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PACE, INC. Purpose. We are required by law to maintain the confidentiality and privacy of your protected health information. “Protected health information” is information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.[2] It also describes your rights to access and control you protected health information. We are required to abide by the terms of this Notice, which is
effective April 14, 2003 . We reserve the right to change the terms of our
Notice at any time as permitted b law. The new Notice will be effective for all
protected health information that we maintain at that time and for information
we receive in the future. We will post a current copy of the policy and will
have copies of our current policy available each time you are here for health
care services. We will also provide you with any revised Notice of Privacy
Practices upon a request made by you via phone or in person. Uses and Disclosures of Protected Health Information for Treatment, Payment and/or Operations.
Treatment: We may use and disclose your protected health
information to provide you with treatment and services and to coordinate your
care. For example, we may disclose your protected health information to other
agency clinical staff that are involved in your care as well as different
departments of the agency in order to coordinate the various services you might
need, such as prescriptions.[3] Payment: Your protected health information may be used to
obtain approval for and payment for services you receive. For example, we may
confirm your eligibility with insurance plans, governmental agencies, or
Medicaid in order to obtain approval and/or payment of services. Operations: We may use or disclose your protected health
information as necessary for our regular business activities such as health
oversight, accreditation, licensing, and quality assurance. For example, members
of the quality assurance team may use information in your health record to
assess the care in your case in an effort to continually improve the quality and
effectiveness of the healthcare services we provide. As part of operations, we may contact you to provide appointment
reminders. We may share your protected health information with third party “business associates” that perform various activities for us involving protected health information (e.g., auditors, attorneys), but only when we have a written contract with the business associate that fully protects the privacy of your protected health information. Other Permitted and/or Required Uses and Disclosures Unless you object, under federal law we may disclose health
information about you to a member of your family, a relative, a close friend or
any other person you identify as involved in your case.[4] We may use or disclose your protected health information in an
emergency situation when use and disclosure of the protected health information
is necessary to prevent serious risk of bodily harm or death.[5] We may use or disclose your protected health information if and
to the extent we are required by federal or state law. You will be notified, if
required by law, or any such uses or disclosures. We may disclose to a court when ordered by the court. We may disclose to a public health authority that is authorized
by law to receive reports of child abuse or neglect. In addition, if we believe
that you have been a victim of abuse, neglect or domestic violence, we may
disclose your protected health information to the governmental entity or agency
authorized to receive such information. Any disclosure of suspected abuse will
be made consistent with the requirements of applicable state law. We may disclose to governmental agencies or private entities
responsible for overseeing health care activities through audits,
investigations, inspections and licensure. Oversight agencies include government
and/or private agencies that oversee the health care systems, government benefit
programs, government regulatory programs and civil rights laws. Required Uses and Disclosures: Under federal law, we must make
disclosures when required by the Secretary of the United States Department of
health and Human Services to investigate or determine our compliance with the
requirements of 45 C.F.R. Part 164.308 et. seq. We may disclose for public health purposes such as notifying
public health authorities regarding specific communicable diseases, but only to
the extent authorized by state law. We may disclose to federal, state or local agencies engaged in
disaster relief to the extent that such information is required to enable them
to carry out their responsibilities in specific disaster situations. Uses and Disclosures of Protected Health Information Based
Upon Your Written Authorization. You Have the Right to Request Restrictions: You have the
right to request a limitation or restriction on the protected health information
we use or disclose about you for treatment, payment or healthcare operations. We
are not required to agree to restriction that you may request. If we agree to
the requested restriction, we may not use or disclose your protected health
information in violation of the restriction unless it is needed to provide
emergency treatment. You must make this request in writing to our Privacy
Contact at the address listed below. Right to Request Confidential Communication: You have the
right to request to receive confidential communications from us in a certain way
or at an alternative location. For example, you can ask that we only contact you
at home or by mail. We will accommodate reasonable requests. We may also
condition this accommodation by asking you for specification of an alternative
address or other method of contact. The request must be made in writing to our
Privacy Contact at the address listed below specifying how or where you wish to
be contacted. Right to Inspect and Copy: You have the right to inspect
and obtain a copy of protected health information about you that we maintain. To
inspect and/or obtain a copy of protected health information, you must submit
your request in writing to our Privacy Contact. If you request a copy of the
information, we may charge a reasonable fee for the costs of copying, mailing,
or other related costs. We may deny your request to inspect a copy in certain limited
circumstances. Under federal law, for example, you may not inspect or copy the
following records; psychotherapy notes; information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative action or
proceeding. We are also permitted to deny your request to inspect
and copy if the protected health information was obtained from someone under a
promise of confidentiality. Please contact our Privacy Contact if you have
questions about access to your records. Right to Amend: If you believe that health
information we have about you is incorrect or incomplete, you may request that
we amend it. Your request must be in writing, submitted to the
address listed below, and must state the reason you are seeking an amendment. If
we deny your request for amendment, you have the right to file a statement of
disagreement with us which will be made a part of your record. We may prepare a
rebuttal to your statement and will provide you with a copy of such rebuttal.
Please contact our Privacy Contact if you have questions about amending your
record. Right to Receive an Accounting of Disclosure: You have
the right to an accounting of disclosures for purposes other than treatment,
payment or healthcare operations as described in this Notice. You have the right
to receive specific information regarding these disclosures that occurred after
April 14, 2003 . You must submit your request in writing to the addresses listed
at the end of this Notice. The right to receive this information is subject to
certain exceptions, restrictions and limitations. Right to Receive a Copy: You have aright to receive a paper copy of the notice of Privacy Practices upon request. Complaints If you believe we have violated your privacy rights, you may complain to us or to the Secretary of Health and Human Services. You may file a complaint with us by notifying our Privacy Contact. We will not retaliate against you for filing a complaint. Contacting Privacy Officer PACE, Inc. 1] This notice is based on the requirements of
the Federal Health Insurance Portability and Accountability Act (HIPAA), 45
C.F.R. Parts 160 and 164. |
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