Notice of Privacy Practices
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. If you have any questions about this Notice please contact Marilyn Muffly. This Notice of Privacy Practices describes how we may use and disclose your protected client information to carry out services, payment or for other purposes that are permitted or required by law. It also describes your rights to access and control your protected client information. Protected Client 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. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected client information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you in the mail by contacting Marilyn Muffly at 298-1700 ext. 23.Uses and Disclosures of Protected Client Information
Uses and Disclosures of Protected Client Information Based Upon Your Written Consent
You will be asked by Share Your Care to sign a consent form. Once you have consented to the use and disclosure of your
protected client information for services, payment by signing the consent form, Share Your Care will use or disclose your
protected client information as described in this Section 1. Your protected client information may be used and disclosed by
Share Your Care staff that is involved in your care. Your protected client information may also be used and disclosed to
pay for your Adult Day Service bills, which support the operation of Share Your Care.
Following are examples of the types of uses and disclosures of your protected client care information that Share Your Care
is permitted to make once you have signed our consent form.
Adult Day Services:
Payment:
Adult Day Services Operations:
Business Associates:
Other Disclosures:
Adult Day Services:
We will use and disclose your protected client information to provide, coordinate, or manage your services. This includes
the coordination of information with a third party that has already obtained your permission to have access to your
protected client information. For example, we would disclose your protected client information, as necessary, to your case
manager. We will also disclose protected client information to other providers who may be providing services to you. Your
protected client information may be provided to your Interdisciplinary Team to ensure that your team has the necessary
information to carry out your Individual Service Plan.
Payment:
Your protected client information will be used, as needed, to obtain payment for your Adult Day Services. This may include
the provision of information to funding sources before they approve payment for services such as: making a determination of
eligibility, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
Adult Day Services Operations:
We may use or disclose, as needed, your protected client information in order to support the business activities of Share
Your Care. These activities include, but are not limited to, quality assessment activities and disclosing your protected
client information to licensing authorities. In addition, we may use a sign-in sheet where you will be asked to sign your
name to indicate your attendance that day. We may also call you by name in front of other clients. We may use or disclose
your protected client information, as necessary, to contact you to notify you that the agency is closed due to inclement
weather.
Business Associates:
We will share your protected client information with third party business associates that perform various activities
(e.g., data entry, quality assurance) for the agency. Whenever an arrangement between our office and a business associate
involves the use or disclosure of your protected client information, we will have a written contract that contains terms
that will protect the privacy of your protected client information.
Other Disclosures:
We may use or disclose your protected client information, as necessary, to provide you with information about other
health-related benefits and services that may be of interest to you. Your name and address may be used to send you SYC
information about our services and/or general information about SYC. You may contact our Privacy Contact to request that
these materials not be sent to you.
Uses and Disclosures of Protected Client Information Based upon Your Written Authorization
Other uses and disclosures of your protected client information will be made only with your written authorization, unless
otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing,
except to the extent that Share Your Care has taken an action in reliance on the use or disclosure indicated in the
authorization.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object
We may use and disclose your protected client information in the following instances. You have the opportunity to agree or
object to the use or disclosure of all or part of your protected client information.Unless you object, we may disclose to a
member of your family, a relative, a close friend or any other person you identify, your protected client information that
directly relates to that person’s involvement in your care. If you are unable to agree or object to such a disclosure, we
may disclose such information as necessary if we determine that it is in your best interest based on our professional
judgment. Share Your Care will make attempts to contact your listed emergency contacts.If unable to reach them, SYC then
may use or disclose protected client information to notify or assist in notifying a family member, personal representative
or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or
disclose your protected client information to an authorized public or private entity to assist in disaster relief efforts
and to coordinate uses and disclosures to family or other individuals involved in your care.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected client information in the following situations without your consent or authorization.
These situations include:
Emergencies:
Required by Law:
Public Health:
Communicable Diseases:
Health Oversight:
Abuse or Neglect:
Legal Proceedings:
Law Enforcement:
Coroners:
Criminal Activity:
Emergencies:
We may use or disclose your protected client information in an emergency treatment situation. If this happens, Share Your
Care shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If a Share Your
Care staff member is required by law to obtain emergency treatment for you and has attempted to obtain your consent but is
unable to obtain your consent, he or she may still use or disclose your protected client information to obtain treatment
for you.
We may use and disclose your protected client information if Share Your Care staff attempt to obtain consent from you but are unable to do so due to substantial communication barriers and the staff determine, using professional judgment, that you intend to consent to use or disclosure under the circumstances.
In the event of a communication barrier, every attempt will be made to obtain consent from your emergency contact.If unable to reach emergency contact, SYC, using professional judgment, will determine that you intend to consent to use or disclosure under the circumstances.
We may use and disclose your protected client information if Share Your Care staff attempt to obtain consent from you but are unable to do so due to substantial communication barriers and the staff determine, using professional judgment, that you intend to consent to use or disclosure under the circumstances.
In the event of a communication barrier, every attempt will be made to obtain consent from your emergency contact.If unable to reach emergency contact, SYC, using professional judgment, will determine that you intend to consent to use or disclosure under the circumstances.
Required by Law:
You will be notified of any such uses as required by law.
Public Health:
We may disclose your protected client information for public health activities and purposes to a public health authority
that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling
disease, injury or disability. We may also disclose your protected client information, if directed by the public health
authority, to a foreign government agency that is collaborating with the public health authority.
Communicable Diseases:
We may disclose your protected client information, if authorized by law, to a person who may have been exposed to a
communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight:
We may disclose protected client information to a health oversight agency for activities authorized by law, such as audits,
investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the
health care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect:
We may disclose your protected vulnerable health information to a public health authority that is authorized by law to
receive reports of child or vulnerable adult abuse,neglect or exploitation. In addition, we may disclose your protected
client information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental
entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the
requirements of applicable federal and state laws.
Legal Proceedings:
We may disclose protected client information in the course of any judicial or administrative proceeding, in response to an
order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions
in response to a subpoena, discovery request or other lawful process.
Law Enforcement:
We may also disclose protected client information, so long as applicable legal requirements are met, for law enforcement
purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information
requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has
occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of SYC, and (6) medical
emergency (not on SYC’s premises) and it is likely that a crime has occurred.
Coroners:
We may disclose PCI to a corner or medical examiner for identification purposes, determining cause of death or for the
coroner or medical examiner to perform other duties authorized by law.
Criminal Activity:
Consistent with applicable federal and state laws, we may disclose your protected client information, if we believe that
the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person
or the public. We may also disclose protected client information if it is necessary for law enforcement authorities to
identify or apprehend an individual.
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 et. Seq.
Your Rights
Following is a statement of your rights with respect to your protected client information and a brief description of how you
may exercise these rights.
Right to inspect and copy your protected client information:
This means you may inspect and obtain a copy of protected client information about you that is contained in a designated
record set for as long as we maintain the protected client information. A designated record set contains medical and billing
records and any other records that Share Your Care uses for making decisions about you.
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 client information that is subject to law that prohibits access to protected client information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to your medical record.
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 client information that is subject to law that prohibits access to protected client information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to your medical record.
Right to request a restriction of your protected client information:
This means you may ask us not to use or disclose any part of your protected client information for the purposes of payment
or Adult Day Care operations. You may also request that any part of your protected client 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.
Your physician is not required to agree to a restriction that you may request. If Share Your Care believes it is in your best interest to permit use and disclosure of your protected client information, your protected client information will not be restricted. If Share Your Care does agree to the requested restriction, we may not use or disclose your protected client information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You may request a restriction by contacting any SYC staff person.
Your physician is not required to agree to a restriction that you may request. If Share Your Care believes it is in your best interest to permit use and disclosure of your protected client information, your protected client information will not be restricted. If Share Your Care does agree to the requested restriction, we may not use or disclose your protected client information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You may request a restriction by contacting any SYC staff person.
Right to request to receive confidential communications form us by alternative means or at an alternative location:
We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how
payment will be handled or specification of an alternative address or other method of contact. We will not request an
explanation from you as to the basis for the request. Please make this request in writing to your Program Coordinator or
Program Director at your Program site.
Right to request an amendment to your protected client information:
This means you may request an amendment of protected client information about you in a designated record set for as long as
we maintain this information. In certain cases, we may deny your request for an amendment. 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. Please contact your Program Coordinator or Director if you have
questions about amending your client record.
Right to receive an accounting of certain disclosures we have made, if any, of your protected client information:
This right applies to disclosures for purposes other than adult day services provider, payment or operations as described
in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family
members or friends involved in your care, or for notification purposes. You have the right to receive specific information
regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive
this information is subject to certain exceptions, restrictions and limitations.