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HIPAA Notice of Privacy Practices
COSHOCTON CITY HEALTH DEPARTMENT
COSHOCTON CITY HOME HEALTH AGENCY
760 CHESTNUT STREET
COSHOCTON, OHIO 43812
740-622-1736
740-622-8078
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 of Privacy
Practices describes how we may use and disclose your protected health
information (PHI) to carry out treatment, payment or health care operations
(TPO) and for other purposes that are permitted or required by law. It
also describes your rights to access and control your protected health
information. “Protected health information” is information about you,
including demographic information, that may identify you and that relates
to your past, present or future physical or mental health or condition
and related health care services.
Uses and Disclosures
of Protected Health Information
Uses and Disclosures of
Protected Health Information
Your protected health
information may be used and disclosed by your physician, our office staff
and others outside of our office that are involved in your care and treatment
for the purpose of providing health care services to you, to pay your
health care bills, to support the operation of the health department/home
health agency, and any other use required by law .
Treatment:
We will use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services. This
includes the coordination or management of your health care with a third
party. For example, we would
disclose your protected health information, as necessary, to a laboratory
in order to have your blood tested or a portable x-ray company to have
home x-rays taken. For example,
your protected health information may be given, as necessary, to a medical
supply company in order for them to provide you with medical supplies
and/or equipment.
Payment:
Your protected health information will be used, as needed, to obtain payment
for your health care services. For example, your protected health information
may be given to Medicare, Medicaid, Bureau of Workers Compensation or
your private insurance company to secure payment for services provided
by the agency.
Healthcare Operations:
We may use or disclose, as-needed, your protected health information in
order to support the business activities of
the health department/home health agency. These activities include,
but are not limited to, quality assessment activities, employee review
activities, licensing, and conducting or arranging for other business
activities. For example, we may disclose your protected health information
in order to assess the type of care we give our clients or to improve
treatment practices. We may use or disclose your protected health information,
as necessary, to contact you to remind you of your appointment and/or
home health visit.
We may use or disclose
your protected health information in the following situations without
your authorization. These situations include: as Required By Law, Public
Health issues as required by law, Communicable Diseases: Health Oversight:
Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings:
Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research:
Criminal Activity: Military Activity and National Security: Workers’ Compensation:
Inmates: Required Uses and Disclosures: Under the law, we must make disclosures
to you and when required by the Secretary of the Department of Health
and Human Services to investigate or determine our compliance with the
requirements of Section 164.500.
Other Permitted and
Required Uses and Disclosures
Will Be Made Only With Your Consent, Authorization or Opportunity to Object
unless required by law.
You may revoke this
authorization, at any time,
in writing, except to the extent that the health department/home health
agency has taken an action in reliance on the use or disclosure indicated
in the authorization.
Your Rights
Following is a statement
of your rights with respect to your protected health information.
You have the right
to inspect and copy your protected health information.
Under federal law, however, 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,
and protected health information that is subject to law that prohibits
access to protected health information.
You have the right to
request a restriction of your protected health information.
This means you may ask us not to use or disclose any part of your protected
health information for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your protected health
information not be disclosed to family members or friends who may be involved
in your care or for notification purposes as described in this Notice
of Privacy Practices. Your request must state the specific restriction
requested and to whom you want the restriction to apply.
The health department/home
health agency is not required to agree to a restriction that you may request.
If we believe it is in your best interest to permit use and disclosure
of your protected health information, your protected health information
will not be restricted. You then have the right to use another Healthcare
Provider.
You have the right
to request to receive confidential communications from us by alternative
means or at an alternative location.
You have the right to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice alternatively
i.e. electronically.
You may have the
right to have the health department/home health agency amend your protected
health information. If we
deny your request for amendment, you have the right to file a statement
of disagreement with us and we may prepare a rebuttal to your statement
and will provide you with a copy of any such rebuttal.
You have the right
to receive an accounting of certain disclosures we have made, if any,
of your protected health information.
We reserve the right
to change the terms of this notice and will inform you by mail of any
changes. You then have the
right to object or withdraw as provided in this notice.
Complaints
You may complain to us
or to the Secretary of Health and Human Services if you believe your privacy
rights have been violated by us. You may file a complaint with us by notifying
our privacy contact of your complaint. We will not retaliate against
you for filing a complaint.
This notice was published
and becomes effective on/or before April 14, 2003.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please contact our HIPAA Compliance Officer at the address or phone number listed on the beginning of this form.