NOTICE OF PRIVACY PRACTICES
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA)
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 APPLIES TO THE PRIVACY PRACTICES OF THE FOLLOWING HEBREW SENIORLIFE (HSL) AFFILATED COVERED ENTITIES:
The words "Hebrew SeniorLife" or "HSL" in this Notice include Hebrew SeniorLife, Inc. and all of the affiliated covered entities listed in this Notice. These entities are committed to the protection of your health information created, and/or maintained by Hebrew SeniorLife, including any information that we receive from other health care providers or facilities.
OUR RESPONSIBILITY TO YOU
We at HSL pledge to provide you with quality health care, and to have a relationship with you that is built on trust. This trust includes our commitment to respect the privacy and confidentiality of your health information. HSL maintains your records for the time period required by law.
At HSL, your privacy is a priority. We follow strict federal and state guidelines to maintain the confidentiality of your protected health information (PHI). We are required to extend certain protections to your PHI and to give you this Notice about our privacy practices that explains how, when and why we may use or disclose your PHI. Except when disclosing PHI relating to your treatment, payment or health care operations, we must use or disclose only the minimum necessary PHI to accomplish the purpose of the use or disclosure.
We are required by law to maintain the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of this Notice at any time. If we do so, we will publish the revised Notice on the HSL website at http://www.hebrewseniorlife.org. You may request a copy of the new Notice from the Chief Privacy Officer (see contact information below).
PROTECTED HEATLH INFORMATION
Protected Health Information (PHI) is any information about your past, present or future health care, or payment for this care.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION.
We use and disclose PHI for many different reasons. For some of these uses or disclosures, we need your written authorization. Below we describe the different categories of our uses and disclosures and give you some examples of each category.
I. USES AND DISCLOSURES RELATING TO TREATMENT, PAYMENT OR HEALTH CARE OPERATIONS.
Except where prohibited by Massachusetts state law or federal laws, HSL and HSL staff may legally use and share your PHI for treatment, payment and health care operations. We do not need to obtain your written authorization to do these things, as explained below:
For treatment: We may disclose your PHI to doctors, medical students, nurses, social workers, rehabilitation therapists, chaplains, other health care personnel, and all members of the HSL team who are involved in managing and providing your care.
To obtain payment: We may use or disclose your PHI in order to bill and collect payment for your health care services. For example, we may release portions of your PHI to Medicaid, Medicare or a private insurer to collect payment for services that we delivered to you.
For health care operations: We may use or disclose your PHI in the course of operating HSL facilities and programs. This includes information shared with outside parties who perform health care operations or other services on behalf of HSL ("business associates"). For example, we may use your PHI in evaluating the quality of services provided or disclose your PHI to our accountant or attorney for audit and legal purposes.
Appointment reminders: We may send you appointment reminders or give you information about treatment alternatives or other health care services or benefits we offer.
II. USES AND DISCLOSURES FOR OTHER PURPOSES:
HSL may also legally use and disclose your PHI to others for the following purposes, without your written authorization:
When required by law: We may disclose PHI when a law requires that we report information about suspected abuse, neglect or domestic violence, or relating to suspected criminal activity, or in response to a court order. We must also disclose PHI to authorities that monitor compliance with these privacy requirements.
To public health activities: We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to the public health authority. For example, cause of death is noted on the death certificate, which is maintained at the State's Registry of Vital Records and Statistics.
For health oversight activities: We will provide information to assist the government or a licensing agency when it conducts an investigation or inspection of a health care provider or organization.
Relating to decedents: We may disclose PHI relating to an individual's death to coroners, medical examiners or funeral directors, and to organ procurement organizations relating to organ, eye or tissue donations or transplants.
For research purposes: In certain circumstances, and under supervision of our Research Department, we may disclose PHI to assist medical research.
To avoid harm: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm. For example, we may disclose your PHI if needed for emergency treatment if we reasonably believe you would have approved.
For specific government functions: We may disclose PHI of military personnel and veterans in certain situations, to correctional facilities in certain situations, to government programs relating to eligibility and enrollment, and for national security reasons.
For worker's compensation purposes: We may provide PHI in order to comply with worker's compensation laws.
III. CERTAIN USES AND DISCLOSURES YOU MAY ASK TO LIMIT, OR REQUEST NOT BE MADE
Disclosures to Family, Friends and Others: We may provide your PHI to a family member, friend, or other person that you indicate is involved with your care or the payment for your care, unless you object in whole or in part. We also may share PHI with these individuals to notify them about your location, general condition, or death.
Facillity Directories: If you are admitted to HSL, your name, room location, general condition and religion may be listed in the HSL directory. This information will be shared with members of your family, friends, members of the clergy, and others who ask for you by name. You may ask to have your name taken off the directory list. You may also restrict the information that is given out about you. If you are in an emergency situation and are not able to make your wishes known, we will put this information in the directory if we think it is in your best interest.
IV. USE OR DISCLOSURES THAT IN SOME CASES REQUIRE YOUR WRITTEN AUTHORIZATION:
Fundraising activities: We may use limited PHI to send you fundraising materials for our organizations. This PHI will not include any information about your treatment. HSL fundraising personnel may not use additional PHI, unless they obtain written authorization from you. Fundraising communications will also contain information on how to remove yourself from the HSL fundraising list.
V. USE OR DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION:
All other uses and disclosures of your PHI not otherwise or previously disclosed in the Notice will require your written authorization. If you choose to sign an authorization to disclose your PHI, you can later revoke it in writing to prevent any future uses and disclosures of the PHI, except to the extent that HSL has already acted upon your previously provided consent.
YOUR RIGHTS REGARDING YOUR PHI
You have the following additional rights with respect to your PHI:
To request restrictions on uses or disclosures: You have the right to ask that we limit how we use or disclose your PHI. We will consider your request, but are not legally bound to agree to the restriction. To the extent that we do not agree to any restrictions on our use or disclosure of your PHI, we will put the agreement in writing and make every reasonable effort abide by it except in emergency situations. We cannot agree to limit uses or disclosures that are required by law. You also have the right to restrict disclosures of your PHI to a health plan when you pay for services out-of pocket.
To choose how we contact you. You have the right to ask that we send you information at an alternative address, such as to a post office box or by an alternative means, such as email instead of regular mail. We must agree to your request so long as we can easily provide it in the format you requested.
To see and receive copies of your PHI
You or your legal representative have the right to see and receive a copy of your PHI, subject to federal and state laws (fees may apply). You must ask for this in writing by using our medical records request form. We will respond to your request in a timely manner. You can also access your PHI electronically upon request, if available. Under certain circumstances, we may deny your request. If we do so, we will send you a written notice describing the basis of our denial.
To request a change to your PHI if you think it is wrong or incomplete.
You have the right to ask us to change your PHI related to your treatment and payment if you think that there has been a mistake or that information is missing. We may deny your request under certain circumstances. If we deny your request, we will send you a written notice of denial within 60 days of receiving your request. This Notice will describe the reason for our denial and your right to submit a written statement disagreeing with the denial.
To receive an accounting of disclosures of your PHI:
You have a right to receive a list of instances when your PHI has been released. You must make your request in writing. You may request an accounting as far back as six years, except requests for electronic disclosures relating to treatment, payment or operations disclosures which are limited to three years. The accounting will not include (i) non-electronic disclosures of relating to treatment, payment or operations; (ii) disclosures if you gave your written authorization to share the information; (iii) disclosures made for HSL directories; (iv) disclosures shared with individuals involved in your care; (v) disclosure to you about your health condition; (vi) disclosures made for national security or intelligence purposes or to correctional institutions or law enforcement officials who have custody of you; or (vii) disclosures made before April 14, 2003. We will respond to your request within 60 days of receiving it.
To receive this Notice by mail:
You have a right to receive a paper copy of this Notice and/or an electronic copy of by email upon request.
To file a complaint:
If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with our Chief Privacy Officer as listed below. We will not take retaliatory action against you. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services through the:
Office of Civil Rights
U.S. Department of Health and Human Services
J.F. Kennedy Federal Building-Room 1875
Boston, MA 02203
Phone (617) 565-1340
CONTACT PERSON FOR THIS NOTICE
If you have any questions about this Notice or a complaint about our privacy practices, please contact:
Maxwell Agyei, RHIA
Director of Health Information Management Systems
& Chief Privacy Officer
1200 Centre Street
Boston, MA 02131
Phone (617) 363-8396
Fax (617) 363-8931
Acknowledgment receipt: HIPPA notice of privacy practices
Effective Date of Notice
This Notice takes effect June 17th, 2011