may only inform the person that you suffered an apparent heart attack, stroke, etc., and/or we may provide information on your prognosis or progress. You will be informed and given an opportunity to object to further disclosures of such information as soon as you are able to do so.

 

 

  1. Information Used or Disclosed in the Agency Directory:

We may use or disclose your name, unit or room number, and religious affiliation in our Agency directory. We may also disclose your religious affiliation to a member of the clergy. Information concerning your general condition or room location may be provided to callers or visitors when they ask for you by name. You may object to the release of this information. You may use our Request to Restrict The Use or Disclosure of Protected Health Information form to notify us of your objection or your objection may be made orally. The name, address, and telephone number of the person to whom you may make your objection is listed on the last page of this document. (See also Section VI, paragraph 1.)

 

  1. Information Disclosed to Family Members, Friends or Others Involved in Your Care:

We may disclose your PHI to your family members and friends who are involved in your care or who help pay for your care. We may also disclose your PHI to a disaster relief organization for the purposes of notifying your family and/or friends about your general condition, location, and/or status (i.e., alive or dead). You may object to the release of this information. You may use our Request to Restrict The Use or Disclosure of Protected Health Information form to notify us of your objection or your objection may be made orally. The name, address, and telephone number of the person to whom you may make your objection is listed on the last page of this document. (See also Section VI, paragraph 1.)

V. Uses and Disclosures of Information That Do Not Require Your Consent or Authorization

State and federal laws and regulations either require or permit us to use or disclose your PHI without your consent or authorization. The uses or disclosures that we may make without your consent or authorization include the following:

 

  1. When Required by Law:

We may disclose your PHI when a federal, state or local law requires that we report information about suspected abuse, neglect, or domestic violence, reporting adverse reactions to medications or injury from a health care product, or in response to a court order or subpoena.

 

  1. For Public Health Activities for the Purpose of Preventing or Controlling Disease, Injury or Disability:

We may disclose your PHI when we are required to collect information about diseases or injuries (e.g., your exposure to a disease or your risk for spreading or contracting a communicable disease or condition, product recalls, or to report vital statistics (e.g., births/deaths) to the public health authority).

 

  1. For Health Oversight Activities:

We may disclose your PHI to a health oversight agency such as a protection and advocacy agency, the state agency responsible for inspecting our Agency or to other agencies responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents or to ensure that we are in compliance with applicable state and federal laws and regulations and civil rights issues.

 

  1. To Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations or Tissue Banks:

We may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death. We may also disclose your PHI to a funeral director for the purposes of carrying out your wishes and/or for the funeral director to perform his/her necessary duties.

 

If you are an organ donor, we may disclose your PHI to the organization that will handle your organ, eye or tissue donation for the purposes of facilitating your organ or tissue donation or transplantation.

 

  1. For Research Purposes:

We may disclose your PHI for research purposes only when a privacy board has approved the research project. However, we may use or disclose your PHI to individuals preparing to conduct an approved research project in order to assist such individuals in identifying persons to be included in the research project. Researchers identifying persons to be included in the research project will be required to conduct all activities onsite. If it becomes necessary to use or disclose information about you that could be used to identify you by name, we will obtain your written authorization before permitting the researcher to use your information. Researchers will be required to sign a Confidentiality and Non-Disclosure Agreement form before being permitted access to PHI for research purposes. A sample copy of this agreement may be obtained from the business office.

 

  1. To Avert a Serious Threat to Health or Safety:

We may disclose your PHI to avoid a serious threat to your health or safety or to the health or safety of others. When such disclosure is necessary, information will only be released to those law enforcement agencies or individuals who have the ability or authority to prevent or lessen the threat of harm.

 

 

  1. For Specific Government Functions:

We may disclose PHI of military personnel and veterans, when requested by military command authorities, to authorized federal authorities for the purposes of intelligence, counterintelligence, and other national security activities (such as protection of the President), or to correctional institutions.

 

      8.     Submission of MDS Information:

               

Skilled nursing facilities for Medicare and Medicaid are required to conduct comprehensive, accurate, standardized and reproducible assessments of each resident/client’s functional capacity and health status.  As of June 22, 1998, all skilled nursing and nursing facilities are required to establish a database of resident/client assessment information and to electronically transmit this information to the State.  The State is then required to transmit the data to the federal Central Office Minimum Data Set (M.D.S.) repository of the Health Care Financing Administration.  This data is protected under the requirements of the Federal Privacy Act of 1974 and the M.D.S. Long Term Care System of Records.

VI. Your Right Regarding Your PHI

You have the following rights concerning the use or disclosure of your PHI that we create or that we may maintain on our premises:

 

  1. To Request Restrictions on Uses and Disclosures of Your PHI:

You have the right to request that we limit how we use or disclose your PHI for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care or services. For example, you could request that we not disclose to family members or friends information about a medical treatment you received.

 

Should you wish a restriction placed on the use and disclosure of your PHI, you must submit such request in writing. (Note: You may submit such request using our Request To Restrict The Use and Disclosure of Protected Health Information form. Copies of this form are available in the business office.) The name, address, and telephone number of the person to whom the request is to be submitted is listed on the last page of this document.

 

We are not required to agree to your restriction request. However, should we agree, we will comply with your request not to release such information unless the information is needed to provide emergency care or treatment to you.

 

  1. The Right to Inspect and Copy Your Medical and Billing Records:

You have the right to inspect and copy your PHI, such as your medical and billing records that we use to make decisions about your care and services. In order to inspect and/or copy your PHI, you must submit a written request to us. If you request a copy of your medical information, we may charge you a reasonable fee for the paper, labor, mailing, and/or retrieval costs involved in filing your requests. We will provide you with information concerning the cost of copying your PHI prior to performing such service. The name, address, and telephone number of the person to whom you may file your request is listed on the last page of this document. You may submit your requests on our Request for Inspection/Copy of Protected Health Information form. Copies of these forms are available in the business office.

 

We will respond within thirty (30) days of receipt of such requests. Should we deny your request to inspect and/or copy your PHI, we will provide you with written notice of our reasons of the denial and your rights for requesting a review of our denial. If such review is granted or is required by law, we will select a licensed health care professional not involved in the original denial process to review your request and our reasons for denial. We will abide by the reviewer’s decision concerning your inspection/copy requests. You may submit your denial review requests on our Denial of Inspection/Copy of Protected Health Information form. Copies of these forms are available in the business office.

 

  1. The Right to Amend or Correct Your PHI:

You have the right to request that your PHI be amended or corrected if you have reason to believe that certain information is incomplete or incorrect. You have the right to make such requests of us for as long as we maintain/retain your PHI. Your requests must be submitted to us in writing. We will respond within sixty (60) days of receiving the written request. If we approve your request, we will make such amendments/corrections and notify those with a need to know of such amendments/corrections.

 

We may deny your request if:

a.        Your request is not submitted in writing;

b.       Your written request does not contain a reason to support your request;

c.        The information was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

d.       It is not a part of the PHI kept by or for our Agency;

e.        It is not part of the information which you would be permitted to inspect and copy; and/or

f.         The information is already accurate and complete.

 

If your request is denied, we will provide you with a written notification of the reason(s) of such denial and your rights to have the request, the denial, and any written response you may have relative to the information and denial process appended to your PHI.

 

The name, address, and telephone number of the person to whom you may file your request is listed on the last page of this document. You may submit your amendment/correction requests on our Request for Amendment/Correction of Protected Health Information form. Copies of these forms are available in the business office.

 

  1. The Right to Request Confidential Communications:

You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you may request that we not send any PHI about you to a family member’s address. We will agree to your request as long as it is reasonable for us to do so. You are not required to reveal nor will we ask the reason for your request. To request confidential communications you must:

 

a.        Notify us in writing;

b.       Indicate the manner in which you would like for us to communicate with you;

c.        Indicate whether or not you wish to limit or restrict our use or disclosure of such information; and

d.       Identify to whom the restrictions apply (e.g., which family member(s), agency, etc).

 

The name, address, and telephone number of the person to whom you may file your request is listed on the last page of this document. You may submit your requests on our Request for Restriction of Confidential Communications form. Copies of these forms are available in the business office.

 

  1. The Right to Request an Accounting of Disclosures of PHI:

You have the right to request that we provide you with a listing of when, to whom, for what purpose, and what content of your PHI we have released over a specified period of time. This accounting will not include any information we have made for the purposes of treatment, payment, or health care operations or information released to you, your family, or the Agency directory, disclosures made for national security purposes, or any releases pursuant to your authorization.

 

Your request must be submitted to us in writing and must indicate the time period for which you wish the information (e.g., May 1, 2003 through August 31, 2005). Your request may not include releases for more than six (6) years prior to the date of your request and may not include releases prior to April 14, 2003. Your request must indicate in what form (e.g., printed copy or email) you wish to receive this information. We will respond to your request within sixty (60) days of the receipt of your written request. Should additional time be needed to reply, you will be notified of such extension. However, in no case will such extension exceed thirty (30) days. There may be a reasonable fee charged for your request.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

 

The name, address, and telephone number of the person to whom you may file your request is listed on the last page of this document. You may submit your requests on our Request for an Accounting of Disclosures of Protected Health Information form. Copies of these forms are available in the business office.  You may contact:

                               

Lutheran Social Services of Central Ohio

                                Privacy Officer

                                750 East Broad Street

                                Columbus, Ohio  43205

                                614-228-5200

                               

  1. The Right to Receive a Paper Copy of This Notice:

You have the right to receive a paper copy of this notice even though you may have agreed to receive an electronic copy of this notice. You may request a paper copy of this notice at anytime or you may obtain a copy of this information from our website (as applicable). The name, address, and telephone number of the person to whom you may obtain a paper copy of this notice is listed on the last page of this document.  You may contact:

 

Lutheran Social Services of Central Ohio

                                Privacy Officer

                                750 East Broad Street

                                Columbus, Ohio  43205

                                614-228-5200

VII. How to File a Complaint About Our Privacy Practices

If you believe your rights have been violated, you may file a complaint with our office and/or with the Secretary of the United States Department of Health and Human Services.  To file a complaint with our office, contact our Privacy Officer at the number listed on the first page of this Notice or submit your complaint in writing on the form provided by our Agency.  You may also file a complaint with:

 

Lutheran Social Services of Central Ohio             Secretary of the United States Department of Health and Human Services

Privacy Officer                                                             Region V, Office for Civil Rights

750 East Broad Street                                                 U. S. Department of Health and Human Services

Columbus, Ohio  43205                                              233 N. Michigan Avenue, Suite 240

614-228-5200                                                                Chicago, Illinois  60601

                       Voice Phone:  312-886-2359

                                                                                       Facsimile:  312-886-1807

                       TDD:  312-353-5693

All complaints to the Secretary must be submitted in writing and no more                        than 180 days after the event that you are concerned about took place. 

You will not be penalized for filing a complaint.