NOTICE OF PRIVACY PRACTICES
(45 CFR §164.520(a))
Effective Date: April 14,
2003
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.
WHO WILL FOLLOW
THIS NOTICE.
This notice describes our practices and that of:
Ø Any health care professional authorized to enter information into your chart.
Ø All departments and units of Bona Vista Programs, Inc.
Ø Any member of a volunteer group we allow to help you at Bona Vista Programs, Inc.
Ø All employees, staff and other personnel of Bona Vista Programs, Inc.
Ø All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or Bona Vista Programs, Inc. operations purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION.
We are required by law to:
· make sure that medical information that identifies you is kept private;
· give you this notice of our legal duties and privacy practices with respect to medical information about you; and
· follow the terms of the notice that is currently in effect.
HOW WE ARE REQUIRED BY LAW TO DISCLOSE MEDICAL INFORMATION ABOUT YOU.
Ø
As Required By Law.
We will disclose medical information about you when required to do so by
federal, state or local law.
Ø
To Avert a Serious
Threat to Health or Safety. We
will use and disclose medical information about you when we have a “Duty to
Report” under state or federal law, because we believe that it is necessary to
prevent a serious threat to your health and safety or the health and safety of
the public or another person. Any
disclosure, however, would only be to someone able to help prevent the threat.
Ø
Public Health Risks.
We will disclose medical information about you for public health
reporting required by federal or state law.
These activities generally include the following:
·
to prevent or control disease, injury or disability;
·
to report births and deaths;
·
to report child abuse or neglect;
·
to report reactions to medications or problems with products;
·
to notify people of recalls of products they may be using;
·
to notify a person who may have been exposed to a disease or may
be at risk for contracting or spreading a disease or condition;
·
to notify the appropriate government authority if we believe a
Client has been the victim of abuse, neglect or domestic violence.
We will only make this disclosure if you agree or when required or
authorized by law.
Ø
Health Oversight
Activities. We will
disclose medical information as required by law to a health oversight agency for
activities authorized by law. These
oversight activities include, for example, audits, investigations, inspections,
and licensure. These activities are
necessary for the government to monitor the health care system, government
programs, and compliance with civil rights laws.
Ø
Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, we will disclose medical
information about you when properly ordered to do so by a court.
Ø
Law Enforcement.
We will release medical information if asked to do so by a law
enforcement official, and if permitted by law:
·
In response to a court order;
·
If required by state or federal law;
·
To identify or locate a suspect, fugitive, material witness, or
missing person;
·
About the victim of a crime if, under certain limited
circumstances, we are unable to obtain the person's agreement;
·
About a death we believe may be the result of criminal conduct;
·
About criminal conduct at a Bona Vista Programs, Inc. facility;
and
·
In emergency circumstances to report a crime; the location of the
crime or victims; or the identity, description or location of the person who
committed the crime.
Ø
Protective Services for
the President and Others. We
will disclose medical information about you to authorized federal officials so
they may provide protection to the President, other authorized persons or
foreign heads of state or conduct special investigations.
Ø For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, psychologists, nurses, social workers, therapists, technicians, medical students, or other Bona Vista Programs, Inc. personnel who are involved in taking care of you. Different departments of the Bona Vista Programs, Inc. also may share medical information about you in order to coordinate the different things you need. We also may disclose medical information about you to people outside Bona Vista Programs, Inc., such as other health care providers involved in providing medical treatment for you and to people who may be involved in your medical care, such as family members, clergy or others we use to provide services that are part of your care.
Ø
For Payment.
We may use and disclose medical information about you so that the
treatment and services you receive at Bona Vista Programs, Inc., or other health
care providers from whom you receive treatment, may be billed to, and payment
may be collected from, you, an insurance company or a third party.
For example, we may need to give your health plan information about
treatment you received at Bona Vista Programs, Inc. so your health plan will pay
us or reimburse you for your treatment. We
may also tell your health plan about a treatment you are going to receive to
obtain prior approval or to determine whether your plan will cover the
treatment.
Ø
For Health Care
Operations. We may use and
disclose medical information about you for Bona Vista Programs, Inc. operations
or to another health care provider or health plan, if you have a relationship
with that health care provider or health plan . These uses and disclosures are necessary to run Bona Vista
Programs, Inc. and make sure that all of our Clients receive quality care.
For example, we may use medical information to review our treatment and
services and to evaluate the performance of our staff in caring for you.
We may also combine medical information about many Clients to decide what
additional services Bona Vista Programs, Inc. should offer, what services are
not needed, and whether certain new treatments are effective. We may also disclose information to doctors,
social workers, therapists, nurses, psychologists, technicians, medical
students, and other personnel for review and learning purposes.
We may also combine the medical information we have with medical
information from other Health Care Rehabilitation Facilitys to compare how we
are doing and see where we can make improvements in the care and services we
offer. We may remove information that identifies you from this set
of medical information so others may use it to study health care and health care
delivery without learning who the specific Clients are.
Ø
Appointment Reminders.
We may use and disclose medical information to contact you as a reminder
that you have an appointment for treatment or medical care at Bona Vista
Programs, Inc.
Ø
Treatment Alternatives.
We may use and disclose medical information to tell you about or
recommend possible treatment options or alternatives that may be of interest to
you.
Ø
Health-Related Benefits
and Services. We may use
and disclose medical information to tell you about health-related benefits or
services that may be of interest to you.
Ø
Fundraising Activities.
We may use medical information about you to contact you in an effort to
raise money for Bona Vista Programs, Inc. and its operations.
We may disclose medical information to a foundation related to Bona Vista
Programs, Inc. so that the foundation may contact you in raising money for Bona
Vista Programs, Inc. We only would release contact information, such as your
name, address and phone number and the dates you received treatment or services
at Bona Vista Programs, Inc. If you
do not want Bona Vista Programs, Inc. to contact you for fundraising efforts,
you must notify Angie Donahue in writing at 1220 E Laguna, P.O. Box 2496, Kokomo,
IN 46904-2496.
Ø
Facility Directory.
We may include certain limited information about you in a facility
directory while you are a Client at a Bona Vista Programs, Inc.’s facility. This information may include your name, location, your
general condition (e.g., fair, stable, etc.) and your religious affiliation.
The directory information, except for your religious affiliation, may
also be released to people who ask for you by name.
Your religious affiliation may be given to a member of the clergy, such
as a priest or rabbi, even if they don’t ask for you by name.
This is so your family, friends and clergy can visit you at the facility
and generally know how you are doing.
Ø
Individuals Involved in
Your Care or Payment for Your Care.
We may release certain limited information about you to a friend or
family member who is involved in your medical care.
We may also give information to someone who helps pay for your care.
We may also tell your family or friends your condition. In addition, we may disclose medical information about you to
an entity assisting in a disaster relief effort so that your family can be
notified about your condition, status and location.
Ø
Research.
Under certain circumstances, we may use and disclose medical information
about you for research purposes. For
example, a research project may involve comparing the health and recovery of all
Clients who received one medication to those who received another, for the same
condition. All research projects, however, are subject to a special approval
process. This process evaluates a proposed research project and its
use of medical information, trying to balance the research needs with Clients'
need for privacy of their medical information.
Before we use or disclose medical information for research, the project
will have been approved through this research approval process, but we may,
however, disclose medical information about you to people preparing to conduct a
research project, for example, to help them look for Clients with specific
medical needs, so long as the medical information they review does not leave
Bona Vista Programs, Inc. We may
ask for your specific permission if the researcher will have access to your
name, address or other information that reveals who you are, or will be involved
in your care at the hospital.
SPECIAL SITUATIONS
Ø
Organ and Tissue
Donation. If you are an
organ donor, we may release medical information to organizations that handle
organ procurement or organ, eye or tissue transplantation or to an organ
donation bank, as necessary to facilitate organ or tissue donation and
transplantation.
Ø
Military and Veterans.
If you are a member of the armed forces, we may release medical
information about you as required by military command authorities.
We may also release medical information about foreign military personnel
to the appropriate foreign military authority.
Ø
Coroners, Medical
Examiners and Funeral Directors. We may release medical information to a coroner or medical
examiner. This may be necessary,
for example, to identify a deceased person or determine the cause of death.
We may also release medical information about Clients of Bona Vista
Programs, Inc. to funeral directors as necessary to carry out their duties.
Ø
National Security and
Intelligence Activities. We
may release medical information about you to authorized federal officials for
intelligence, counterintelligence, and other national security activities
authorized by law.
Ø Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we maintain about you:
Ø Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Melissa Steele. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, under some circumstances you may request that the denial be reviewed. Another licensed health care professional chosen by Bona Vista Programs, Inc. will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Ø Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Bona Vista Programs, Inc.
To request an amendment, your request must be made in writing and submitted to Melissa Steele. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
· Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
· Is not part of the medical information kept by or for the hospital;
· Is not part of the information which you would be permitted to inspect and copy; or
· Is accurate and complete.
Ø Right to an Accounting of Disclosures. You have the right to request an "Accounting of Disclosures." This is a list of the disclosures we made of medical information about you.
To request this list or accounting of disclosures, you must submit your request in writing to Melissa Steele. Your request must state a time period which may not be longer than six years and may not include dates before February 26, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. 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.
Ø Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a specific treatment session you had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to Melissa Steele. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Ø Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to Melissa Steele. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Ø Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website, http://www.bonavista.org/HIPAA.htm.
To obtain a paper copy of this notice, you may print this page or send a written request to Bona Vista Programs, Inc., 1220 E Laguna, P.O. Box 2496, Kokomo, IN 46904-2496.
CHANGES TO THIS NOTICE
Ø We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in each of our facilities. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at or are admitted to Bona Vista Programs, Inc. for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Bona Vista Programs, Inc. or with the Secretary of the Department of Health and Human Services. To file a complaint with Bona Vista Programs, Inc., contact Melissa Steele, phone 765-457-8273. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION.
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
IM-HIPAA
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