The Verland Foundation
NOTICE OF PRIVACY PRACTICES
This Notice describes how
health information about you may be used and disclosed and how you can get
access to this information. Please
review it carefully.
We have a legal duty to
safeguard your protected health information.
We will protect the privacy of
the health information that we maintain that identifies you, whether it deals
with the provision of health care to you or the payment for health care. We must provide you with this Notice about
our privacy practices. It explains how,
when and why we may use and disclose your health information. With some exceptions, we will avoid using or
disclosing any more of your health information than is necessary to accomplish
the purpose of the use or disclosure.
We are legally required to follow the privacy practices that are
described in this Notice, which is currently in effect.
However, we reserve the right
to change the terms of this Notice and our privacy practices at any time. Any changes will apply to any of your health
information that we already have.
Before we make an important change to our policies, we will promptly
change this Notice and post a new Notice on the information bulletin boards
located in our reception area and our homes.
You may also request, at any time, a copy of our Notice of Privacy
Practices that is in effect at any given time, from the Records Department. You may view and obtain an electronic copy
of this Notice on our web site at www.verland.org.
We would like to take this
opportunity to answer some common questions concerning our privacy practices:
Question: How Will this Organization Use and Disclose
My Protected Health Information?
Answer: We use and disclose health information for
many different reasons. For some of
these uses or disclosures, we need your specific authorization. Below, we describe the different categories
of our uses and disclosures and give you some examples of each.
A.
Uses and Disclosures Relating to Treatment, Payment or
Healthcare Operations. We may, by federal law, use and disclose your health
information for the following reasons:
1.
For Treatment: With the possible exception of information concerning
mental health disorders and/or treatment, drug and alcohol abuse and/or
treatment, and HIV status (for which we may need your specific authorization),
we may disclose your general health information to other health care providers
who are involved in your care. For
example, we may disclose your medical history to a hospital if you need medical
attention while at our facility, or to a residential care program we are
referring you to. Reasons for such a
disclosure may be: to get them the medical history information they need to
appropriately treat your condition, to coordinate your care or to schedule
necessary testing.
2.
To Obtain Payment for Treatment: With the
possible exception of information concerning mental health disorders and/or
treatment, drug and alcohol abuse and/or treatment, and HIV status (for which
we may need your specific authorization), we may use and disclose necessary
health information in order to bill and collect payment for the treatment that
we have provided to you. For example,
we may provide certain portions of your health information to your health
insurance company, Medicare or Medicaid, in order to get paid for taking care
of you. To do this, we will need to
provide your health information to the billing company that handles our health
insurance claims.
3.
For Health Care Operations: We may, at
times, need to use and disclose your health information to run our
organization. For example, we may use
your health information to evaluate the quality of the treatment that our staff
has provided to you. We may also need
to provide some of your health information to our accountants, attorneys and
consultants in order to make sure that we’re complying with law; if this
information concerns mental health disorders and/or treatment, drug and alcohol
abuse and/or treatment, and/or HIV status, we may be further limited in what we
provide and may be required to first obtain from you specific authorization.
B.
Certain Other Uses and Disclosures are Permitted by
Federal Law. We may use and disclose your health information without
your authorization for the following reasons:
1.
When a Disclosure is Required by Federal, State or
Local Law, in Judicial or Administrative Proceedings or by Law
Enforcement. For example, we may disclose your protected health
information if we are ordered by a court, or if a law requires that we report
that sort of information to a government agency or law enforcement authorities,
such as in the case of a dog bite, suspected child abuse or a gunshot wound.
2.
For Public Health Activities. Under the law,
we need to report information about certain diseases, and about any deaths, to
government agencies that collect that information. With the possible exception of information concerning mental
health disorders and/or treatment, drug and alcohol abuse and/or treatment, and
HIV status (for which we may need your specific authorization), we are also
permitted to provide some health information to the coroner or a funeral
director, if necessary, after a client’s death.
3.
For Health Oversight Activities. For
example, we will need to provide your health information if requested to do so
by the County and/or the State when they oversee the program in which you
receive care. We will also need to
provide information to government agencies that have the right to inspect our
offices and/or investigate healthcare practices.
4.
For Organ Donation. If one of our clients wished to
make an eye, organ or tissue donation after their death, we may disclose
certain necessary health information to assist the appropriate organ
procurement organization.
5.
For Research Purposes. In certain
limited circumstances (for example, where approved by an appropriate Privacy
Board or Institutional Review Board under federal law), we may be permitted to
use or provide protected health information for a research study.
6.
To Avoid Harm.
If one of our professionals,
physicians or nurses believes that it is necessary to protect you, or to
protect another person or the public as a whole, we may provide protected
health information to the police or others who may be able to prevent or lessen
the possible harm. If you are treating
with our organization for the propensity to commit a particular type of action,
we may not report your statements or provide protected health information about
that particular propensity for purposes of avoiding harm.
7.
For Specific Government Functions. With
the possible exception of information concerning mental health disorders and/or
treatment, drug and alcohol abuse and/or treatment, and HIV status (for which
we may need your specific authorization), we may disclose the health
information of military personnel or veterans where required by U.S. military
authorities. Similarly, we may also
disclose a client’s health information for national security purposes, such as
assisting in the investigation of suspected terrorists who may be a threat to
our nation.
8.
For Workers’ Compensation. We may provide your
health information as described under the workers’ compensation law, if your
condition was the result of a workplace injury for which you are seeking
workers’ compensation.
9.
Appointment Reminders and Health-Related Benefits or
Services. Unless you tell us that you would prefer not to receive
them, we may use or disclose your information to provide you with appointment
reminders or to give you information about/send to you newsletters about alternative
programs and treatments that may help you.
10.
Fundraising Activities. For example, if our
Organization chose to raise funds to support one or more of our programs or
facilities, or some other charitable cause or community health education
program, we may use the information that we have about you to contact you. If you do not wish to be contacted as part
of any fundraising activities, please contact the Development Office.
C.
Certain Uses and Disclosures Require You to Have the
Opportunity to Object.
1.
Disclosures to Family, Friends or Others Involved in
Your Care. We may provide a limited amount of your health
information to a family member, friend or other person known to be involved in
your care or in the payment for your care, unless you tell us not to. For example, if a family member comes with
you to your appointment and you allow them to come into the treatment room with
you, we may disclose otherwise protected health information to them during the appointment,
unless you tell us not to. (This information may not contain information
about mental health disorders and/or treatment, drug and alcohol abuse and/or
treatment, and HIV status, without your specific authorization.)
2.
Disclosures to Notify a Family Member, Friend or Other
Selected Person. When you first started in our program, we asked that
you provide us with an emergency contact person in case something should happen
to you while you are at our facilities.
Unless you tell us otherwise, we will disclose certain limited health information
about you (your general condition, location, etc.) to your emergency contact or
another available family member, should you need to be admitted to the
hospital, for example. (This
information may not contain information about mental health disorders and/or
treatment, drug and alcohol abuse and/or treatment, and HIV status, without
your specific authorization.)
3.
Disclosures from our Facility Directory. If you reside
with us, we will maintain your name and number in a directory for the
receptionist to be able to direct visitors or callers to you, so long as they
ask for you by name. We may also note
your religion and provide this information to a member of the clergy that would
like to visit our residents that are members of the same religion; your
religious affiliation will not be provided to anyone other than clergy. Please tell us if you do not want this
information to be given to these visitors or callers.
D.
Other Uses and
Disclosures Require Your Prior Written Authorization. In situations
other than those categories of uses and disclosures mentioned above, or those
disclosures permitted under federal law, we will ask for your written authorization before using or
disclosing any of your protected health information. In addition, we need to ask for your specific written
authorization to disclose information concerning your mental health, drug and
alcohol abuse and/or treatment, or to disclose your HIV status.
If
you choose to sign an authorization to disclose any of your health information,
you can later revoke it to stop further uses and disclosures to the extent that
we haven’t already taken action relying on the authorization, so long as it is
revoked in writing.
Question: What Rights Do I Have Concerning My
Protected Health Information?
Answer: You have the following rights with respect
to your protected health information:
A.
The Right to Request Limits on Uses and Disclosures of
Your Health Information. You have the right to ask us to limit how we use and
disclose your health information. We
will certainly consider your request, but you should know that we are not
required to agree to it. If we do agree
to your request, we will put the limits in writing and will abide by them,
except in the case of an emergency.
Please note that you are not permitted to limit the uses and disclosures
that we are required or allowed by law to make.
B.
The Right to Choose How We Send Health Information to
You or How We Contact You. You have the right to ask that we contact you at an
alternate address or telephone number (for example, sending information to your
work address instead of your home address) or by alternate means (for example,
by e-mail/mail instead of telephone).
We must agree to your request so long as we can easily do so.
C.
The Right to See or to Get a Copy of Your Protected
Health Information. In most cases, you have the right to look at or get a
copy of your health information that we have, but you must make the request in
writing. A request form is available
from the Records Department. We will
respond to you within 30 days after receiving your written request. If we do not have the health information
that you are requesting, but we know who does, we will tell you how to get
it. In certain situations, we may deny
your request. If we do, we will tell
you, in writing, our reasons for the denial.
In certain circumstances, you may have a right to appeal the decision.
If you request a copy of any portion of your protected
health information, we will charge you for the copy on a per page basis, only
as allowed under Pennsylvania state law.
We need to require that payment be made in full before we will provide
the copy to you. If you agree in advance, we may be able to provide you with a
summary or an explanation of your records instead. There will be a charge for the preparation of the summary or
explanation.
D.
The Right to Receive a List of Certain Disclosures of
Your Health Information That We Have Made.
You have the right to get a
list of certain types of disclosures that we have made of your health
information. This list would not
include uses or disclosures for treatment, payment or healthcare operations,
disclosures to you or with your written authorization, or disclosures to your
family for notification purposes or due to their involvement in your care. This list also would not include any
disclosures made for national security purposes, disclosures to corrections or
law enforcement authorities if you were in custody at the time, or disclosures
made prior to April 14, 2003. You may
not request an accounting for more than a six (6) year period.
To make such a request, we require that you do so in
writing; a request form is available upon asking the Records Department. We will respond to you within 60 days of
receiving your request. The list that
you may receive will include the date of the disclosure, the person or
organization that received the information (with their address, if available),
a brief description of the information disclosed, and a brief reason for the
disclosure. We will provide such a list
to you at no charge; but, if you make more than one request in the same
calendar year, you will be charged for each additional request that year.
E.
The Right to Ask to Correct or Update Your Health
Information. If you believe that there is a mistake in your health information
or that a piece of important information is missing, you have a right to ask
that we make an appropriate change to your information. You must make the request in writing, with
the reason for your request, on a request form that is available at the Records
Department. We will respond within 60
days of receiving your request. If we
approve your request, we will make the change to your health information, tell
you when we have done so, and will tell others that need to know about the
change.
We may deny your request if the protected health
information: (1) is correct and complete; (2) was not created by us; (3) is not
allowed to be disclosed to you; or (4) is not part of our records. Our written denial will state the reasons
that your request was denied and explain your right to file a written statement
of disagreement with the denial. If you
do not wish to do so, you may ask that we include a copy of your request form,
and our denial form, with all future disclosures of that health
information.
F.
The Right to Get A Paper Copy of This Notice. If you have
agreed to receive this Notice via e-mail, you will always have the right to
request a paper copy of this Notice, also.
Question: How Do I Complain or Ask Questions About This
organization’s Privacy Practices?
Answer:
If you have any questions about
anything discussed in this Notice or about any of our privacy practices, or if
you have any concerns or complaints, please contact the Records Office at
412-741-2375. You also have the right
to file a written complaint with the Secretary of the U.S. Department of Health
and Human Services. We may not take any
retaliatory action against you if you lodge any type of complaint.
Question: When Does This Notice Take Effect?
Answer:
This Notice takes effect on
April 14, 2003.