UNS Home Health Agency, Inc. is providing this Notice of Privacy Practices because the privacy of your health information is very important to you and to us, and in compliance with federal regulations.

By “your health information” we mean the information that we maintain that specifically identifies you and your health status.

Summary

This Notice describes how we use your health information within UNS Home Health Agency, Inc. and disclose it outside UNS Home Health Agency, Inc., and why.

The Notice covers

 · Uses or disclosures which do not require your written authorization

 . Treatment, payment, and health care operations.

 . Uses or disclosures of your health information to which you may object or  

   disclosures required or permitted.

 . Uses or disclosures which require your written authorization.

 . Your rights as a patient regarding privacy of your health information.

 . Our duties in protecting your health information.

 . Complaints, contact person, effective date, and acknowledgement.   

 . Uses or disclosures which do not require your written authorization.

Treatment, Payment, and Health Care Operations

We use or disclose your health information to carry out your treatment; to obtain payment for your treatment; and to conduct health care operations.  For example:

                 For treatment, we use your health information to plan, coordinate, and provide your         

                 care.  We disclose your health information for treatment purposes to physicians and

                 other health care professionals outside our agency who are involved in your care.

                 Uses or disclosures which do not require your written authorization.

Treatment, Payment, and Health Care Operations

 For payment, we use your health information to prepare documentation required by your insurance company or HMO or by Medicare or Medicaid.  We disclose that part of your health information that these organizations require to pay us.

              For health care operations, we use or disclose your health information, for example, to

              improve the quality of our services, to plan better ways of treating patients, and to

              evaluate staff performance.

              Uses or Disclosures of Your Health Information to Which You May Object.

We may use or disclose your health information for the following purposes, unless you ask us not to.

 · Facility directories.

   We maintain a patient directory including, for each patient, name, location in our

   facility, health condition in general terms, and religious affiliation.  We may disclose

   this   information to people who ask for you by name.  We will make known your

   religious affiliation only to clergy.

 · Informing family and friends. 

   We may disclose your health information to family,    

   friends, or others identified by you who are involved in your care.

 · Assistance in disaster relief efforts.

 · Confirming our visits to your home or other appointments.

 · Informing you about treatment alternatives or other health-related benefits and

   services that may be of interest to you.

If you object to our use of your health information for any of these purposes please contact: Susan Molenaar, RN, Executive Director at (269) 226-9363

             . Uses or Disclosures Required or Permitted.

Where we are required or permitted to do so, we may use or disclose your health information in the following circumstances without your written authorization.

· Federal government investigation, when required by the Secretary of Health and

  Human Services to investigate or determine our compliance with federal regulation.

· Federal, state or local law requirements.

· Public health activities, for example to report communicable diseases or death; or for

  matters involving the Food and Drug Administration.

· Reporting of abuse, neglect or domestic violence.

· Health oversight activities by a health oversight agency.  (A health oversight agency is

  an organization authorized by the government to oversee eligibility and compliance

  and to enforce civil rights laws.)

. Judicial or administrative proceedings, for example responding to a court order or

  subpoena.

· Law enforcement purposes, for example to report certain types of wounds or other

  physical injuries or to identify or locate a suspect, fugitive, material witness, or missing  

  person.

· Use by coroners, medical examiners, or funeral directors.

. Facilitating organ, eye, or tissue donation.

· Research, provided that very strict controls are enforced.

· Averting a serious threat to your health or safety or that of the public.

· Specialized government functions such as military or veterans’ affairs; national

  security, and intelligence activities.

· Workers' compensation.

   Uses or disclosures which require your written authorization

Your written authorization, which you may revoke (in writing), is required if we use or disclose your health information for any other purpose, in particular:

· Our use of psychotherapy notes beyond treatment, payment, and health care 

  operations.

. Marketing of goods or services to you.

Your Rights As A Patient to Privacy Of Your Health Information.

· Right to Request Restrictions

  You have the right to request restrictions on our uses and disclosures of your health

  information, however we may refuse to accept the restriction.

· Right to Request Confidential Communications

 You have the right to request that we communicate with you confidentially, for example

  to speak with you only in private; to send mail to an address you designate; or to

  telephone you at a number you designate.  Your request must be in writing. We will

  make every attempt to honor your request.

. Right to Request Access to Your Health Information

   You have the right to request access to your health information in order to inspect or

   copy it.  Your request must be in writing.  We may deny your request and, if so, you

   may request a review of the denial.  However, we will make every attempt to honor

   your request.

· Right to Request an Amendment of Your Health Information

You have the right to request an amendment to your health information.
Your request must be in writing and must provide a reason for the amendment.
We may deny your request and, if so, you may submit a statement of disagreement.
However, we will make every attempt to honor your request.

· Right to Request an Accounting of Disclosures of Your Health Information.

  You have the right to request an accounting of our disclosures of your health

   information for purposes other than treatment, payment, and health care operations. 

   We will make every attempt to honor your request.  We are not required to provide an 

   accounting for disclosures before April 14, 2003 or for more than 6 years prior to the 

   date of your request.

·  Right to Obtain a Paper Copy of this Notice

   If you received this Notice electronically, you have the right to receive a paper copy.

To exercise any of these rights please write to UNS Home Health Agency at 2925 Portage Rd, Kalamazoo, Michigan 49001 or telephone Susan Molenaar, RN, Executive Director at (269) 226-9393.

            Our Duties in Protecting Your Health Information

· We are required by law to maintain the privacy of your health information.

· We must inform patients or their legal representatives of our legal duties and privacy

   practices with respect to health information.  This Notice discharges that duty.

· We must abide by the terms of the Notice currently in effect.

· We reserve the right to change the terms of this Notice and to make the new Notice

   provisions effective for all health information that we maintain.  At any time, you may

   obtain a copy of the current notice from Susan Molenaar, RN, Executive Director at

   (269) 226-9393.

 Complaints, Contact Person, Effective Date, and Acknowledgement

· You may complain to us and to the Secretary of Health and Human Services if you

   believe your privacy rights have been violated.

· You will not be retaliated against for filing a complaint.

. You may file your complaint with our agency by writing to:

     Susan Molenaar, RN, Executive Director

     2925 Portage Rd       

     Kalamazoo, MI  49001

· You may file a complaint with the Secretary of Health and Human Services by writing

   to:

                  Secretary of Health and Human Services

                  U.S. Department of Health and Human Services

                  200 Independence Avenue, S.W.
                  Washington, D.C. 20201
                  (source: www.hhs.gov)

· For further information you may write or call:

    Susan Molenaar, RN, Executive Director

    2925 Portage Rd

    Kalamazoo, MI 49001

                 (269) 226-9363

· This notice is effective April 14, 2003

 

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